What is CAMFT

Ethical Standards Part I

PART I - STANDARDS

The board of directors of CAMFT hereby promulgates, pursuant to Article VI, Section A 1. and 2. and Article VII, Section B 3. of the Association Bylaws, a Revised Code of Ethical Standards for Marriage and Family Therapists. Members of CAMFT are expected to be familiar with and abide by these standards and by applicable California laws and regulations governing the conduct of licensed marriage, and family therapists, interns and trainees. The effective date of these revised standards is May 1, 2002.

The practice of marriage, and family therapy and psychotherapyi is both an art and a science. It is varied and often complex in its approach, technique, modality and method of service delivery. These ethical standards are to be read, understood, and utilized as a guide for ethical behavior. The general principles contained in this code of conduct are also used as a basis for the adjudication of ethical issues and/or complaints (both within and outside of CAMFT) that may arise. Ethical behavior, in a given situation, must satisfy not only the judgment of the individual marriage and family therapist, but also the judgment of his/her peers, based upon a set of recognized norms.

We recognize that the development of standards is an ongoing process, and that every conceivable situation that may occur cannot be expressly covered by any set of standards. The absence of a specific prohibition against a particular kind of conduct does not mean that such conduct is either ethical or unethical. While the specific wording of these standards is important, the spirit and intent of the principles should always be taken into consideration by those utilizing or interpreting this code. Violations of these standards should be brought to the attention of the CAMFT Ethics Committee, in writing, at CAMFT's administrative office, 7901 Raytheon Road, San Diego, CA 92111-1606, or at such other address as may be necessary because of a change in location of the administrative office.

Overview

1. RESPONSIBILITY TO PATIENTSii
Marriage and family therapistsiii advance the welfare of families and individuals, respect the rights of those persons seeking their assistance, and make reasonable efforts to ensure that their services are used appropriately. When patients are not physically present (e.g., therapy by telephone or Internet) during the provision of therapy, marriage and family therapists take extra precautions to meet their responsibilities to patients.

1.1 Marriage and family therapists do not condone, engage in discrimination, or refuse professional service to anyone on the basis of race, gender, religion, national origin, age, sexual orientation, disability, socioeconomic or marital status. Marriage and family therapists make reasonable efforts to accommodate patients who have physical disabilities.
1.2 Marriage and family therapists are aware of their influential position with respect to patients, and they avoid exploiting the trust and dependency of such persons. Marriage and family therapists therefore avoid dual relationshipsiv with patients that are reasonably likely to impair professional judgment or lead to exploitation. A dual relationship occurs when a therapist and his/her patient engage in a separate and distinct relationship either simultaneously with the therapeutic relationship, or during a reasonable period of time following the termination of the therapeutic relationship. Not all dual relationships are unethical, and some dual relationships cannot be avoided. When a dual relationship cannot be avoided, therapists take appropriate professional precautions to insure that judgment is not impaired and that no exploitation occurs.
 
1.2.1 Sexual intercourse, sexual contact or sexual intimacy with a patient, or a patient's spouse or partner, during the therapeutic relationship, or during the two years following the termination of the therapeutic relationship, is unethical.
1.2.2 Other acts which would result in unethical dual relationships include, but are not limited to, borrowing money from a patient, hiring a patient, engaging in a business venture with a patient, or engaging in a close personal relationship with a patient. Such acts with a patient's spouse, partner or family member may also be considered unethical dual relationships.
 
1.2.3 Marriage and family therapists do not enter into therapeutic relationships with persons with whom they have had sexual relationships.
 
1.3 Marriage and family therapists are aware of their professional and clinical responsibilities to provide consistent care to patients and do not abandon or neglect patients. Marriage and family therapists, therefore, maintain practices and procedures that assure undisrupted care. Such practices and procedures may include, but are not limited to, providing contact information and specified procedures in case of emergency, or therapist absence, conducting appropriate terminations, and providing for a professional will.
1.3.1 Marriage and family therapists terminate therapeutic relationships for clinically sound reasons and in an appropriate manner. Reasons for termination may include, but are not limited to, the patient is not benefiting from treatment, continuing treatment is not clinically appropriate, the therapist is unable to provide treatment due to physical or mental illness, or the treatment becomes ethically questionable.
 
1.3.2 Marriage and family therapists assist patients when terminating relationships by making reasonable arrangements for continuation of necessary treatment.
1.3.3 It is unethical to maintain therapeutic relationships solely for financial reasons.
1.3.4 It may be ethical to terminate a patient relationship for non-payment of fees.
1.4 Marriage and family therapists respect the right of patients to make decisions and help them to understand the consequences of these decisions. Marriage and family therapists provide adequate information to patients so that patients can make meaningful decisions about their therapy.
 
1.4.1 Marriage and family therapists inform patients of the potential risks and benefits of service consistent with sound clinical practice.
 
1.4.2 Marriage and family therapists inform patients of the extent of their availability for emergencies and for other contacts between sessions.
1.4.3 Marriage and family therapists advise their patient(s) that decisions on the status of their personal relationships are the responsibilities of the patient(s).
1.4.4 Marriage and family therapists obtain written informed consent from clients before videotaping, audio recording, or permitting third party observation.
 
1.4.5 Marriage and family therapists are encouraged to inform patients as to the limits of confidentiality.
1.4.6 Marriage and family therapists are encouraged to inform patients at an appropriate time and within the context of the psychotherapeutic relationship of their experience, education, specialties, theoretical and professional orientation and any other information deemed appropriate by the therapist.
1.4.7 When therapy occurs by electronic means, marriage and family therapists inform patients of the potential risks and benefits, including but not limited to, issues of confidentiality, clinical limitations, transmission difficulties, and ability to respond to emergencies.
 
1.4.8 Marriage and family therapists inform patients of fee and fee arrangements prior to the provision of therapy.
 
1.5 Marriage and family therapists do not use their professional relationships with patients to further their own interests.
 
1.6 Marriage and family therapists continue therapeutic relationships only so long as it is reasonably clear that patients are benefiting from the relationship.
1.7 Marriage and family therapists assist persons in obtaining other therapeutic services if a therapist is unable or unwilling to provide professional help.
1.8 Marriage and family therapists do not abandon or neglect patients in treatment. If a therapist is unable to continue to provide care, the therapist will assist the patient in making reasonable arrangements for continuation of treatment.
 
1.9 When terminating employment or contractual relationships, marriage and family therapists primarily consider the best interests of the patient when resolving issues of continued responsibility for patient care.
 
1.10 Marriage and family therapists, when treating a family unit(s), shall carefully consider the potential conflict that may arise between the family unit(s) and each individual. Marriage and family therapists clarify at the commencement of therapy which person or persons are clients and the nature of the relationship(s) the therapist will have with each person involved in the treatment.
 
1.11 Marriage and family therapists do not withhold patient records or information solely because the therapist has not been paid for prior therapy services.
 
1.12 Marriage and family therapists consult, associate, collaborate with, and refer to physicians, other health care professionals, and community resources in order to improve and protect the health and welfare of the patient.
 
1.13 Marriage and family therapists advocate for mental health care they believe will benefit their patients. In appropriate circumstances, they challenge denials of care, or denials of payment for care, by managed care organizations, insurers, or other payers.
 
1.14 Marriage and family therapists disclose treatment alternatives to patients, whether or not there is coverage for such treatment under the terms of a managed care plan, insurance policy, or other health care plan.
1.15 When therapy is provided by Internet or other electronic media, marriage and family therapists ensure that patients are intellectually, emotionally, and physically capable of engaging in therapy by such means.
 
1.16 When a marriage and family therapist is not located in the same geographic area as the patient, he/she shall provide a name of another qualified mental health care professional and/or entity in the patient's locale for contact in case of emergency. 


2. CONFIDENTIALITY
Marriage and family therapists have unique confidentiality responsibilities because the "patient" in a therapeutic relationship may be more than one person. The overriding principle is that marriage and family therapists respect the confidences of their patient(s).

2.1 Marriage and family therapists do not disclose patient confidences, including the names or identities of their patients, to anyone except a) as mandated by law b) as permitted by law c) when the marriage and family therapist is a defendant in a civil, criminal or disciplinary action arising from the therapy (in which case patient confidences may only be disclosed in the course of that action), or d) if there is an authorization previously obtained in writing, and then such information may only be revealed in accordance with the terms of the authorization.
2.2 When there is a request for information related to any aspect of psychotherapy or treatment, each member of the unit receiving such therapeutic treatment must sign an authorization before a marriage and family therapist will disclose information received from any member of the treatment unit.
2.3 Marriage and family therapists are aware of the possible adverse effects of technological changes with respect to the dissemination of patient information, and take reasonable care when disclosing such information. Marriage and family therapists are also aware of the limitations regarding confidential transmission by Internet or electronic media and take extra care when transmitting or receiving such information via these mediums.
2.4 Marriage and family therapists store, transfer, transmit, and/or dispose of patient records in ways that protect confidentiality.
2.5 Marriage and family therapists take appropriate steps to ensure, insofar as possible, that the confidentiality of patients is maintained by their employees, supervisees, assistants and volunteers.
2.6 Marriage and family therapists use clinical materials in teaching, writing, and public presentations only if a written authorization has been previously obtained in accordance with 2.1 d, or when appropriate steps have been taken to protect patient identity.
2.7 Marriage and family therapists, when working with a group, explain to the group the importance of maintaining confidentiality, and are encouraged to obtain agreement from group participants to respect the confidentiality of other members of the group.

3. PROFESSIONAL COMPETENCE AND INTEGRITY
Marriage and family therapists maintain high standards of professional competence and integrity.

3.1 Marriage and family therapists are in violation of this Code and subject to termination of membership, or other appropriate action, if they: a) are convicted of a crime substantially related to their professional qualifications or functions; b) are expelled from or disciplined by other professional organizations; c) have their licenses or certificates suspended or revoked or are otherwise disciplined by regulatory bodies; d) if they continue to practice when they are no longer competent to practice because they are impaired due to physical or mental causes or the abuse of alcohol or other substances; or e) fail to cooperate with the Association or the Ethics Committee at any point from the inception of an ethical complaint through the completion of all proceedings regarding that complaint.
3.2 Marriage and family therapists avoid contractual arrangements which provide financial incentives to withhold or limit medically/psychologically necessary care.
3.3 Marriage and family therapists maintain patient records, whether written, taped, computerized, or stored in any other medium, consistent with sound clinical practice.
3.4 Marriage and family therapists seek appropriate professional assistance for their personal problems or conflicts that impair work performance or clinical judgment.
3.5 Marriage and family therapists as teachers, supervisors, and researchers, maintain high standards of scholarship and present accurate information.
3.6 Marriage and family therapists actively strive to understand the diverse cultural backgrounds of their clients by gaining knowledge, personal awareness, and developing sensitivity and skills pertinent to working with a diverse client population. Marriage and family therapists who provide therapy over the Internet or by other electronic media take extra measures to identify and understand the diversity, ethnicity, and cultural sensitivity of such patients.
3.7 Marriage and family therapists are aware of how their cultural/racial/ethnic identity, values and beliefs affect the process of therapy.
3.8 Marriage and family therapists remain abreast of developments in their field through educational activities and clinical experiences.
3.9 Marriage and family therapists do not engage in sexual or other harassment or exploitation of patients, students, interns, trainees, supervisees, employees or colleagues.
3.10 Marriage and family therapists do not assess, test, diagnose, treat, or advise on problems beyond the level of their competence as determined by their education, training and experience. While developing new areas of practice, marriage and family therapists take steps to ensure the competence of their work through education, training, consultation, and/or supervision.
3.11 Marriage and family therapists do not generally provide professional services to a person receiving treatment or therapy from another psychotherapist, except by agreement with such other psychotherapist or after the termination of the patient's relationship with the other psychotherapist.
3.12 Marriage and family therapists initiate services by Internet or other electronic media to patients located only in jurisdictions where the therapist may lawfully provide such services.
3.13 Marriage and family therapists take reasonable steps to prevent the distortion or misuse of their clinical and research findings.
3.14 Marriage and family therapists, because of their ability to influence and alter the lives of others, exercise special care when making public their professional recommendations and opinions through testimony or other public statements.

4. RESPONSIBILITY TO STUDENTS AND SUPERVISEES
Marriage and family therapists do not exploit the trust and dependency of students and supervisees.

4.1 Marriage and family therapists are aware of their influential position with respect to students and supervisees, and they avoid exploiting the trust and dependency of such persons. Marriage and family therapists therefore avoid dual relationships that are reasonably likely to impair professional judgment or lead to exploitation. Provision of therapy to students or supervisees is unethical. Provision of marriage and family therapy supervision to clients is unethical. Sexual intercourse, sexual contact or sexual intimacy and/or harassment of any kind with students or supervisees is unethical.
4.2 Marriage and family therapists do not permit students, employees or supervisees to perform or to hold themselves out as competent to perform professional services beyond their training, level of experience, and competence.
4.3 Marriage and family therapists who act as supervisors are responsible for maintaining the quality of their supervision skills, and obtaining consultation or supervision for their work as supervisors whenever appropriate.

5. RESPONSIBILITY TO COLLEAGUES
Marriage and family therapists treat colleagues with respect, courtesy, fairness, and good faith, and cooperate with colleagues in order to promote the welfare and best interests of the patient.

5.1 Marriage and family therapists respect the confidences of colleagues that are shared in the course of their professional relationships.
5.2 Marriage and family therapists are encouraged to assist colleagues who are impaired due to substance abuse, emotional problems, or mental illness.
5.3 Marriage and family therapists do not file or encourage the filing of ethics or other complaints that they know, or reasonably should know, are frivolous.


6. RESPONSIBILITY TO RESEARCH PARTICIPANTS
Investigators respect the dignity and protect the welfare of participants in research and are aware of federal and state laws and regulations and professional standards governing the conduct of research.

6.1 Investigators are responsible for making careful examinations of ethical acceptability in planning studies. To the extent that services to research participants may be compromised by participation in research, investigators seek the ethical advice of qualified professionals not directly involved in the investigation and observe safeguards to protect the rights of research participants.
6.2 Investigators requesting participants' involvement in research inform them of all aspects of the research that might reasonably be expected to influence willingness to participate. Investigators are especially sensitive to the possibility of diminished consent when participants are also receiving clinical services, have impairments which limit understanding and/or communication, or when participants are children.
6.3 Investigators respect participants' freedom to decline participation in or to withdraw from a research study at any time. This obligation requires special thought and consideration when investigators or other members of the research team are in positions of authority or influence over participants. Marriage and family therapists, therefore, make every effort to avoid dual relationships with research participants that could impair professional judgment or increase the risk of exploitation.
6.4 Information obtained about a research participant during the course of an investigation is confidential unless there is an authorization previously obtained in writing. When the possibility exists that others, including family members, may obtain access to such information, this possibility, together with the plan for protecting confidentiality, is explained as part of the procedure for obtaining informed consent.

7. RESPONSIBILITY TO THE PROFESSION
Marriage and family therapists respect the rights and responsibilities of professional colleagues and participate in activities which advance the goals of the profession.

7.1 Marriage and family therapists remain accountable to the standards of the profession when acting as members or employees of organizations.
7.2 Marriage and family therapists assign publication credit to those who have contributed to a publication in proportion to their contributions and in accordance with customary professional publication practices.
7.3 Marriage and family therapists who are the authors of books or other materials that are published or distributed appropriately cite persons to whom credit for original ideas is due.
7.4 Marriage and family therapists who are the authors of books or other materials published or distributed by an organization take reasonable steps to ensure that the organization promotes and advertises the materials accurately and factually.
7.5 Marriage and family therapists recognize a responsibility to participate in activities that contribute to a better community and society, including devoting a portion of their professional activity to services for which there is little or no financial return.
7.6 Marriage and family therapists are concerned with developing laws and regulations pertaining to marriage and family therapy that serve the public interest, and with altering such laws and regulations that are not in the public interest.
7.7 Marriage and family therapists cooperate with the Ethics Committee and truthfully represent facts to the Ethics Committee. Failure to cooperate with the Ethics Committee is itself a violation of these standards.

8. RESPONSIBILITY TO THE LEGAL SYSTEM
Marriage and family therapists recognize their role in the legal system and their duty to remain objective and truthful.

8.1 Marriage and family therapists who give testimony in legal proceedings testify truthfully and avoid making misleading statements.
8.2 Marriage and family therapists who act as expert witnesses base their opinions and conclusions on appropriate data, and are careful to acknowledge the limits of their data or conclusions in order to avoid providing misleading testimony or reports.
8.3 Marriage and family therapists avoid, wherever possible, performing conflicting roles in legal proceedings and disclose any potential conflicts to prospective clients, to the courts, or to others as appropriate.
8.4 Marriage and family therapists, regardless of their role in a legal proceeding, remain objective and do not compromise their professional judgment or integrity.
8.5 Marriage and family therapists do not express professional opinions about an individual's mental or emotional condition unless they have conducted an examination of the individual, or unless they reveal the limits of the information upon which their professional opinions are based, with appropriate cautions as to the effects of such limited information upon their opinions.


9. FINANCIAL ARRANGEMENTS
Marriage and family therapists make financial arrangements with patients and supervisees that are understandable, and conform to accepted professional practices and legal requirements.

9.1 Marriage and family therapists do not offer or accept payment for referrals.
9.2 Marriage and family therapists do not financially exploit their patients.
9.3 Marriage and family therapists disclose, in advance, their fees and the basis upon which they are computed, including, but not limited to, charges for canceled or missed appointments and any interest to be charged on unpaid balances, at the beginning of treatment and give reasonable notice of any changes in fees or other charges.
9.4 Marriage and family therapists give reasonable notice to patients with unpaid balances of their intent to sue, or to refer for collection. Whenever legal action is taken, therapists will avoid disclosure of clinical information. Whenever unpaid balances are referred to collection agencies, therapists will exercise care in selecting collection agencies and will avoid disclosure of clinical information.
9.5 Marriage and family therapists ordinarily refrain from accepting goods, services, or other non-monetary remuneration from patients in return for professional services. Such arrangements often create conflicts and may lead to exploitation or distortion of the professional relationship.
9.6 Marriage and family therapists represent facts regarding services rendered fully and truthfully to third party payers.


10. ADVERTISING
Marriage and family therapists engage in appropriate informational activities, including those that enable lay persons to choose professional services on an informed basis.

10.1 Marriage and family therapists accurately represent their competence, education, training, and experience relevant to their professional practice.
10.2 Marriage and family therapists assure that advertisements and publications, whether in directories, announcement cards, newspapers, radio, television, Internet or any other electronic media, are formulated to accurately convey information that is necessary for the public to make an appropriate selection.
10.3 Marriage and family therapists do not use a name which could mislead the public concerning the identity, responsibility, source, and status of those practicing under that name and do not hold themselves out as being partners or associates of a firm if they are not.
10.4 Marriage and family therapists do not use any professional identification, including but not limited to: a business card, office sign, letterhead, telephone or association directory listing, Internet or any other electronic media, if it includes a statement or claim that is false, fraudulent, misleading, or deceptive. A statement is false, fraudulent, misleading, or deceptive if it a) contains a material misrepresentation of fact; b) fails to state any material fact necessary to make the statement, in light of all circumstances, not misleading; or c) is intended to or is likely to create an unjustified expectation.
10.5 Marriage and family therapists correct, wherever possible, false, misleading, or inaccurate information and representations made by others concerning the therapist's qualifications, services, or products.
10.6 Marriage and family therapists do not solicit testimonials from patients.
10.7 Marriage and family therapists make certain that the qualifications of persons in their employ are represented in a manner that is not false, misleading, or deceptive.
10.8 Marriage and family therapists may represent themselves as specializing within a limited area of marriage and family therapy, but only if they have the education, training, and experience which meet recognized professional standards to practice in that specialty area.
10.9 CAMFT clinical, associate and prelicensed members may identify such membership in CAMFT in public information or advertising materials, but they must clearly and accurately represent whether they are clinical, associate, or prelicensed members.
10.10 Marriage and family therapists may not use the initials CAMFT following their name in the manner of an academic degree.
10.11 Marriage and family therapists may use the CAMFT logo only after receiving permission in writing from the Association. Permission will be granted by the Association to CAMFT members in good standing in accordance with Association policy on use of CAMFT logo. The Association (which is the sole owner of its name, logo, and the abbreviated initials CAMFT) may grant permission to CAMFT committees and chartered chapters in good standing, operating as such, to use the CAMFT logo. Such permission will be granted in accordance with Association policy on use of the CAMFT logo.
10.12 Marriage and family therapists use their membership in CAMFT only in connection with their clinical and professional activities.

Violations of these standards should be brought to the attention of the CAMFT Ethics Committee, in writing, at CAMFT's administrative office, 7901 Raytheon Road, San Diego, CA 92111-1606, or at such other address as may be necessary because of a change in location of the administrative office.

i The terms psychotherapy, therapy and counseling are used interchangeably throughout the Ethical Standards.

ii The word "patient," as used herein, is synonymous with such words as "client" or "counselee."

iii The term "marriage and family therapist," as used herein, is synonymous with the term "licensed marriage, family and child counselor," and is intended to cover registered interns and trainees doing marriage, family and child counseling under supervision.

iv Dual relationships include multiple relationships with patients.

All known dates of ethical standards revisions: 5/02, 4/97, 4/92, 10/87, 9/78, and 3/66.