A Closer Look at the Revised CAMFT Code of Ethics: Part II

Michael Grifin, JD, LCSW
Staff Attorney
The Therapist
September/October 2020

On December 7, 2019, following several years of work by the CAMFT Ethics Committee, CAMFT staff, and consultants, the revised CAMFT Code of Ethics was released for use by members of CAMFT. The revised Code has been reorganized, and it contains numerous changes from the prior version, some of which are quite significant. In several instances, there is entirely new content. This article is intended as part two of a three-part series that focuses on sections of the Code of Ethics that are new or that contain content that has been substantively revised.^{1 2 3} The following discussion examines such content in sections 5 through 8 of Part I of the Code. Changes to sections 9 through 13 of the Code will be discussed in upcoming issues of The Therapist. As in part one of this series, the following discussion does not involve sections that have been subject to minor, non-substantive revisions.

PART I — THE STANDARDS

New Section 5.1

5.1 CONVICTION OF A CRIME
Marriage and family therapists are in violation of this Code and subject to termination of membership, or other appropriate action, if they: are convicted of a crime substantially related to their professional qualifications or functions, are expelled from or disciplined by other professional organizations, or have licenses or certificates that are lapsed, suspended, or revoked, or are otherwise disciplined by regulatory bodies.

Why Is There a New Section 5.1?
Section 5.1 includes content from section 3.1 of the former Code of Ethics. Language that concerns the issue of practicing when impaired because of physical or mental causes or the abuse of alcohol or other substances can be found in section 5.5 Practicing While Impaired.

New Section 5.3

5.3 CLIENT/PATIENT RECORDS
Marriage and family therapists create and maintain client/patient records consistent with sound clinical judgment, standards of the profession, and the nature of the services being rendered.

Why Is There a New Section 5.3?
This section includes language located in section 3.3 of the former Code of Ethics, but outdated terminology has been removed and language has been added that reflects the requirements applicable to marriage and family therapists for creating and maintaining client/patient records, as expressed in Business & Professions Code, §4982(v).

New Section 5.5

5.5 PRACTICING WHILE IMPAIRED
Marriage and family therapists do not practice when their competence is impaired because of physical or psychological causes or the use of alcohol or other substances.

Why Is There a New Section 5.5?
The Ethics Committee believed that it was appropriate to devote a discrete section to the topic of practicing while impaired to underscore the importance of this issue.

New Section 5.7

5.7 SENSITIVITY TO DIVERSITY
Marriage and family therapists actively strive to identify and understand the diverse backgrounds of their clients/patients by obtaining knowledge, gaining personal awareness, and developing sensitivity and skills pertinent to working with a diverse client/patient population.

Why Is There a New Section 5.7?
This section includes language located in section 3.6 of the former Code of Ethics. A significant change is that the word “culture” in the title of the section has been changed to “diversity” to reflect a broader sensitivity to all forms of diversity. While “culture” may be viewed as pertaining only to race or nationality, “diversity” includes factors that may be unique to the client/patient such as race, gender, sexual orientation, religious beliefs, disability, and socioeconomic status.

New Section 5.8

5.8 GIFTS
Marriage and family therapists carefully consider the clinical and cultural implications of giving and receiving gifts or tokens of appreciation. Marriage and family therapists take into account the value of the gift, the effect on the therapeutic relationship, and the motivations of the client/patient and the psychotherapist for giving, receiving, or declining the gift.

Why Is There a New Section 5.8?
The Ethics Committee believed that it was important to create an entirely new section regarding the topic of gifts to provide additional guidance on a topic that is a common source of confusion. While it is not unethical, per se, for a therapist to give a gift to a client/patient or to receive one, it is always important to consider the relevant clinical and cultural implications. For example, an individual may offer a gift to the therapist as part of a cultural tradition, or the therapist’s refusal of a gift from a client/patient may be experienced as a personal rejection and prove harmful to the therapeutic relationship.

New Section 5.12

5.12 DUPLICATION OF THERAPY
Marriage and family therapists do not generally duplicate professional services to a prospective client/patient who is already receiving treatment from another psychotherapist. When making a determination to provide services, marriage and family therapists carefully consider the needs, presenting treatment issues, and welfare of the client/patient to minimize potential confusion and/or conflict. Prior to rendering services to the prospective client/patient, marriage and family therapists address these issues, including the nature of the client’s/ patient’s relationship with the other treating psychotherapist and whether consultation with the other psychotherapist is appropriate.

Why Is There a New Section 5.12?
Section 5.12 addresses the issue of a client/ patient seeing more than one therapist. The standards in this section are significantly more flexible in contrast to those found in section 3.10 of the former Code of Ethics, which generally prohibited more than one therapist treating the same person in the absence of an agreement between the therapists. A significant change is that section 5.12 provides that consultation with the other therapist in these circumstances in now elective rather than required. This section also requires the therapist to consider the prospective client’s/ patient’s needs and input, as well as their relationship with the other therapist, when deciding whether to provide services.

New Section 5.13

5.13 PUBLIC STATEMENTS
Because of their ability to influence and alter the lives of others, marriage and family therapists exercise caution when making public their professional recommendations or opinions through testimony, social media, Internet content, or other public statements.

Why Is There a New Section 5.13?
The content of this section is based on the language of section 3.10 of the former Code of Ethics but includes modernized terminology such as “social media” and “Internet content.”

New Section 5.14

5.14 LIMITS OF PROFESSIONAL OPINIONS
Marriage and family therapists do not express professional opinions about an individual’s psychological condition unless they have treated or conducted an examination and assessment 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 on their opinions. (See also section 10.7 Professional Opinions in Court-Involved Cases.)

Why Is There a New Section 5.14?
Section 5.14 is based on the language of section 3.14 of the former Code of Ethics but utilizes the term “psychological conditions” in place of “mental and emotional disorders” to modernize the terminology and broaden the application to mental, emotional, and behavioral disorders. Another change is that section 5.14 alerts the reader that section 10.7 should also be considered when the issue concerns professional opinions in courtinvolved cases.

New Section 6

6. TELEHEALTH(NEW PREAMBLE)
Marriage and family therapists recognize that ongoing technological developments promote availability and access to healthcare and expand opportunities to provide their services outside of the therapy office. When utilizing telehealth to provide services to clients/ patients, marriage and family therapists consider the welfare of the client/patient and the appropriateness and suitability of the modality in meeting the client’s/patient’s needs. They make appropriate disclosures to the client/patient regarding the use of telehealth, exercise reasonable care when utilizing technology, and remain current with the relevant laws and regulations.

Why Is There a New Section 6 and Preamble?
Section 6 was created to provide significantly expanded guidelines on the topic of telehealth. It incorporates content from various sections of the former Code of Ethics. The new preamble for section 6 identifies several key considerations for therapists to address when contemplating the use of telehealth as a modality and points out important actions that therapists should take when utilizing telehealth.

New Section 6.1

6.1 TELEHEALTH
Marriage and family therapists take precautions to meet their responsibilities to clients/patients who are not physically present during the provision of therapy. Prior to utilizing telehealth, marriage and family therapists consider the appropriateness and suitability of this therapeutic modality in meeting the client’s/patient’s needs. This includes consideration of factors such as the client’s/patient’s familiarity with the modality, the issues to be addressed, and the therapeutic orientation. Marriage and family therapists then employ telehealth competently.

Why Is There a New Section 6.1?
This section incorporates content from section 1.4.2 of the former Code of Ethics but offers a clearer, more concise description of the therapist’s key considerations when contemplating whether telehealth is appropriate and suitable for a particular client/ patient. The language is also consistent with the requirements set forth in regulations at 16 C.C.R. §1815.5, California’s Standards of Practice for Telehealth.

New Section 6.2

6.2 COMPLIANCE WITH TELEHEALTH LAWS
Marriage and family therapists are familiar with the state and federal laws governing telehealth and ensure compliance with all relevant laws prior to engaging in telehealth

.Why Is There a New Section 6.2?
This new section is intended to convey that therapists are expected to be familiar with the relevant federal and state laws when engaging in telehealth. In addition to the California regulations that address the practice of telehealth (located at 16 C.C.R. §1815.5), the Health Insurance and Portability Accountability Act (HIPAA) outlines legal requirements that concern the security and privacy of private health information that is electronically transmitted.

New Section 6.3

6.3 DISCLOSURES
Marriage and family therapists inform clients/patients of the potential risks, consequences, and benefits of the telehealth modality, including but not limited to issues of confidentiality, clinical limitations, and transmission/technical difficulties

.Why Is There a New Section 6.3?
This new section incorporates language from section 1.4.2 of the former Code of Ethics but deletes the phrase “ability to respond to emergencies,” as this issue, if applicable, falls under clinical limitations.

New Section 7.1

7.1 MAINTAINING PROFESSIONAL BOUNDARIES WITH SUPERVISEES AND STUDENTS
Marriage and family therapists are aware of their influential position with respect to their students and supervisees, and they avoid exploiting the trust and dependency of such persons. Marriage and family therapists, therefore, avoid engaging in relationships with supervisees and students (over whom they exercise professional authority) that are likely to impair professional judgment or lead to exploitation. It is unethical for a supervisor or educator to provide therapy to students or supervisees over whom they exercise professional authority, and it is unethical to provide marriage and family therapy supervision to clients/patients. Other acts that are likely to be unethical include, but are not limited to, borrowing money from a supervisee, engaging in a business venture with a supervisee, and engaging in a close personal relationship with a supervisee or student. Such acts with a supervisee’s spouse, partner, or immediate family member may also be considered unethical dual relationships.

Why Is There a New Section 7.1?
Section 7.1 incorporates content from section 4.1 of the former Code of Ethics, with revisions. This section highlights the importance of maintaining professional boundaries with supervisees and students. Although this section does not express a blanket prohibition of dual/multiple relationships between supervisors/educators and supervisees/students, it clarifies that supervisors and educators should avoid engaging in dual relationships with supervisees and students over whom they exercise professional authority where such relationships are likely to impair the professional judgment of the supervisor/ educator or lead to exploitation of the supervisee/student. As in the former CAMFT Code of Ethics, this section also cautions supervisors against engaging in certain relationships (such as a close personal friendship or a business venture) with a supervisee’s spouse or close family member.

New Section 7.2

7.2 SEXUAL CONTACT WITH SUPERVISEES AND STUDENTS
Marriage and family therapists do not engage in sexual contact with supervisees or students over whom they exercise professional authority. Prohibited sexual contact includes, but is not limited to, sexual intercourse, sexual intimacy, and sexually explicit communications that have no sound clinical, supervisory, or educational basis. Such acts with the spouse, partner, or immediate family member of a supervisee or student are likely to be unethical and exploitive. (See also section 4.5 Sexual Contact.)

Why Is There a New Section 7.2?
Section 7.2 incorporates content from section 4.1 of the former Code of Ethics. It specifically prohibits supervisors and educators from engaging in sexual contact with supervises or students over whom they exercise professional authority, and it further clarifies that sexual contact includes sexually explicit communications that have no sound clinical, supervisory, or educational basis. This section also alerts the reader to the fact that section 4.5 Sexual Contact is relevant to this topic.

New Section 7.4

7.4 COMPETENCE OF SUPERVISEES
Marriage and family therapists ensure that the extent, quality, and kind of supervision provided is consistent with the education, training, and experience level of the supervisee. Marriage and family therapists do not permit their students, employees, or supervisees to perform or hold themselves out beyond their pre-licensed status or to perform professional services beyond their scope of competence.

Why Is There a New Section 7.4?
This section incorporates language from section 4.2 of the former Code of Ethics, utilizes the terms “education, training, and experience level” to define the scope of competence more precisely.

New Section 7.6

7.6 KNOWLEDGE OF LAWS AND REGULATIONS
Supervisors and supervisees have a responsibility to be knowledgeable about relevant laws and regulations pertaining to the practice of marriage and family therapy.

Why Is There a New Section 7.6?
The language of section 7.6 incorporates content from sections 4.4 and 4.1 of the former Code of Ethics, with revisions to state succinctly that supervisors are expected to be knowledgeable about laws and regulations that pertain to the practice of marriage and family therapy.

New Section 7.7

7.7 CHANGES IN LEGAL REQUIREMENTS AND ETHICAL STANDARDS
Supervisors maintain awareness of and stay current with changes in professional and ethical standards and legal requirements. Supervisors ensure that their supervisees are aware of professional and ethical standards and legal responsibilities.

Why Is There a New Section 7.7?
Section 7.7 includes language from section 4.5 of the former Code of Ethics, with a more succinct expression of the need for supervisors to maintain awareness of, and stay current with, changing legal and ethical standards.

New Section 7.11

7.11 BUSINESS PRACTICES
When acting as employers and/or supervisors, marriage and family therapists follow lawful business practices.

Why Is There a New Section 7.11?
This section incorporates language from section 4.9 of the former Code of Ethics. It clarifies that therapists have a duty to follow lawful business practices when acting as employers and/or supervisors. The related issue of a therapist’s ethical duties when faced with an employer’s policies that conflict with the Code of Ethics is addressed in section 9.1.

New Section 7.12

7.12 BARTERING WITH SUPERVISEES
Marriage and family therapists ordinarily refrain from accepting goods or services from supervisees in return for services rendered because of the potential for conflict, exploitation, and/or distortion of the professional relationship. Bartering should only be considered and conducted if the supervisee requests it, the bartering is not otherwise exploitive or detrimental to the supervisory relationship, and it is negotiated without coercion. Marriage and family therapists are responsible for ensuring that such arrangements are not exploitive and that a clear written agreement is created. Marriage and family therapists are encouraged to consider the relevant social and/or cultural implications of bartering, including whether it is an accepted practice among professionals within the community. (For bartering with clients/patients, see also section 12.5 Bartering.)

Why Is There a New Section 7.12?
Section 7.12 is entirely new. Similar to the language found in section 12.5, which offers an updated discussion of the topic of bartering with clients/patients, this section emphasizes that bartering should only be considered if the supervisee requests it; if the agreement is clear, fairly negotiated, and nonexploitive; and, perhaps most importantly, if it is not detrimental to the supervisory relationship.

New Section 7.13

7.13 PERFORMANCE ASSISTANCE
Supervisors guide supervisees in securing assistance, such as personal psychotherapy, education, training, or consultation, when needed for the supervisee to maintain or improve performance. Supervisees have the responsibility to seek information and to ask for supervisorial guidance when necessary.

Why Is There a New Section 7.13?
This section incorporates language from section 4.10 of the former Code of Ethics, with revisions, including a statement expressing that supervisees are expected to seek out information and supervisorial guidance when needed.

New Section 7.17

7.17 SUPERVISOR QUALIFICATIONS
Supervisors maintain licensure and meet/ satisfy the qualifications, laws, and regulations that pertain to supervision.

Why Is There a New Section 7.17?
In creating this new section, the Ethics Committee intends to express a clear and succinct statement concerning the need for supervisors to be vigilant about satisfying these requirements.

New Section 7.18

7.18 SUPERVISEE REGISTRATION AND LIMITED ROLE
Supervisees maintain registrations when required by law and/or regulation and function within this limited role as permitted by licensing laws and/or regulations.

Why Is There a New Section 7.18? Similar to section 7.17, the Ethics Committee intends this new section to provide a succinct statement concerning the need for supervisees to be vigilant about satisfying these requirements and/or regulations.

New Section 8.3

8.3 ETHICAL COMPLAINTS AGAINST COLLEAGUES
Marriage and family therapists are encouraged to take reasonable actions to resolve disputes with colleagues before filing an ethics complaint. Reasonable measures may include addressing the matter with the colleague, consultation, and/or mediation. 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.

Why Is There a New Section 8.3?
The language of this section encourages therapists, if possible, to pursue reasonable measures to resolve disputes with colleagues prior to filing an ethics complaint.

New Section 8.4

8.4 SOLICITING OTHER CLIENTS/PATIENTS
Marriage and family therapists neither solicit clients/patients nor encourage clients/patients to leave other therapists when the client/ patient, because of circumstances, may be vulnerable to undue influence.

Why Is There a New Section 8.4?
Section 8.4 incorporates language from section 5.4 of the former Code of Ethics, with significant revisions to comply with the Federal Trade Commission (FTC) ruling against ethical standards that are overbroad and anti-competitive, or that restrict a licensee’s ability to practice. The prohibition of soliciting clients/patients to leave other therapists must be limited to patients or other persons “who because of their particular circumstances are vulnerable to undue influence.”

The Code of Ethics Provides Guidance to Therapists
The Code of Ethics provides information and guidance to therapists regarding the application of ethical standards to a wide array of issues. It is important to understand that ethical standards, generally speaking, are meant to offer guidance to therapists in determining an ethical course of action. They are not intended as rigid absolutes that can be mechanically applied to any person or circumstance. When considering what an appropriate action should be, or determining whether a violation of these standards has occurred, the answer may not be immediately evident. It is important to be thoughtful and to carefully consider the circumstances and relevant facts that may help to explain a person’s conduct.

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Michael Griffin, JD, LCSW, is a staff attorney at CAMFT. Michael is available to answer member calls regarding legal, ethical, and licensure issues.

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Endnotes

¹ The term “client/patient” as used in the Code of Ethics is synonymous with such words as “consumer” and “counselee.” The Committee adopted the use of the term “client/patient” throughout the Code instead of interchanging “client” and “patient,” as in prior versions of the Code.

² The Introduction to the Code of Ethics includes the updated title for MFT Registrants (”Registered Associate Marriage and Family Therapists”) and clarifies that all members of CAMFT (including MFTs and non-MFTs) are expected to be familiar with the requirements expressed in the Code of Ethics.

³ Part one of this series, published in the May/June issue of The Therapist, discusses changes made in sections 1-4 of the Code of Ethics.

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This article is not intended to serve as legal advice and is offered for educational purposes only. The information provided should not be used as a substitute for independent legal advice and it is not intended to address every situation that could potentially arise. Please be aware that laws, regulations and technical standards change over time. As a result, it is important to verify and update any reference or information that is provided in this article.