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The Legal Department articles are not intended to serve as legal advice and are 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 the article.
Staff Attorney Michael Griffin, JD, LCSW, discusses various changes to the CAMFT Code of Ethics, focusing on substantive revisions to sections 9-13 of the Code. This article is part III of a three-part series regarding the revised Code of Ethics.
Michael Griffin JD, LCSW
According to Article VII, §B(3) of the CAMFT Bylaws, the CAMFT Ethics Committee is responsible for regularly proposing revisions, deletions and additions to the CAMFT Code of Ethics. On December 7, 2019, publication of the current version of the Code of Ethics culminated several years of work on the ethical standards by the Ethics Committee, (along with two former Committee chairs in the role of consultants). This article is the final part of a three-part series regarding sections of the Code of Ethics that are new or which contain content that has been substantively revised.1 2 3
The following discussion examines significant changes to sections 9 through 13 of the Code. As in the first two articles on this topic, minor or non-substantive changes to the Code are not subject to discussion.
PART I — THE STANDARDS
New Section 9
9. RESPONSIBILITY TO THE PROFESSION
Marriage and family therapists respect the rights and responsibilities of colleagues. Marriage and family therapists cooperate with colleagues to act in the best interest of the profession. Marriage and family therapists participate in activities that advance the goals of the profession.
Why is there a new section 9?
The content expressed in sections 9 through 9.7 was located in section 7 of the prior Code of Ethics. Section 9 provides additional language in the preamble for this section, in order to underscore the value of cooperation among colleagues to act in the best interest of the profession.
New Section 9.1
9.1 ACCOUNTABILITY TO THE STANDARDS OF THE PROFESSION
Marriage and family therapists remain accountable to the standards of the profession when acting as members or employees of organizations. If an organization with whom a marriage and family therapist is employed or affiliated has policies, procedures, or demands that conflict with the CAMFT Code of Ethics, the marriage and family therapist shall make known their ethical obligations as set forth in the Code of Ethics and take reasonable steps to resolve such conflicts.
Why is there a new section 9.1?
Section 9.1 offers guidance to therapists who encounter policies, procedures, or demands within an organization that conflict with the Code of Ethics. Therapists are required to comply with the Code of Ethics, even in circumstances where their employer policies may conflict with the Code. In such instances, therapists are expected to make known any conflicts between the policies or demands, and to take reasonable steps to resolve such conflicts.
Sections 9.2 through 9.6
Sections 9.2 through 9.6 have undergone minor, non-substantive revisions.
New Section 9.7
9.7 FAILURE TO COOPERATE WITH THE ETHICS COMMITTEE
Marriage and family therapists cooperate with the Ethics Committee or its designee and truthfully represent facts to the Ethics Committee or its designee at any point from the inception of an ethical complaint through the completion of proceedings regarding a complaint. Failure to cooperate with the Ethics Committee is itself a violation of these standards.
Why is there a new section 9.7?
The revisions to this section clarify that cooperation with the Ethics Committee and with the Committee’s designee (such as a member of the legal staff who has been directed by the Committee to communicate with the member) is expected from the inception of an ethics complaint thought the completion of relevant proceedings.
New Section 10
10. RESPONSIBILITY TO THE LEGAL SYSTEM
Marriage and family therapists recognize their duty to remain objective and truthful. Marriage and family therapists recognize that court cases involving therapeutic services introduce factors and dynamics into the delivery of treatment services that are likely to impact their working alliance with the clients/ patients; they are cognizant of the tendency of clients/patients to equate their own best interests with prevailing in a legal dispute. Marriage and family therapists understand that their role is not to produce a pre-determined outcome in the legal process; they should not align with the client’s/patient’s legal position as this might distort information received, or impair their ability to support the client/ patient in dealing with the stresses of the process and potential outcomes.
Why is there a new section 10?
The Ethics Committee has reviewed numerous ethical complaints involving circumstances where the client/patient is involved in the legal system, and the client’s/patient’s therapist is invited to offer an opinion, or to be involved in the legal proceeding in some manner. To assist therapists in recognizing, and understanding the various issues that may exist when working with a client/patient who is involved with the legal system, including the possible implications of offering an opinion in such matters, the Committee provided additional guidance in the revised, expanded language that is offered throughout section 10. Changes throughout this section significantly expand upon language that was located in section 8 of the prior Code of Ethics.
New Section 10.1
Marriage and family therapists who give testimony in legal proceedings testify truthfully and avoid making misleading statements. Marriage and family therapists inform the court of any conflicts between the expectations of the court and their ethical obligations or role limitations. Marriage and family therapists should anticipate that clients, attorneys, or the court, might ask them to offer opinions or information beyond the limits of their knowledge base or expert role. In such circumstances, marriage and family therapists safeguard their professional objectivity by clarifying these issues with the court and respectfully declining to offer such testimony.
Why is there a new section 10.1?
Clients/patients, attorneys, and courts commonly ask treating therapists to offer an opinion which may conflict with their ethical obligations (such as client/patient confidentiality), and/or, call for an opinion by a therapist that is outside of the therapist’s knowledge base or role (such as when the treating therapist is asked to provide an opinion on the custody of a minor client/ patient.) In such instances, a therapist should attempt to clarify such issues with the court and decline to provide testimony that is outside of their scope and role.
New Section 10.2
10.2 EXPERT WITNESSES
Marriage and family therapists who act as expert or who provide expert opinions in any context, orally or in writing, clarify their expert role to their clients/patients, fellow professionals, attorneys, and the court as necessary. Marriage and family therapists base their opinions and conclusions on appropriate data and are careful to acknowledge the limits of their training, data, recommendations or conclusions, in order to avoid providing unsubstantiated, misleading, distorted, or biased testimony or reports. Marriage and family therapists carefully distinguish between the roles of “treating therapist” and “forensic expert.” Treating therapists primarily provide opinions on the assessment, diagnosis, treatment progress and recommendations, and prognosis of their clients/patients. A treating expert’s testimony should be limited to the therapist’s particular area of expertise and issues directly relevant to the treatment role. They understand that their role is to facilitate successful psychological functioning, and not to promote a predetermined legal outcome. Forensic experts are retained to offer opinions and make recommendations in a variety of legal contexts, including specific parenting and custody plans or decision-making authority in legal proceedings.
Why is there a new section 10.2?
The language that was added to this section is intended to help therapists understand the difference between the two expert witness roles and the scope of such roles. Expert witnesses may testify as “treating therapist experts” or “forensic experts,” as articulated in Cal. Code Civ. Proc. §2034.430(b)(2), and Government Code §68092.50.
New Section 10.3
10.3 CONFLICTING ROLES
Whenever possible, marriage and family therapists avoid performing conflicting roles in legal proceedings and disclose any potential conflicts to prospective clients/patients, to the courts, or to others as appropriate. At the outset of the service to be provided and as changes occur, marriage and family therapists clarify role expectations, limitations, conflicts, and the extent of confidentiality to pre-existing or prospective clients, to the courts, or to others as appropriate.
Why is there a new section 10.3?
The language in this section explains that therapists are expected to clarify role expectations, as well as any limitations or conflicts which may exist, and the extent of confidentiality to both current and prospective patients, the courts, or others as appropriate.
New Section 10.4
10.4 DUAL ROLES
Marriage and family therapists avoid providing both court evaluations and treatment concurrently or sequentially for the same clients/patients or treatment units in legal proceedings such as child custody, visitation, dependency, or guardianship proceedings, unless otherwise required by law or initially appointed pursuant to court order. When pre-existing clients/patients become involved in a legal proceeding and the marriage and family therapist continues to provide treatment, they should discuss the potential effects of legal involvement with their clients/patients, including clarifying the potential role conflicts, clients’/patients’ expectations, and possible requests to release treatment information.
Why is there a new section 10.4?
This section intends to clarify the meaning of “evaluations,” when they are performed for the purpose of child custody, visitation, dependency, or guardianship proceedings, as distinguished from evaluations of a client/patient, conducted by their therapist for treatment purposes. The addition of “concurrently or sequentially” is intended to clarify that therapists generally avoid performing court evaluations and treatment to a client/patient at the same time, or providing one service after the other. The added language is intended to guide therapists in determining which factors are important to discuss with current clients/patients who become involved in legal proceedings.
New Section 10.5
Marriage and family therapists, regardless of their role in a legal proceeding, remain impartial and do not compromise their professional judgment or integrity. Marriage and family therapists understand that their testimony and opinions are impactful on legal outcomes. Marriage and family therapists use particular caution when drawing conclusions or forming or expressing opinions from limited observations or sources of information. Why is there a new section 10.5? This section underscores the importance to therapists of remaining impartial when providing testimony and opinions in legal proceedings.
New Section 10.6
10.6 MINORS AND PRIVILEGE
Marriage and family therapists determine who holds the psychotherapist-patient privilege on behalf of minor clients/patients prior to releasing information or testifying. Marriage and family therapists determine who are the legal recipients of privileged information and the extent of the information to be released. When legally permitted, Marriage and family therapists are encouraged to inform parents/legal guardians about whether, how, and what information they will communicate to the court.
Why is there a new section 10.6?
The language of this section provides guidance to therapists when disclosing minor patients’ treatment information in the context of legal proceedings that concern the minor. To help therapists determine whether the disclosure of the information would be detrimental to the minor’s psychological or physical well-being or to the professional relationship, the therapist should identify the recipient of the privileged information and the extent of the information to be released. To clarify expectations and limitations of the therapist’s role, the therapist should inform the parents/legal guardians about whether, how, and what information the therapist will communicate to the court.
Section 10.7 has undergone minor, nonsubstantive revisions.
New Section 10.8
10.8 CUSTODY EVALUATORS
Marriage and family therapists who are custody evaluators (private or court-based) or special masters provide such services only if they meet the requirements established by relevant ethical standards, guidelines, laws, regulations, and rules of court.
Why is there a new section 10.8?
The Ethics Committee believed that it was appropriate to include a reference to relevant ethical standards and guidelines pertinent to therapists acting as custody evaluators (e.g., the Association of Family and Conciliation Courts Model Standards and American Psychological Association Child Custody Guidelines.)
New Section 10.9
10.9 CONSEQUENCES OF CHANGES IN THERAPIST ROLES
Marriage and family therapists inform the client/patient or the treatment unit of any potential consequences of therapist-client/ patient role changes. Such role changes include, but are not limited to: child’s therapist, family’s therapist, couple’s therapist, individual’s therapist, mediator, and special master. Marriage and family therapists are encouraged to obtain consultation before changing roles to consider how the role change might create a conflict of interest or affect the therapeutic alliance, and to explore whether appropriate alternatives exist that would reduce such risks.
Why is there a new section 10.9?
This section urges therapists to seek appropriate consultation to avoid possible conflicts of interest and to explore whether appropriate alternatives may be available in circumstances where changes in the therapist’s role may create unnecessary confusion or complexity in the therapist-client/patient relationship. The word “evaluator” was deleted from this section, since relevant ethical standards and Rules of Court do not allow for therapists who have treated a patient to act as a custody evaluator for the patient, or, for a custody evaluator in a case to also serve as the treating therapist for a party in the case.
New Section 10.10
10.10 FAMILIARITY WITH JUDICIAL AND ADMINISTRATIVE RULES
Marriage and family therapists, when assuming treatment or forensic expert roles, are or become familiar with the judicial, jurisdictional, and administrative rules governing their roles.
Why is there a new section 10.10?
This section clarifies that therapists who serve as expert witnesses should be familiar with the various rules which may apply to the therapist’s role, in the respective court.
New Section 10.11
10.11 CUSTODY DISPUTES
When treating families and minors who are involved in a custody determination or dispute, marriage and family therapists obtain information about how the decision to enter therapy was made, who was involved in the decision, and the outcomes expected by the parents, other parties, or the court. Marriage and family therapists take care to clarify and determine who has the legal authority to provide consent and treatment for the minor and avoid initiating treatment of the minor until such determination is made. Marriage and family therapists are encouraged to request copies of any court judgements or orders and determine who has the legal authority to make decisions about entering or continuing treatment, or access to or release of confidential information. When providing legally permitted disclosures of confidential information or professional opinions about minor clients/ patients in court-involved cases, marriage and family therapists generally limit the scope of such information to issues which concern the minor’s psychotherapeutic treatment. In order to avoid an inaccurate or incomplete assessment of the minor’s needs, marriage and family therapists use caution in the interpretation of a minor’s pictures, writings, or other materials produced in the course of treatment as well as behaviors or statements when the minor expresses a position on disputed adult issues.
Why is there a new section 10.11?
Section 10.11 offers guidance to therapists who are working with families and minors, where the parents are divorced, separated, or in the process of a custody dispute. Therapists treating minors have an ethical duty to determine who has the legal authority to consent to the minor’s treatment, and they are encouraged to request the relevant court order or custody agreement to determine who has the legal authority to make treatment decisions. The issue of who can consent to a minor’s treatment can be complex, and there is an increased risk to therapists of encountering ethics complaints, and complaints to licensing boards, when working with families who are engaged in custodial disputes. The Ethics Committee recommends that therapists take care to obtain key information at the outset of therapy. This includes determining who made the decision to enter therapy and identifying what the expected benefit, or anticipated outcome of therapy is.
When addressing issues that are the subject of legal contention or dispute by the minor’s parents or guardians, it is important for therapists to remain objective and impartial and to exercise care when interpreting statements, behaviors, and materials that may be produced by their minor client/patient.
New Section 10.12
10.12 PROFESSIONAL COMMUNICATIONS
Marriage and family therapists are aware of the potential impact of the adversarial nature of legal disputes on their actions, observations, and opinions. When communicating with clients/patients, parents, counsel, the court, or other parties, marriage and family therapists ensure that their communications are properly authorized, unbiased, and accurate. Marriage and family therapists decline to communicate when there is insufficient data to form a reliable opinion or where the opinion is inconsistent with their role.
Why is there a new section 10.12?
Section 10.12 reiterates and stresses that therapists have an ethical duty to remain objective in their communications, and to provide accurate information which can be supported by sufficient data when communicating with clients/patients, legal counsel, the court, and other parties.
New Section 11
11. RESPONSIBILITY TO RESEARCH PARTICIPANTS
Section 11 concerns the topic of responsibility to research participants, which was located in section 6 of the prior Code of Ethics. Sections 11 through 11.5 Sections 11 through 11.5 have undergone minor, non-substantive revisions.
New Section 12
12. FINANCIAL ARRANGEMENTS
Section 12 addresses the topic of financial arrangements, which was located in section 9 of the prior Code of Ethics.
Sections 12 through 12.4
Sections 12 through 12.4 have undergone minor, non-substantive revisions.
New Section 12.5
Marriage and family therapists ordinarily refrain from accepting goods or services from clients/ patients in return for services rendered due to the potential for conflicts, exploitation, and/ or distortion of the professional relationship. Bartering should only be considered and conducted if the client/patient requests it, the bartering is not otherwise exploitive or detrimental to the therapeutic relationship, and it is negotiated without coercion. Marriage and family therapists are responsible to ensure that such arrangements are not exploitive and that a clear written agreement is created. Marriage and family therapists are encouraged to consider relevant social and/or cultural implications of bartering including whether it is an accepted practice among professionals within the community. (For bartering with supervisees, see also section 7.12 Bartering with Supervisees).
Why is there a new section 12.5?
Section 12.5 offers a greatly expanded discussion of bartering, compared to the limited language found in Section 9.5 of the prior Code of Ethics. The current language continues to recommend, however, that therapists generally avoid the use of bartering due to the potential for exploitation of clients/patients, the possible distortion of the therapeutic relationship, and possible conflicts of interest.
The Ethics Committee recognized that situations may arise in which bartering may be appropriate, such as when the client/patient requests to barter, or when the bartering does not lead to exploitation of the client/patient or prove harmful to the therapeutic relationship, and is negotiated between the client/patient and the therapist without coercion. Therapists have an ethical duty to assure that any bartering arrangement is consistent with these standards and to secure a written agreement with the client/patient when bartering is utilized for payment. Therapists should also carefully consider the social and cultural implications of bartering with their clients/patients.
New Section 12.6
12.6 THIRD-PARTY PAYERS
Marriage and family therapists represent facts regarding services rendered and payment for services fully and truthfully to third-party payers and/or guarantors of payment. When appropriate, marriage and family therapists make reasonable efforts to assist their clients/ patients in obtaining reimbursement for services rendered.
Why is there a new section 12.6?
The addition of “guarantors of payment” in this section, was to include individuals and entities who have agreed to assume responsibility for payment on behalf of a client/ patient. In addition, content regarding the issue of assisting client/patients in obtaining reimbursement for services (located in section 1.12 of the prior Code of Ethics) was incorporated here. Therapists are usually in the best position to advocate for reimbursement of services rendered, especially if they are contracted with the third-party payer.
WITHOLDING RECORDS FOR NONPAYMENT
Section 12.7 has undergone minor, nonsubstantive revisions.
New Section 13
Section 13 addresses the topic of advertising, which was located in section 10 of the prior Code of Ethics.
Sections 13 and 13.1
Sections 13 and 13.1 have undergone minor, non-substantive revisions.
New Section 13.2
13.2 ASSURING ACCURACY
Marriage and family therapists take reasonable steps to assure that advertisements and publications, whether in directories, business cards, newspapers, radio, television, websites, email, social media, or any other media, are formulated to convey accurate information to the public.
Why is there a new section 13.2?
Updated examples of advertising and marketing tools have been added to this section.
New Section 13.3
13.3 FICTITIOUS/OTHER NAMES
Marriage and family therapists do not use a name that 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.
Why is there a new section 13.3?
This section contains the language from section 10.3 of the prior Code of Ethics.
New Section 13.4
13.4 FALSE, MISLEADING, OR
Marriage and family therapists do not use any means of professional identification, including but not limited to: a business card, office sign, letterhead, telephone, email address, association directory listing, Internet, social media or any other 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 contains a material misrepresentation of fact, omits any material fact necessary to make the statement, in light of all circumstances, not misleading, or is intended to or is likely to create an unjustified expectation.
Why is there a new section 13.4?
Updated examples of advertising and marketing tools have been added to this section.
New Section 13.5
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. Why is there a new section 13.5? The language of this section is from section 10.5 of the prior Code of Ethics.
New Section 13.6
13.6 SOLICITATION OF TESTIMONIALS
Marriage and family therapists do not solicit testimonials from those clients/patients who, due to their particular circumstances, are vulnerable to undue influence.
Why is there a new section 13.6?
The language of this section is a significant departure from the provisions stated in section 10.6 of the prior Code of Ethics, which simply stated that, “marriage and family therapists do not solicit testimonials from patients.” The revised language concerning this issue incorporates language that is necessary for this standard to be compatible with anti-trust law, which does not allow for a blanket prohibition of soliciting testimonials. Pursuant to the Federal Trade Commission (“FTC”), the prohibition of testimonials must be limited to the solicitation of testimonials from patients or persons “who because of their particular circumstances are vulnerable to undue influence.”
While it is, in fact, permissible to solicit testimonials from current patients, before doing so, therapists must first consider whether the particular client/patient is, in the opinion of the therapist, vulnerable to undue influence. If such is the case, the therapist should avoid asking that person for a testimonial, or, consider asking for the testimonial when the person is no longer a client/patient. Of course, the fact that it may be permissible to ask a client/patient for a testimonial in some circumstances, does not imply that it is necessarily advisable, clinically, to do so. Therapists may consider seeking consultation from a trusted colleague, prior to asking a current client for a testimonial.
New Section 13.7
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.
Why is there a new section 13.7?
The language of this section is from section 10.17 of the prior Code of Ethics.
New Section 13.8
Marriage and family therapists may represent themselves as either specializing in or having expertise within a limited area of marriage and family therapy, but only if they have the education, training, and experience that meets recognized professional standards to practice in that specialty area.
Why is there a new section 13.8?
The language of this section is from section 10.18 of the prior Code of Ethics.
New Section 13.9
13.9 ADVERTISING OF CAMFT MEMBERSHIP
CAMFT members may identify their membership in CAMFT in public information or advertising materials, but they must clearly and accurately represent their membership status. Marriage and family therapists may use the CAMFT logo only after receiving written permission from the Association.
Why is there a new section 13.9?
This section includes language from section 10.11 (Use of CAMFT Logo) from the prior Code of Ethics, and it deletes language regarding specific procedures for obtaining permission for use of the CAMFT logo, which is more suitable for Association policies.
The Code of Ethics is an Important Resource
The Code of Ethics offers a set of standards that are intended to help therapists in determining what constitutes ethical behavior. While such standards are an important resource (they help to determine whether a particular action is, or is not ethical, under the circumstances), they may not, in themselves, dictate what a therapist should, or should not, do. The situations that therapists (and their clients/patients) find themselves in are often complex, and it is necessary for therapists to consider clinical and ethical standards when determining an appropriate course of action. In considering whether a violation of these standards may have occurred, it is essential to consider the particular circumstances, including the client’s/patient’s needs, and any relevant facts that may help to explain a therapist’s conduct. When dealing with any challenging clinical scenario, or with a case that entails difficult ethical challenges, it is often worthwhile to seek consultation from a trusted colleague.
Michael Griffin, JD, LCSW, is a staff attorney at CAMFT. Michael is available to answer member calls regarding legal, ethical, and licensure issues.
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. Part two of the series, published in the Sept/Oct issue of The Therapist, discusses changes made in sections 5-8 of the Code. Also see the workshop entitled, “The CAMFT Code of Ethics: Everything You Need to Know,” by Michael Griffin, Esq., LCSW and Raymond Cameron, MA, LMFT, located in the On- Demand video’s section of the CAMFT website at www.camft.org.
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.