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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.

Treating Couples Identifying and Managing Legal & Ethical Issues

We invite you to provide CAMFT with your written analysis of the legal and ethical issues that arise based on the actions taken by the therapists in four clinical vignettes.

 

by Michael Griffin, JD, LCSW
Staff Attorney
The Therapist
July/August 2012 

Couples therapy can be a very demanding and difficult treatment modality. There are several reasons for this, including, but not limited to: The powerful nature of the issues that are involved; the emotional intensity (or volatility, depending on the couple) of couples therapy in general, and, the unique nature of working with two persons as part of a therapeutic triangle,1 instead of the usual (and comparatively, much more sedate) therapist-patient dyad. Even the most experienced couples therapist may be challenged by managing the clinical issues that are involved in treating a couple. In this light, it is understandable that a therapist may fail to recognize the presence of one or more legal or ethical issues in the case, or simply underestimate the potential for such problems to arise. However common this may be, there can be serious consequences for making such an error. The failure to identify and appropriately respond to legal and ethical issues may lead to a disciplinary action against a therapist by his or her licensing Board, an ethics complaint to his or her professional association or a civil claim against him or her for negligence.

We invite you to provide CAMFT with your written analysis of the legal and ethical issues that arise based on the actions taken by the therapists in the following four clinical vignettes. In an upcoming issue of The Therapist, CAMFT will print the best overall response(s), as judged by Jill Epstein, David Jensen, Catherine Atkins, Sara Kashing, Ann Tran-Lien, and Michael Griffin. In addition, CAMFT will provide two (2) self-study continuing education units for members who answer all four (4) vignettes. Please Note: To receive any continuing education units, you will need to answer all four vignettes.

When analyzing each of the vignettes, members are free to discuss any California law2 or any section of the CAMFT Code of Ethics3 that is relevant to the vignette being discussed. However, particular consideration should be given to the possible application of CAMFT's Code of Ethics to the circumstances described. When discussing each of the vignettes, respondents should take care to consider whether one or more of the following sections of the CAMFT Code of Ethics may be applicable: 1.9, 1.13, 1.14, 1.15, 2.2, 1.3.1, 1.3.2, 1.3.4, 1.4, 1.9, 8.3, 8.4, 8.5, and 8.9.

Vignette #1 
Mary contacted Tom, a Marriage and Family Therapist, to inquire about the possibility of participating in marital therapy with her husband, Aaron. During their third marital session, Aaron announced that he would no longer be attending marital therapy. In Aaron's opinion, the previous two marital sessions demonstrated to him that his marriage couldn't be saved and that further marital therapy was a waste of everyone's time. Aaron also stated that Mary should feel free to continue in individual therapy with Tom, and that, under the circumstances, "the least he could do" would be to pay for those sessions. Aaron then stood up, apologized for the fact that he had to leave the session twenty minutes early, and left the office.

Questions applicable to Vignette #1

  1. Under the circumstances described in Vignette #1, should Tom consider this session to be his final (termination) visit with Aaron? If "yes," why? If "no,"why not?
  2. Under the circumstances described in Vignette #1, should Tom provide individual therapy to Mary? If "yes," why? If "no," why not? Is there any additional information that you would like to have to answer this question? If so, what information would you like to have?
  3. How should Tom respond to Aaron's comments about paying for Mary's therapy?4
  4. If Tom agreed to accept Aaron's offer to pay for Mary's therapy, assuming that she decided to participate in such therapy, what should Tom do if Aaron ultimately refused to pay for her sessions?

Vignette #2 
Rose provided weekly individual therapy to Jonathan for about six months. During that period of time, Jonathan's wife, Sue, agreed to participate in some conjoint sessions with him and Rose, in order to help Jonathan address some of his individual issues. Although Jonathan and Sue both found those sessions to be productive, Jonathan was particularly encouraged by the positive changes in his relationship with Sue. Later, Jonathan persuaded Sue to join him in marital therapy with Rose. Based on her belief that the various issues addressed in the therapy sessions were closely related, and to simplify her recordkeeping, Rose documented all of the therapy sessions that were provided to Jonathan and Sue in a single treatment record.

Questions applicable to Vignette #2

  1. Was it appropriate to include Jonathan's wife in collateral visits with Jonathan during his individual therapy? If "yes," why? If "no," why not?
  2. Was it problematic to provide marital therapy to Jonathan and Sue at the conclusion of his individual therapy? If "yes," why? If "no," why not?
  3. Was it problematic for Rose to document all of the therapy provided to Jonathan and Sue in a single treatment record? If "yes," why? If "no," what would have been preferable?
  4. How should Rose respond if either Sue or Jonathan requested a copy of the progress notes for the marital sessions?5

Vignette #3 
After participating in marital therapy with Tom for a few months, Ronald and Michelle decided to pursue a trial separation. The couple agreed that Tom was a "good therapist," and they decided to ask him if he could facilitate a discussion between them on the topic of co-parenting their ten-year-old daughter Lisa. Although Tom was reluctant to assist them with such issues, Ronald and Michelle stressed that they were extremely concerned about Lisa's reaction to their separation and they agreed that Tom was the "best person" to assist them in discussing a temporary agreement, because he already knew them and was familiar with their concerns. Tom made a point of telling them that he would assist them, so long as they clearly agreed not to involve him in any subsequent litigation that may arise concerning the issues of custody or visitation. Ronald and Michelle quickly agreed to Tom's terms, but Tom said that he wanted to "play it safe" and he had them sign an agreement promising not to involve him in any litigation. After meeting a few times, Ronald and Michelle both informed Tom that they were pleased with the outcome of their discussions regarding Lisa's care and thanked him for his help. About one year later, Michelle contacted Tom to inform him that she and Ron were involved in a very contentious divorce. Michelle asked Tom if he would be willing to schedule a few sessions with Lisa "to see how she was coping with everything."

Questions applicable to Vignette #3

  1. Was it problematic for Tom to help Ronald and Michelle form a plan for co-parenting their daughter Lisa during their trial separation? If "yes," why? If "no," why not?
  2. If Tom or Michelle decided to subpoena Tom to testify at a deposition or hearing regarding their discussions in therapy, can Tom refuse to appear in Court, based upon his earlier agreement with them concerning his possible involvement in litigation?
  3. How should Tom respond to Michelle's request to meet with Lisa?

Vignette #4 
David provided individual therapy to Anne, a particularly rebellious 15-year-old. After almost 18 months of therapy with David, Anne said that she had had enough treatment and wanted to "take a break for awhile." Anne's parents agreed with David's recommendation that it was "ok" to give Anne some space, and they allowed her to discontinue therapy. Shortly thereafter, David met with Anne's parents to work on some co-parenting issues, but the meetings evolved into marital therapy that lasted nearly a year. Eventually, Anne's parents decided that she should return to therapy with David due to her failing grades.

Questions applicable to Vignette #4

  1. What issues exist, (if any), with respect to the manner in which termination was handled with either Anne or her parents?
  2. Did David encounter any potential conflicts of interest in providing treatment to Anne or to her parents? If so, please discuss and indicate how David might have responded differently at any point in time.
  3. What issues exist, (if any), in vignette #4, with respect to the issue of consent to treatment? If you were David's consultant, please discuss any suggestions that you might wish to offer to him regarding this issue.

Michael Griffin, JD, LCSW, is a Staff Attorney at CAMFT. Michael is available to answer members questions regarding business, legal, and ethical issues.

Instructions 
Remember, to receive the two (2) self-study continuing education units, you must answer all four (4) vignettes.

*BBS Provider #PCE 50

Mailed responses must be typed and submitted to: CAMFT, 7901 Raytheon Road, San Diego, CA, 92111. Responses may be submitted as e-mail attachments to: vignettes@camft.org. In order to be considered, your response must be received by CAMFT on or before September 1, 2012.

Endnotes

1. See Generally, Dallies, Rudi, Vetere, Ariene, "Systems Theory, Family Attachments and Processes of Triangulation: Does the Concept of Triangulation offer a Useful Bridge?" Journal of Family Therapy, May, 2012, Vol. 34, issue 2 pgs. 117-137; Young, Sally, "Two's Company, Three's a Crowd: Revisiting Triangles in Family Therapy," The Australian and New Zealand Journal of Family Therapy, March 1, 2010; Bowen, M., Family Therapy in Clinical Practice. (1978) New York: Jason Aronson (The foregoing journal articles may be found in the EBSCO Behavioral Sciences Collection, via the CAMFT website at www.camft.org. CAMFT members have access to the EBSCO database of approximately 600 scholarly journals as a benefit of membership).

2. Sections of the California Business & Professions Code and the California Code of Regulations that are applicable to Marriage and Family Therapists, Clinical Social Workers and Licensed Professional Clinical Counselors (the "licensing law"), can be found on the California Board of Behavioral Sciences website, at www.bbs.ca.gov under he heading: "Statutes and Regulations."

3. The CAMFT Code of Ethics is available (in a searchable PDF format) on the CAMFT website at: www.camft.org

4. See, Griffin Michael, JD, "On Ethics: Avoiding Problems with Fees, Health Insurance and Payment Agreements," The Therapist, March/April, 2012.

5. See, Atkins, Catherine, JD, "Confidentiality and Privilege: Group, Conjoint, Family and Collateral Therapy Issues," The Therapist, July/August, 2009.

 

Ethics