The Therapist
January/February 2011

Four vignettes are presented below discussing hypothetical situations involving a therapist’s treatment of patients in the military. We invite you to provide CAMFT with your written analysis of the legal and ethical issues evident in each of the following four vignettes and the actions taken by the therapist. In an upcoming issue of The Therapist, CAMFT will print the best overall response(s), as judged by Mary Riemersma, David Jensen, Catherine Atkins, Doug Lee, Ann Tran, and Michael Griffin. In addition, CAMFT will provide two (2) self-study continuing education units for members who answer all four (4) vignettes.

Vignette #1
MFT Mary is seeing numerous military patients under an Employee Assistance Program (“EAP”). Mary decided to become a contracted provider with the EAP after reading about how the military was allowing service members to obtain mental health therapy (due to the increase in suicide rates) away from the site of the base, so that privacy and confidentiality will be maintained. Mary has been seeing most of her patients for over a year and many of the patients have issues related to Post Traumatic Stress Disorder (“PTSD”), drug and alcohol abuse, domestic violence, etc. Today she received a call from the EAP, and they informed her that she must turn over all records for each of her EAP patients and also that she is not to tell her patients about the EAP’s request. Mary reviewed her files, and the only document the patients signed was a document stating that “…the files are confidential to anyone outside the EAP.” Mary is unsure of whether she must, can, and/or should turn over the files to the EAP.

Vignette #2
MFT Mary is seeing Patient Paul. Paul is a Major in the Air Force, and his job is to fly active nuclear bombs to various parts of the country where the bombs can be dismantled. Paul’s wife left him last week and he has admitted that he has begun drinking and often feels depressed, but not suicidal. He stated that he often falls asleep after drinking too much, and that he is likely to be sleepy and disoriented for hours afterward. Paul again assured Mary that he is not suicidal but does feel depressed. Paul has an upcoming flight in which he will be transporting an active bomb over populated areas. Due to the destructive nature of the cargo he is carrying, Mary determined that Paul is a danger to others and called the police.

Vignette #3
MFT Mary works as a therapist on the Camp Pendleton military base in San Diego, California. Corporal Ronald, one of Mary’s patients, recently admitted to her that he has a lot of difficulty controlling his temper, and may also have an addiction to prescription pain killers (for an injury he sustained while deployed in Kuwait). Today, Ronald’s commanding officer called Mary and said that he would like to discuss Ronald’s suspected addiction to pain killers and his anger management issues. During Mary’s intake and in her agreement for services she states that, according to California law, she will only breach confidentiality in cases of child or elder and dependent adult abuse, where the patient poses a serious danger of violence toward another, or as compelled by law. Because Ronald signed her agreement for services, and in accordance with her understanding of California law concerning confidentiality, Mary informed the commanding officer that she cannot release any records without Ronald’s consent.

Vignette #4
MFT Mary works as a therapist and her specialty is working with veterans who are experiencing symptoms of PTSD. Today, longstanding patient Cliff came in and told Mary he had to get something off his chest. Cliff explained to her that during his last tour in Iraq, he committed many war crimes including torture, murder, and sexual assault. In addition, he admitted that he actually enjoyed the harm he inflicted on the victims as they were “the enemy” and stated that if he comes in contact with more of the enemy, he would be inclined to commit the same crimes. Cliff is to be redeployed to Iraq next week. Mary has called the Defense Department to report the war crimes committed by Cliff, as well as called the police to inform them about Cliff ’s deployment and intent to commit more crimes.

Instructions
Remember, to receive the two (2) self-study continuing education units, you must answer all four (4) vignettes. Please address the following questions for each vignette:

A. Discuss whether or not, in your opinion, the therapist’s conduct is appropriate in
the context of any and all laws, regulations, and ethical standards that may apply.

B. Explore any other options that are available to the therapist and any potential consequences of those options. Indicate what you believe to be the best course of action, in light of the applicable laws, regulations, and ethical standards.

We are interested in the specific reasons for any positions that you take. Mailed responses must be typed and submitted to: CAMFT 7901 Raytheon Rd., San Diego, CA, 92111. Responses may be submitted as e-mail attachments to: eileen@camft.org. Please type “Vignette Response” in the subject line. In order to be considered, your response must be received by CAMFT on or before March 1, 2011.

*BBS Provider #PCE 50

Catherine L. Atkins, JD, is a Staff Attorney and the Deputy Executive Director at CAMFT. Cathy is available to answer members’ questions regarding business, legal, and ethical issues.