___________________________________ Code of Ethics for Counselors and Marriage and Family Therapists
Case 2 A PhD and marriage and family therapist (MFT) had treated a client, a former policeman, for three years. The therapy centered on work-related injuries and the breakup of a 17-year relationship with a woman who began to date someone else. The client allegedly told the therapist that he was having suicidal thoughts in early June. The therapist recommended hospitalization and asked for permission to speak with the client’s father. The father told the therapist that his son was deeply depressed, had lost his desire to live, and had mentioned harming the man his former girlfriend was currently dating. The client checked himself into the hospital as a voluntary patient on June 17. The therapist received a phone call from the client’s father the next morning stating that the hospital would soon release his son. The therapist then called the admitting physician and urged him to maintain the client’s hospitalization for further observation through the weekend. The psychiatrist disagreed and released the client. The client did not contact his therapist after he was released from the hospital. No one from the hospital contacted the therapist after releas- ing the client. On June 23, the client shot the boyfriend of his ex-partner and then killed himself with the same handgun. The parents of the new boyfriend filed a wrongful death law- suit and named the therapist as one of the defendants. The lawsuit claimed the therapist had a duty to warn their son of the risk from the client. A judge dismissed the case against the therapist, who asserted that his client did not disclose a threat to the new boyfriend directly to him. Ultimately, the California Court of Appeals reinstated the case, explaining, “When the communication of a serious threat of physical harm is received by a therapist from the patient’s immediate family and is shared for the purpose of facilitating and furthering the patient’s treatment, the fact that the family member is not technically the patient is not crucial.” Analysis The court expressed that psychotherapy does not occur in a vacuum and that for therapy to be effective, therapists must be aware of the context of a client’s history and their personal relationships. The court advised that communications from clients’ family members in the context comprised a “patient communication.” Mental health professionals, however, must use caution when accepting the warnings of third parties, such as parents or spouses, who are emotionally involved as they may have ulterior motives. This ruling required that if the therapist determines that individuals have credible information, then that constitutes patient communication and necessitates the duty to warn.
RECORD ACCESS BY FAMILY MEMBERS Case 1: Record Access by Family Members
D.C. battled cancer for many years and received the assistance of a counselor on several occasions. She did not have regularly scheduled sessions, but D.C. would consult the counselor when she faced medical issues and treatments that intensified her anxiety and depression. During a planned surgery, there were complications, and D.C. had to be resuscitated. This left her in a coma on life support. Her physicians informed her family of the possibility that she would remain on life support and her prognosis for recovery was bleak, at best. Members of her family decided to approach the court for authorization to take D.C. off of life-support. The family was instructed by the court to locate any informa- tion they could find that would shed some light on D.C.’s wishes concerning end-of-life issues. The family asked the counselor if any of the records from her counseling sessions might help to provide some guidance to the court concern- ing D.C.’s end of life plans in order to make decisions about her treatment. The counselor refused and decided to consult a colleague. The family turned to the court for an order to compel the counselor and the counselor’s colleague to release all information and communication concerning D.C.’s end- of-life wishes. The courts issued a subpoena for all records and communications. The counselor eventually complied to avoid sanctions by the court. Analysis Family members have many reasons to seek access to the records of other family members. Some are legitimate; others have the potential to harm the client or lead to an ethical violation if mistakes are made in disclosing information to the wrong party. In this situation, the client was incapacitated and could not make her wishes known. In these cases, the courts recognize a surviving line of consent as follows: • The first in line in the chain to grant consent is the spouse. This is true even if they are estranged and living apart, but not divorced. • Next would be the children of legal age: each child would be given equal weight in the decision. • Next are parents or grandparents, followed by siblings, each having equal weight. • If there are no family members, the courts may appoint the next closest relative or close friend. The ethics codes are clear that in cases with clients who are minors, or clients who meet criteria as legally incompetent, that parents or legal guardians will be given full access to records. Therapists must understand the complex nature of confidenti-
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