Code of Ethics for Counselors and Marriage and Family Therapists __________________________________
Confidentiality in the professional–client relationship is consistent with the obligation to serve as an advocate for the client and for the greater society. Confidentiality, as addressed in ethics codes and case study examples of violations, will be presented in this course. The Tarasoff v. University of California case and its resulting legal actions led to revisions to the codes of ethics [9]. This precedent-setting case has led to changes in many state laws concerning the release of confidential informa- tion, duty to warn, and protection from harm. Confidentiality in Group Counseling Providing services to a family or group presents ethical chal- lenges when the practitioner works with multiple clients at the same time. The counselor or therapist must inform all members of the group of their rights to confidentiality at the onset of services and include a statement that the practitioner will not disclose any information that one family member offered in a private discussion. Some practitioners decide to address this situation by meeting only in a group setting with the family and never with one member individually. The practitioner working with a family or a group may need to assess progress frequently as new issues may emerge that must be addressed and added to the written services agree- ment. Interventions that were planned for one member of the family may not be appropriate for others or may have a negative effect on some members. The practitioner must always maintain their view of the family as a unit and not appear to focus on one member of the group. The practitioner must also keep everyone informed of their obligation to maintain confidentiality. Informed consent is an ongoing process as the treatment plan or service agreement evolves. In most cases, the initial contact to the therapist or counselor’s office for assistance is made by one of the group members. The other members may not share this desire or commitment to participate in the treatment plan. Informed consent by all group members is particularly important in these situations, especially with minors who cannot legally provide consent. The reluctance on the part of some members may complicate the delivery of effective services, including maintaining confi- dentiality. The therapist or counselor must avoid being viewed as biased toward one member over another and must work to establish the trust of all members. Establishing trust is impor- tant to encourage sharing, communication, and participation among members, and respect for confidentiality rules. The therapist or counselor should avoid contact with any members outside of the professional setting to avoid any appearance of favoritism and potential ethical boundary violations. When counseling groups or families, confidentiality may be difficult to accomplish. Each client has different behaviors, levels of maturity, affiliations, loyalties, and attitudes toward the counseling or therapy. There are also levels of varying commitments to keep information from the group sessions private. In all codes of ethics, there are statements that guide the counselor to build commitment to confidentiality:
• Inform all clients in the group of the rules of confidentiality. • Define ground rules and parameters for the group to support positive, productive discussions among members. • Identify who the client is in the counseling setting. • Discuss how confidentiality matters will be addressed. • Determine how information by one member may be disclosed to other members by the counselor. • Discuss how to disclose information that was previously held as secret in the group counseling session. • Provide rules for communication, fairness, and respect in the group. • Explain that confidentiality cannot be guaranteed in the group setting. • Identify and discuss the impact of distance counseling regarding confidentiality. The ACA suggests that counselors clearly explain the impor- tance and parameters of confidentiality as it applies to mem- bers of the group [10]. Additionally, the AAMFT notes, as with other information shared in a counseling setting, that marriage and family therapists [11]: • Do not disclose client confidences except by written authorization, waiver, or when mandated by law. • Do not take verbal authorization except when permitted in an emergency situation or when ordered by law. • Do not disclose information outside the treatment context without a written authorization from each individual competent to execute the waiver. • Disclose the nature of confidentiality to clients, as well as the possible limitations of the clients’ right to confidentiality. • Review with clients the circumstances where confidential information may be requested and when it can be disclosed. • Understand the circumstances that may necessitate repeated disclosures. • Do not reveal any individual’s confidences to others in the client group without the prior written permission of that individual. The foregoing information serves as a guideline only and it is recommended that the entire AAMFT Code of Ethics be reviewed to understand the complex nature of confidentiality in group therapy. The NBCC 2023 Standards include the following directives: • Counselors shall clearly identify in writing the primary client in the record.
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