● Counselors who provide clinical supervision services shall keep accurate records of supervision goals and the supervisee’s progress. All supervision-related information shall be treated as confidential, except to prevent serious and foreseeable harm to a client or others, or when legally required to do so by a court or government agency order. The AAMFT Code of Ethics includes the following standards: ● Marriage and family therapists disclose to clients and other interested parties at the outset of services the Multicultural Issues A major focus of the ACA Code of Ethics’ expanded revision in 2014 was multicultural diversity competency. Multicultural diversity is a major component of the NBCC and AAMFT ethics codes as well. As the population increases and becomes more diverse, increased proficiency in multicultural diversity must be considered, and therapists and counselors must consider their personal values and biases. Cultural influences must be recognized and appreciated in order to build trust and collaboration for effective counseling and therapeutic relationships. These influences are complex, and counseling and therapy methods must be individualized and specific to the diverse needs of the client. Counselors and marriage and family therapists may work with client groups that represent multiple sexual orientations, genders, cultures, ethnic, racial, generational, and religious groups; therefore, multicultural diversity awareness and acceptance is central to effective therapy. Ethical challenges in multicultural diversity may begin with the validity of assessments because appropriate evaluation tools must be used. It is crucial to locate a culture fair or a culture-free method of assessment. The APA (2023a) defines a culture-fair test and cross-cultural testing as follows: ● A test based on common human experience and considered to be relatively unbiased with respect to special background influences. Unlike some standardized intelligence assessments, which may reflect predominantly middle-class experience, a culture-fair test is designed to apply across social lines and to permit equitable comparisons among people from different backgrounds. ● Cross-cultural testing is the assessment of individuals from different cultural backgrounds. The use of instruments that are free of bias is essential to valid cross-cultural testing, as it provides for the measurement equivalency necessary to ensure that outcomes have the same meaning across diverse populations of interest. For example, scores on a coping questionnaire that possesses bias may be a legitimate measure of coping if they are compared within a single cultural group, whereas cross-cultural differences identified on the basis of this questionnaire may be influenced by other factors, such as translation issues, item inappropriateness, or differential response styles. Therapists should strive to be culturally aware and learn about the cultural identities they serve. The client’s cultural identity impacts assessment, communication, client goals, and methods of service, and counselors must expand their strategies and skills to be effective in a variety of cultural contexts. Problems may also arise when making a diagnosis in a multicultural context when using the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition–Text Revision (DSM-5-TR). There are many cultural beliefs and
nature of confidentiality and possible limitations of the client’s right to confidentiality. ● Therapists review with clients the circumstances where confidential information may be requested and where disclosure of confidential information may be legally required. Circumstances may necessitate repeated disclosures. ● Marriage and family therapists do not disclose client confidences, except by written authorization or waiver or where mandated or permitted by law. ● Verbal authorization will not be sufficient except in emergency situations, unless prohibited by law. experiences that influence diagnosis, and the DSM-5-TR revision in 2022 incorporated greater cultural sensitivity and understanding in the diagnostic process (APA, 2022): Some changes implemented in DSM-5-TR include language that challenges the view that races are discrete and natural entities: ● The term “racialized” is used instead of “race/racial” to highlight the socially constructed nature of race. ● The term “ethnoracial” is used in the text to denote the U.S. Census categories, such as Hispanic, White, or African American, that combine ethnic and racialized identifiers. ● The terms “minority” and “non-White” are avoided because they describe social groups in relation to a racialized “majority,” a practice that tends to perpetuate social hierarchies. ● The emerging term “Latinx” is used in place of Latino/ Latina to promote gender-inclusive terminology. ● The term “Caucasian” is not used because it is based on obsolete and erroneous views about the geographic origin of a prototypical pan-European ethnicity. ● Prevalence data on specific ethnoracial groups were included when existing research documented reliable estimates based on representative samples. In addition, information is provided on variations in symptom expression, attributions for disorder causes or precipitants, and factors associated with differential prevalence across demographic groups. Cultural norms that may affect the level of perceived pathology are also reported. Attention was paid to the risk of misdiagnosis when evaluating individuals from socially oppressed ethnoracial groups. Clearly, it is impossible to be an expert in working with all cultures. Many researchers in this field report that it is important to look at the universal principles and standards that are at the core of therapy and counseling. These are basic human rights, and promoting an individual’s mental health to reach full potential is fundamental. A counselor should work beyond their cultural beliefs and social systems and strive to understand clients from their viewpoints. A counselor must be aware of a client’s external influences that may impact the development of service plans. There are many training and educational programs to help build competence in multicultural diversity and to help the practitioner appreciate the social and cultural influences that shape a client’s view of the world. Practitioners who do not consider these influences may incorrectly evaluate, or label, the client. They risk diagnosing behavior as pathological or impaired, although it may be an accepted and normal practice in the client’s culture.
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