An Overview of the Revised CAMFT Ethical Standards

By Michael Griffin, JD, LCSW
Staff Attorney
The Therapist
(September/October 2008


As of July 1, 2008, the revised CAMFT Ethical Standards, Part L became effective. The product of many hours of hard work over the past two years by the CAMFT Ethics Committee, Executive Director and CAMFT legal staff and consultants, the Ethical Standards have undergone a considerable number of revisions, both large and small. The revised standards also include a total of twenty new sections which address a variety of issues, including twelve sections that specifically concern the activity of supervisors, educators, supervisees, and students.

Although it is important that all members of CAMFT take the time to carefully read each of the revised standards, it may be helpful to illuminate the major changes that have been made. Therefore, this discussion provides an overview of the primary substantive revisions that have been made in Part I of the Ethical Standards. 1

Sexual Contact
The revised Sections 1.2.2 and 1.2.3 replace Sections 1.2.1 and 1.2.3 respectively, and provide additional clarifying language (noted in bold) concerning sexual intimacy with a member of a patient's family.

1.2.2 Sexual Contact
Sexual intercourse, sexual contact or sexual intimacy with a patient, or a patient's spouse or partner, or a patient's immediate family member, during the therapeutic relationship, or during the two years following the termination of the therapeutic relationship, is unethical.

Should a marriage and family therapist engage in sexual intimacy with a former patient or a patient's spouse or partner, or a patient's immediate family member, following the two years after termination or last professional contact, the therapist shall consider the potential harm to or exploitation of the former patient or to the patient's family.

1.2.3 Prior Sexual Relationship
A marriage and family therapist does not enter into a therapeutic relationship with a person with whom he/she has had a sexual relationship or with a partner or the immediate family member of a person with whom he/she has had a sexual relationship.

Internet/Telephone Therapy
Information concerning therapy provided via the Internet or Telephone was scattered among multiple sections of the previous standards. The revised Section 1.4.1 is intended to unifY/clarifY language that was formerly located in Sections 1, 1.4.7, 1.15 and 3.6.; Section 3.11 replaces section 3.12, with minimal changes.

1.4. 7 Electronic Therapy
When patients are not physically present (e.g., therapy by telephone or Internet) during the provision of therapy, marriage and family therapists take extra precautions to meet their responsibilities to patients. Prior to utilizing electronic therapy, marriage and family therapists consider the appropriateness and suitability of this therapeutic modality to the patient's needs. When therapy occurs by electronic means, marriage and family therapists inform patients of the potential risks, consequences, and benefits, including but not limited to, issues of confidentiality, clinical limitations, transmission difficulties, and ability to respond to emergencies. Marriage and family therapists ensure that such therapy complies with the informed consent requirements of the California Telemedicine Act.

3.11 Electronic Services
Marriage and family therapists provide services by Internet or other electronic media to patients located only in jurisdictions where the therapist may lawfully provide such services.

Disclosures to Patients
Section 1.5 clarifies the language previously found in Section 1.4 concerning therapist disclosures to patients; Section 1.5.1 replaces Section 1.4.1 and clarifies that, in specific circumstances, therapists are expected to notifY patients concerning the risks and benefits of treatment; Section 1.5.4 replaces Section 1.4.5 with language that encourages therapists to inform patients regarding the various exceptions to confidentiality; Section 1.17 is a new standard that addresses the need to advise patients regarding the information that will likely be disclosed to third party payers.

1.5 Therapist Disclosures
Marriage and family therapists provide adequate information to patients in clear and understandable language so that patients can make meaningful decisions about their therapy.

1.5.1 Risks And Benefits
Marriage and family therapists inform patients of the potential risks and benefits of therapy when utilizing novel or experimental techniques or when there is a risk of physical harm that could result from the utilization of any technique.

1.5.4 Limits Of Confidentiality
Marriage and family therapists are encouraged to inform patients as to certain exceptions to confidentiality such as child abuse reporting, elder and dependent adult abuse reporting, and patients dangerous to themselves or others.

1.17 Third Party Payer Disclosures
Marriage and family therapists advise patients of the information that will likely be disclosed when submitting claims to managed care companies, insurers, or other third party payers, such as dates of treatment, diagnosis, prognosis, progress, and treatment plan.

Emergency Contact! Therapist Availability
Section 1.5.2 revises/replaces Sections 1.16 and 1.4.2, and addresses the need for therapists to inform patients of the extent of their availability for emergencies and to provide patients with appropriate emergency resources in the patient's locale.

1.5.2 Emergencies/Contact Between Sessions
Marriage and family therapists inform patients of the extent of their availability for emergencies and for other contacts between sessions. When a marriage and family therapist is not located in the same geographic area as the patient, he/she shall provide the patient with appropriate resources in the patient's locale for contact in case of emergency.

Patient Benefit/ Treatment Efficacy
Section 1.7 revises/replaces Section 1.6, by adding language that states that therapists are expected to continually monitor their effectiveness and take steps to improve when necessary.

1.7 Patient Benefit
Marriage and family therapists continually monitor their effectiveness and take steps to improve when necessary. Marriage and family therapists continue therapeutic relationships only so long as it is reasonably clear that patients are benefiting from the relationship.

Conflicts of Interest/Dual Relationships
There are a number of revisions to the ethical standards concerning conflicts of interest, dual relationships and therapist's roles. Section 1.14 revised the ambiguous wording of Section 1.10, and clarifies that therapists are expected to carefully consider potential conflicts when providing different treatment modalities concurrently or sequentially to a patient; Section 8.4 is a new standard concerning dual roles and the need to avoid providing treatment and evaluations for the same patients in legal proceedings; Section 1.16 is a new standard that addresses the issue of therapist participation in non-clinical roles; Section 8.3 is revised to reflect the importance of clarifying role expectations and the extent of confidentiality at the outset of treatment and as changes occur; Section 8.9 is a new standard that addresses the need to inform patients of any potential consequences of therapist-client role changes.

1.14 Potential Conflicts
Marriage and family therapists carefully consider potential conflicts when providing concurrent or sequential individual, couple, family, and group treatment, and will take reasonable care to avoid or minimize such conflicts.

8.4 Dual Roles
Marriage and family therapists avoid providing both treatment and evaluations for the same clients or treatment units in legal proceedings such as child custody, visitation, dependency, or guardianship proceedings, unless otherwise required by law or initially appointed pursuant to court order.<< />

1.16 Non Therapist Roles
When marriage and family therapists engage in professional roles other than treatment or supervision (including, but not limited to, managed care utilization review, consultation, coaching, adoption service, or behavior analysis), they act solely within that role and clarify, when necessary to avoid confusion with consumers and employers, how that role is distinguished from the practice of marriage and family therapy.

8.3 Conflicting Roles
Whenever possible, marriage and family therapists avoid performing conflicting roles in legal proceedings and disclose any potential conflicts. At the outset of the service to be provided and as changes occur, marriage and family therapists clarify role expectations and the extent of confidentiality to prospective clients, to the courts, or to others as appropriate.

8.9 Consequences of Changes in Therapist Roles
Marriage and family therapists inform the patient or the treatment unit of any potential consequences of therapist-client role changes. Such role changes include, but are not limited to, child's therapist, family's therapist, couple's therapist, individual's therapist, mediator, evaluator, and special master.

Documenting Treatment Decisions
Section 1.15 is a new standard concerning the documentation of significant treatment decisions.

1. 15 Documenting Treatment Decisions
Marriage and family therapists are encouraged to carefully document in their records when significant decisions are made, e.g., determining reasonable suspicion of child, elder or dependent adult abuse, determining when a patient is a danger to self or others, when making major changes to a treatment plan, or when changing the unit being treated.

Professional Competence
Section 3.5 replaces Sections 3.5 and 3.8. It requires that a therapist remain abreast of developments in his or her field of practice; Section 8.7 replaces Section 8.5 and provides a standard concerning professional opinions by therapists and the limits of such opinions; Sections 8.8 and 8.10 are new standards that require therapists in forensic roles, including custody evaluators and/or special masters, to meet the legal requirements for such roles and to maintain familiarity with the applicable judicial/administrative rules.

3.5 Staying Current
Marriage and family therapists remain abreast in their field through educational activities or clinical experiences. Marriage and family therapists, when acting as teachers, supervisors, and researchers, stay abreast of changes in the field, maintain relevant standards of scholarship, and present accurate information.

8.7 Opinions About Persons Not Evaluated
Marriage and family therapists shall only express professional opinions about clients they have treated or examined. Marriage and family therapists, when expressing professional opinions, specify the limits of the information upon which their professional opinions are based. Such professional opinions include, but are not limited to, mental or emotional conditions or parenting abilities.

8.8 Custody Evaluators
Marriage and family therapists who are custody evaluators (private or court-based) or special masters provide such services only if they meet the requirements established by pertinent laws, regulations, and rules of court.

8.10 Familiarity with Judicial and Administrative Rules
Marriage and family therapists, when assuming forensic roles, are or become familiar with the judicial and administrative rules governing their roles.

Cultural Sensitivity
Section 3.6 is revised by removing unrelated content concerning Internet therapy; Section 3.7 is revised by clarifying the need for a therapist to make continuous efforts to be aware of the impact of his or her own cultural/racial/ethnic values and beliefs.

3.6 Cultural Sensitivity
Marriage and family therapists actively strive to identify and understand the diverse cultural backgrounds of their clients by gaining knowledge, personal awareness, and developing sensitivity and skills pertinent to working with a diverse client population.

3.7 Therapist Cultural Values
Marriage and family therapists make continuous efforts to be aware of how their cultural/racial/ethnic identity, values, and beliefs affect the process of therapy.

Responsibility to Students and Supervisees
The standards concerning responsibility to students and supervisees have been the focus of significant attention. Sections 4.4, 4.5, 4.6, 4.7, 4.8, 4.9, 4.10, 4.11, 4.12, 4.13, 4.14 and 4.15 are entirely new, and are intended to address a range of issues in this area and to provide corresponding ethical standards for supervisors and educators. In addition, Section 4.1 is revised, and provides additional examples of dual relationships with students and/or supervisees, including relationships with a supervisee's spouse, partner or family member.

4.1 Dual Relationships
Marriage and family therapists are aware of their influential position with respect to students and supervisees, and they avoid exploiting the trust and dependency of such persons. Marriage and family therapists therefore avoid dual relationships that are reasonably likely to impair professional judgment or lead to exploitation. Provision of therapy to students or supervisees is unethical. Provision of marriage and family therapy supervision to clients is unethical. Sexual intercourse, sexual contact or sexual intimacy and/or harassment of any kind with students or supervisees is unethical. Other acts which could result in unethical dual relationships include, but are not limited to, borrowing money from a supervisee, engaging in a business venture with a supervisee, or engaging in a close personal relationship with a supervisee. Such acts with a supervisee's spouse, partner or family member may also be considered unethical dual relationships.

4.4 Knowledge Of Supervisors
Supervisors and educators are knowledgeable about supervision, relevant laws and regulations, and the practice of marriage and family therapy. Supervisors and educators are knowledgeable about and abide by the laws and regulations governing the conduct of supervisors and supervisees.

4.5 Changes In Laws And Ethics
Supervisors and supervisees are aware of and stay abreast of changes in professional and ethical standards and legal requirements, and supervisors ensure that their supervisees are aware of professional and ethical standards and legal responsibilities.

4.6 Cultural Diversity
Supervisors and educators are aware of and address the role that culture and diversity issues play in the supervisory relationship, including, but not limited to, evaluating, terminating, disciplining, or making decisions regarding supervisees or students.

4.7 Policies And Procedures
Supervisors and educators create policies and procedures that are clear and that are disclosed to supervisees and students at the commencement of supervision or education.

4.8 Performance Appraisals
Supervisors and educators provide supervisees with periodic performance appraisals and evaluative feedback throughout the supervisory relationship and identify and address the limitations of supervisees and students that might impede their performance.

4.9 Business Practices
Supervisors follow lawful business practices and employer policies when employing and/ or supervising interns, trainees, applicants, and associates.

4:10 Performance Assistance
Supervisors and educators guide supervisees and students in securing assistance when needed for the supervisee to maintain or improve performance, such as personal psychotherapy, additional education, training, or consultation.

4.11 Dismissal
Supervisors shall document their decisions to dismiss supervisees.

4. 12 Review Of Trainee Agreements
Supervisors are aware of and review any trainee agreements with qualified educational institutions.

4.13 Patients Are Patients Of Employer
Supervisees understand that the patients seen by them are the patients of their employers.

4.14 Knowledge Of Laws And Regulations
Supervisees have a responsibility to be knowledgeable about relevant laws and regulations pertaining to the license and practice of marriage and family therapy.

4.15 Maintain Registrations
Supervisees maintain registrations when required by law and/or regulation and function within this limited role as permitted by the licensing law and!or regulations.

Psychotherapist-Patient Privilege
Section 8.6 is anew standard, which addresses the need for therapists to confirm the holder of psychotherapist-patient privilege when working with minors.

8.6 Minors And Privilege
Marriage and family therapists confirm the holder of the psychotherapist patient privilege on behalf of minor clients prior to releasing information or testifYing.

Advertising
Section lOis revised. It expresses the fundamental necessity to provide accurate information when advertising; Section 10.8 is revised to provide a clearer standard regarding the use of specializations by therapists.

10. Advertising
Marriage and family therapists who advertise do so appropriately. Their advertising enables consumers to choose professional services based upon accurate information.

10.8 Specializations
Marriage and family therapists may represent themselves as either specializing or having expertise within a limited area of marriage and family therapy, but only if they have the education, training, and experience that meets recognized professional standards to practice in that specialty area.

Having accomplished the foregoing revisions, the CAMFT Ethics Committee is presently engaged in the process of reviewing/revising Part II of the CAMFT Ethical Standards: Procedures for Handling Complaints of Violations of the Code of Ethical Standards for Marriage and Family 1herapists. Members who may have questions about any of the CAMFT Ethical Standards are welcome to contact CAMFT.


Michael Griffin, ]D, LCSW; is an attorney at law and a Licensed Clinical Social Worker. He is available to answer member calls regarding business, legal and ethical issues.


REFERENCES
1 There are numerous grammatical changes and minor revisions in Part I that are beyond the scope of this discussion.


This article appeared in the September/October 2009 issue of The Therapist, the publication of the California Association of Marriage and Family Therapists, headquartered in San Diego, California. This article is intended to provide guidelines for addressing difficult legal dilemmas. It is not intended to address every situation that could potentially arise, nor is it intended to be a substitute for independent legal advice or consultation. When using such information as a guide, be aware that laws, regulations and technical standards change over time, and thus one should verify and update any references or information contained herein.