Ethics and Law for Marriage and Family Therapy

Signature Assignment- Abby and Muriel
Nikki Napolitano
Touro University
Ethics and Law for Marriage and Family Therapy-MFT-630
Dr. Lloyd
After reviewing the case study of Abby and Muriel I can see a plethora of legal and
ethical issues that arose. First off, Abby stated when she met Muriel that she can speak to her in
confidence and that she will not share it. Unfortunately, Muriel is under the age of 18 and she is
still governed by her parents. Legally speaking, people under the age of 18 do not typically have
a right to confidentiality in therapy.
Why is this an error/ Correct Actions:
According to the American Association of Marriage and Family Therapy (AAMFT)
(2015), “Marriage and family therapists disclose to clients and other interested parties at the
outset of services the nature of confidentiality and possible limitations of the clients’ right to
confidentiality.” Abby should have told Muriel her limits of confidentiality because she is a
minor and information can be shared with her parents. Abby saying that it was “completely
confidential” is a false statement that could get Abby into a lot of trouble. If it were me, I would
make sure I tell Muriel that I am a mandated reporter and then I would disclose my limits of
confidentiality. I would make sure that I make the client, Muriel feel as comfortable as possible
but explain to her the ethical and legal code that I must follow. I would also then answer any
questions she may have about this.
Mandated Reporting
Muriel stated to Abby that she was upset about her ex-boyfriend. In this conversation
Muriel admitted that she was engaging in sexual behavior with him. This is a bit of concern
because Muriel is 16 and her ex-boyfriend is 21. Because Muriel is a minor and her ex-boyfriend
would be considered an adult it is important to consider the legal and ethical laws in your state.
For the state of Nevada where I live the law states “In Nevada, at 16 years old you are not
considered an adult, but you are now capable of fully consenting to sex.” (Southern Nevada
Health District, n.d.)
Why is this an error/ Correct Actions:
While this is not an error in my state it may be in another state. Abby needs to be mindful
of her state legal requirements for consent are. This is especially important because Abby is a
newly graduated MFT student making errors like this in the beginning can be detrimental. I
would make sure I am aware of the state consent laws to make sure I am abiding by them.
While Muriel was telling Abby about her troubles with her ex-boyfriend it appeared that
Abby was reminded of feelings of being heart broken when she was her age. Abby thought “just
knew she was the one to help her through this” and this could be the start of trouble. This could
be viewed as countertransference.
Why is this an error/ Correct Actions:
According to Good Therapy (2019), countertransference, which occurs when a therapist
transfers emotions to a person in therapy, is often a reaction to transference, a phenomenon in
which the person in treatment redirects feelings for others onto the therapist. The American
Association of Marriage and Family Therapy (2015) states “marriage and family therapists
pursue appropriate consultation and training to ensure adequate knowledge of and adherence to
applicable laws, ethics, and professional standards.” Abby should be aware that transference and
countertransference is possible and how to avoid that. Sometimes it is inevitable not to have
connections to a client’s story or situation, but it is important to make sure that you are not
transferring your emotions to that client. If this were to happen to me I would make sure I
contact my supervisor or other therapists for instructions on how to carry on and move on
without harming the client.
At the end of the session between Abby and Muriel, Abby stated “call or FaceTime me
anytime you need to talk, I know how hard this can be.” This is a clear crossing of boundaries
between the therapist and client relationship. It is important to know boundaries are important to
follow. In the therapeutic relationship boundaries keep the professional setting and keep the
therapist and client safe. The continuation of facetime calls when “Muriel really needed her” is
absolutely unacceptable and unhealthy.
Why is this an error/ Correct Actions:
Boundaries are limits people set in order to create a healthy sense of personal space.
Boundaries can be physical or emotional in nature, and they help distinguish the desires, needs,
and preferences of one person from another. In research from Yandura (2020) Boundary
crossings and violations can contaminate the therapy so that it doesn’t work as well.
Unfortunately, boundaries were crossed when Abby gave her personal phone number to Muriel
and stated call me anytime even facetime. This is not a healthy therapeutic relationship.
Personally, I would never give my phone number out to a client. Instead, I would tell Muriel that
if she was having a rough time then to write down her feelings and we can talk about it during
the next session. I would also ask her if she has any close friends or family members in which
she trusts that she can reach out to. Setting boundaries in the beginning sessions with a client is
very important.
Informed Consent:
During the session Muriel decided she would like to see Abby again. However, Abby
stated that she needs parent permission to continue and informed consent will need to be signed.
Muriel then stated that she would prefer Abby to speak to her mother only because her dad
doesn’t believe in therapy. Generally speaking, even if the consent of only one parent is required,
it is clinically appropriate to obtain the consent of both parents. Because of this therapists can
inadvertently alienate a parent by failing to seek the consent of that parent prior to the
commencement of treatment. In the case study it states that Abby pointed out the locations to
sign it did not say that she explained the informed consent process. Informed consent needs to be
explained to the client so that they understand the process of therapy.
Why is this an error/ Correct Actions:
Abby should not be listening to her minor client on gaining consent. Instead, Abby should
know and understand and consider the ramifications of only seeking one parents permission.
This alienation can lead to mistrust of the therapist, which can undermine the treatment of the
minor. Because it appears that the informed consent was not explained this is an error in ethics.
Informed consent should have been explained to Muriel and her mother. According to the
AAMFT (2015), Marriage and family therapists obtain appropriate informed consent to therapy
or related procedures and use language that is reasonably understandable to clients. It has the
premise that the clients should have the capacity to consent, has been adequately informed of
significant information concerning treatment processes and procedures, has been adequately
informed of potential risks and benefits of treatments, and has freely and without undue
influence expressed consent that is appropriately documented. If Muriel was my client I would
make sure I have consent from both parents and I would have ongoing communication with them
and only share pertinent information. In addition, I would have explained informed consent to
Muriel and her mother in laymen’s terms and make sure that they fully understood.
Duty to protect:
Mandated reporting and the duty to protect came up again in the case study when Muriel
stated, “I just want it all to be over with, I’m so sad.” Therapists have a duty to protect and
should report if they believe the client is in danger and have a legal duty to disclose certain
information, even when the child otherwise has a right to confidentiality. For example,
mandated reporters must disclose suspected child abuse to child protective services. According to
research (Good Therapy Editor Team, 2019) “a therapist must act to protect the child if they
believe the child may engage in self-harm or hurt others”. Muriel’s mother inquired with Abby
because Muriel laid in bed all weekend and to see how the sessions were going. Abby did not say
anything and stated that this behavior is typical of a ”normal teen breakup”.
In a later session that week Muriel revealed that she took some painkillers from her
grandfather’s bathroom when no one was home and she had them in her room “just in case”.
Abby felt uneasy about it but did not say much and had her promise that she will not take them
and to call her first.
Why is this an error/ Correct Actions:
When Muriel’s mother reached out to Abby she had the opportunity to address her
concerns and protect Muriel. Instead Abby remembered that she felt like this when she was going
through a breakup ( countertransference) and said nothing. Abby missed the opportunity and her
legal and ethical obligation under the duty to protect. Any statements of self-harm or suicide
should be taken seriously. Abby finished the conversation with “ if anything alarming comes up I
will let you know”. Abby should realize that Muriel stating she wanted to end things is an
alarming statement. When Muriel’s mother reached out I would have explained that Abby is
having a hard time getting through a break up. I would then explain that she did state “I just want
it all to be over with, I’m so sad.” I would then say I am monitoring the situation and I think that
she should do the same at home. I would also ask if she has ever heard anything from Muriel like
this before and that will stay in contact and be notified of any changes.
Abby is continuing to fail at the duty to protect. This is not confidential information any
longer and since Muriel is a minor this should be mentioned to her parents to protect Muriel from
harming herself. It is completely unethical to have her make a promise like that. This is an error
in ethics and in judgment and Abby is not making ethically sound decisions. The next night
Muriel called her, but Abby could not reach her again until she arrived at the next session. There
are so many what ifs that could have happened and there are some things that could have been
avoided if Abby made the correct ethical decision to protect her client. I struggle with this
question on what I would do. Since I am struggling to answer I know I should start off by saying
that I would reach out to my supervisor to seek help in this situation. I suppose I would then
contact Muriel’s mother and let her know that she is in possession of pills that she took from her
grandfather’s bathroom.
Termination occurs once the client and therapist agree that the treatment goals have been
met or sufficient progress has been made and/or the client improves and no longer needs clinical
services. Abby stated that she feels angry at Muriel for making her so worried for nothing and
decides to talk to her supervisor about terminating sessions with Muriel because she is too
dramatic. According to research from Felton (2019) Some of those reasons include:
● Clients have mental health needs that are beyond the social worker’s area of expertise.
For example, the client requires a different level of treatment (e.g., inpatient or crisis
intervention) or more specialized treatment (e.g., trauma or substance abuse) than the
social worker provides in the practice setting.
● Therapist is unable or unwilling, for appropriate reasons, to continue to provide care (e.g.,
therapist is retiring/closing practice or client threatened therapist with violence).
● Conflict of interest is identified after treatment begins.
● Client fails to make adequate progress toward treatment goals or fails to comply with
treatment recommendations.
● Client fails to participate in therapy (e.g., non-compliance, no shows, or cancellations).
● Lack of communication/contact from the client
Why is this an error / Correct Actions:
When terminating a client, you want to ensure that you do no harm. “Abandonment is a
specific form of malpractice that can occur in the context of a mental health professional’s
termination of services (Felton, 2019)”. Abandonment, also referred to as ‘premature
termination,’ occurs when a therapist is unavailable or discontinues service to a client who is in
need. Muriel is still in need of help and this case has become more serious over time.
Terminating Muriel could cause more harm than good at this time. In addition, you cannot
terminate a client because “ they made you mad for no reason”. This statement appears childish
but a true reflection of the therapy that Abby was offering Muriel. If I were the therapist and I
felt that this therapeutic was no longer beneficial I would seek termination based on the listed
items above. I would see guidance from my supervisor or on the appropriate course of action to
make this an easy transition for Muriel.
Overall, it appears that Abby needs to get more acquainted with the American Association
of Marriage and Family code of ethics. When counseling clients it is important to remember to
do no harm. I am not sure if that was the case between Abby and Muriel. Abby should be more in
touch with her supervisor and that should allow her to gain a better understanding of things she is
still unsure about.
Felton, E. (2019, January 22). Termination: Ending the Therapeutic RelationshipAvoiding Abandonment. NASWCANEWS.ORG.
Good Therapy. (2017, June 28). Boundaries. GoodTherapy.Org Therapy Blog.
Good Therapy. (2019, September 26). Countertransference. GoodTherapy.Org Therapy
Good Therapy Editor Team. (2019, October 7). When Do Minors in Therapy Have a
Right to Confidentiality? When Do Minors in Therapy Have a Right to
Southern Nevada Health District. (n.d.). Age, Safety & the Law. Retrieved April 23, 2021,
Yandura, K. (2020, May 8). What Boundaries Should You Have With Your Therapist?
MFT National Exam Sample Questions:
1. For question 1 my answer would be number 2. to see the client, but let them know that
whatever is disclosed will not be kept confidential from their partner at the next conjoint
session. I believe it is up to the therapist to see the couples individually or together during
the sessions. However, it is important to note there should be a “ no secrets policy” and
information shared during the individual session. This policy allows the therapist to
disclose private information shared by you in individual sessions with your partner during
a shared session. Thus, your secrets are safe with your couples therapist, but not if they
are in conflict with the interests of your relationship.
2. For questions 2 my answer is number 2. Legally maintain confidentiality, and ethically
provide for safety. While doing this I will work on what caused the anger and how to
move through it effectively without resorting to violence. You could not report child
abuse if the children were not hurt. There is not mandated reporting for spousal abuse and
that is why you make sure the wife is safe and move toward following legal guidelines.
3. For question 3 my answer is number 1. You indicate to your client that she can give your
number to the program coordinator. I believe that this is okay because you are in the same
work field and a referral or recommendation does not cross any ethical boundaries. The
only other plausible answer to this one is to wait until therapy has been terminated but I
do not believe there are ethical guidelines stated that it needs to be ended before being
recommended or referred.

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