AAMFT’s proposed new ethics code: Mostly good, a couple of problems

Golden gavel 1, By walknboston (Flickr: Gavel) [CC-BY-2.0 (http://creativecommons.org/licenses/by/2.0)], via Wikimedia CommonsThe draft Code proposes new requirements around technology, among other changes.

The public comment period on the proposed 2015 Code of Ethics for the American Association for Marriage and Family Therapy (AAMFT) ends on August 1, and I finally submitted my feedback yesterday. How’d they do?

Mostly really well. The technical changes in the Code really do clarify some of the standards, and they’ve taken out language that was outdated, incomplete, or confusing. They’ve also added a number of requirements, particularly around the use of technology in therapy and supervision. These are very good changes.

There are a few problems, though. One of the technology standards, as currently proposed, would make every practitioner unethical. Another proposed change is tough on rural therapists. And there’s missed opportunity to deal with a brewing controversy in the field.

  1. Let’s address the technology piece first. Kudos to AAMFT for recognizing that their members need guidance when it comes to using technology to provide therapy or supervision, and developing standards around such practice that are largely clear and consistent with standards of other organizations. The problem is this (bold in original, italics mine for emphasis):

6.3 Confidentiality and professional responsibilities. It is the therapist’s or supervisor’s responsibility to choose technological platforms that ensure the highest level of confidentiality and quality of services possible.

Call me a stickler for language, but there’s only one “highest level possible,” and it probably involves concrete walls, windowless rooms, and a fully closed-circuit connection guarded by armed security. No therapist or client would bother to go to such lengths, but they are possible, and that’s why this standard won’t work as written. Some recognition needs to be given to cost and other practical realities of service provision. Elsewhere when talking about technology the Code proposes language like “high standard” or even “careful choices… to optimize” and those would be a much better fit for addressing confidentiality as well.

  • Rural therapists should be upset by the proposal to change the “two-year rule” for romantic relationships with former clients or their family members into a lifetime ban. As I explained here, a rural therapist providing good service to their community would be slowly whittling down their dating pool to nothing. That’s an unreasonable price to ask rural therapists to pay for practicing in areas that already have trouble recruiting and retaining qualified providers.

    I live in a big urban area, so it’s easy for me to say that we should forever ban such relationships, but that fails to recognize the complicated mess of multiple relationships that is rural living. A better standard would be the 5-year ban used by the American Counseling Association.

  • Lastly, I was disappointed by what wasn’t in the proposed new Code: Any meaningful statement about the role of the therapist’s values in the therapy process. While my writing on the topic has focused on whether therapists should be able to use their religious beliefs as a basis for refusing to treat gay and lesbian clients (see here and here), the appropriate role of the therapist’s values is really a broader issue than this one particular application of them. The CAMFT Code is a useful example:

    3.7 THERAPIST VALUES: Marriage and family therapists make continuous efforts to be aware of how their cultural/racial/ethnic identities, values, and beliefs affect the process of therapy. Marriage and family therapists do not exert undue influence on the choice of treatment or outcomes based on such identities, values, and beliefs.

    That language makes it clear that we do not enter the room as value-less automatons, but at the same time, our personal values don’t rule the day. The ACA Code is even clearer (bold in original, italics mine for emphasis):

    A.4.b Personal values. Counselors are aware of — and avoid imposing — their own values, attitudes, beliefs, and behaviors. Counselors respect the diversity of clients, trainees, and research participants and seek training in areas in which they are at risk of imposing their values onto clients, especially when the counselor’s values are inconsistent with the client’s goals or are discriminatory in nature.

    I like the ACA language better, but any language on this issue is better than no language. Given the recent court cases on the subject, I think it is important that we as a field make a clear statement: The personal values of the therapist cannot outweigh or overrule the values of the profession they have chosen to join.

All this said, I do think the proposed changes to the AAMFT Code are largely good. Based on my own experience,* I have a good sense of just how difficult it is to write such language in a way that is clear and enforceable yet also flexible enough to allow for the full range of acceptable practice. I do think the issues above deserve a second look, but that’s what public comment is for — to help the organization see where there may be unintended or undesirable consequences of the changes they’ve proposed. The folks who have been doing the work of drafting this language for AAMFT deserve a great deal of credit. It isn’t easy.

Again, the public comment period for the draft 2015 AAMFT Code of Ethics goes through August 1. If you’re interested, I would strongly encourage you to provide your perspective on the changes. They really do read and attempt to address every single piece of feedback they get.

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* In the interest of full disclosure, I was part of a task force that developed recommendations for the 2012 update to the AAMFT Code. I had no involvement with the current process of developing the 2015 Code.

What do you think of the AAMFT draft? While you should use the link above to give them your feedback directly, your comments here are welcome too. You can post them in the comments below, or email me ben[at]bencaldwell[dot]com.