Updated May 10, 2016: They’re moving the conference. A written statement from President Thelma Duffey is here, and a video from CEO Richard Yep further explaining the decision is here.
Updated April 29, 2016: The ACA has released a statement on HB1840 and asking for patience as their leadership weighs its options for the 2017 conference. The full statement is available here.
Updated April 28, 2016: Tennessee Governor Bill Haslam signed the “religious freedom” bill allowing counselors to freely discriminate, and directly contradicting the ACA Code of Ethics. The ACA should move the conference. My original post, published April 21 under the headline “What should the ACA do about its 2017 conference?” follows. -bc
The American Psychological Association apologized on Friday for its actions that allowed psychologists to participate in the torture of military detainees. Those actions are detailed in the extensive “Independent Review Relating to APA Ethics Guidelines, National Security Interrogations, and Torture” (otherwise known simply as the Hoffman report). It is the most thorough examination to date of how APA staffers, aiming to remain in the good graces of the Central Intelligence Agency and (especially) the Department of Defense, actively sought to create ethics policies that allowed psychologists to be involved with torture and shielded them from consequences for doing so.
Indiana’s Religious Freedom Restoration Act, signed into law by Governor Mike Pence last week, has raised a great deal of controversy. In the psychotherapy community, the law could have an immediate impact in the form of professional events and conferences moving out of the state. In the longer term, the bill is likely to impact training and practice by making it harder for universities and licensing boards to discipline discriminatory behavior.
1.5 Sexual Intimacy with Former Clients and Others. Sexual intimacy with former clients, their spouses or partners, or individuals who are known to be close relatives, guardians or significant others of clients is likely to be harmful and is therefore prohibited for two years following the termination of therapy or last professional contact. After the two years following the last professional contact or termination, in an effort to avoid exploiting the trust and dependency of clients, marriage and family therapists should not engage in sexual intimacy with former clients, or their spouses or partners. If therapists engage in sexual intimacy with former clients, or their spouses or partners, more than two years after termination or last professional contact, the burden shifts to the therapist to demonstrate that there has been no exploitation or injury to the former client, or their spouse or partner.
The proposed new rule is much simpler and more stark:
1.5 Sexual Intimacy with Former Clients and Others. Sexual intimacy with former clients or with known members of the client’s family system is prohibited.
Gone would be the current “two-year rule.” Under the current rule, a therapist could get into a sexual relationship with a client’s family member without fear of repercussions if two years have passed since the end of therapy. However, a therapist who engages in a sexual relationship with the former client or their partner is always at some level of risk; it is, after all, very hard to prove the negative, especially in mental health. If someone says they have suffered emotionally, as the result of a romantic relationship with their former therapist, it is a high bar for the therapist to prove otherwise. As such, the current code effectively discourages relationships with former clients or their partners forever. The proposed new rule would shift that discouragement into a clear prohibition, and extend its reach to include all known members of the client’s family system, not just their partners.
There is a potential problem with the application of a blanket rule like this. Consider the family therapist working in a rural area, who may run parenting groups or other workshops for their county — a not-uncommon situation, especially when the therapist may be the only licensed mental health provider in the county (or one of very few). That therapist would never be able to date anyone who had come to a single parenting class, a single therapy session, or a single workshop, even if decades had passed since then. And even if you’re on board with that part (I waffle; it’s easy for me to judge from a place like Los Angeles, but I wonder whether my view would be different living someplace else), bear in mind that the therapist also would never be able to date anyone who had a family member who had ever come to a single parenting class, a single therapy session, or a single workshop, no matter how many years ago.
By working in a rural area, a therapist would be systematically dismantling their dating pool.
This proposed AAMFT rule seems to me to be unduly punitive to those therapists working in rural areas (the same argument could be made, albeit a bit less strongly, for those working in insular communities in urban areas), especially those who do so for a long time. It is right and appropriate to demand that therapists not get romantically involved with former clients or their family members when the therapeutic relationship was recent enough to bring a certain “ick factor,” or any risk of harm or exploitation, into the dating relationship; extending the post-therapy prohibition on such relationships from the current two years to five or even ten would be fine with me, and it seems reasonable to include family members in addition to the client and their partner in that prohibition. But to tell a therapist she can’t date someone if she discovers that person’s aunt and uncle had come to her for two sessions of marriage counseling 20 years ago? That, to me, is going too far.
And it isn’t just me. When the American Counseling Association (which represents counselors of various forms, including LPCs and LPCCs) adopted their new Code of Ethics for this year, they kept their five-year prohibition on romantic relationships with former clients rather than moving to one that would last forever. The ACA language, I think, gets it right, by putting a high demand on counselors to consider (and, importantly, document that they considered) the risk of harm or exploitation before engaging in any such relationship, but stopping short of outlawing them for all time:
A.5.c. Sexual and/or Romantic Relationships With Former Clients
Sexual and/or romantic counselor-client interactions or relationships with former clients, their romantic partners, or their family members are prohibited for a period of 5 years following the last professional contact. This prohibition applies to both in-person and electronic interactions or relationships. Counselors, before engaging in sexual and/or romantic interactions or relationships with former clients, their romantic partners, or their family members, demonstrate forethought and document (in written form) whether the interaction or relationship can be viewed as exploitive in any way and/or whether there is still potential to harm the former client; in cases of potential exploitation and/or harm, the counselor avoids entering into such an interaction or relationship.
As a general rule, I really like the 2014 ACA Code, particularly for how well it handles issues related to technology. AAMFT could learn from the example. And while I have concerns about this particular piece, there is certainly much to like in the draft AAMFT code as well; as I said, more on that to come. The public comment period for the current AAMFT draft Code of Ethics goes through August 1.
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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 working draft.
What do you think of the AAMFT draft? Your comments here are welcome. You can post them in the comments below, by email to ben[at]bencaldwell[dot]com, or on my Twitter feed.
Around the country, state governments have wrestled with questions of how to best recognize relationship commitments among same-sex couples. To provide guidance and respond to questions from legislators and the public, most mental health organizations have developed clear and specific policy statements that show where the organizations stand:
The National Association of Social Workers gives wholehearted “support for same-sex marriages, and strongly opposes any attempt to pass federal legislation or amend the United States Constitution to discriminate against same-sex couples or prohibit governmental recognition of these relationships.” They also have a fair amount of deeper documentation on the issue.
AAMFT believes that all couples who willingly commit themselves to each other, and their children, have a right to expect equal support and benefits in civil society. Thus, we affirm the right of all committed couples and their families to legally equal benefits, protection, and responsibility.
That policy statement was developed through careful deliberation, member comments (about 800 pages’ worth), and importantly, a very extensive report (on their web site, but restricted to members) on the state of the research around same-sex couples and their children.
The California Association of Marriage and Family Therapists (CAMFT) has taken a very different approach to the question: Avoidance. Even after a great deal of member protest, at its most recent board meeting CAMFT only went so far as to put out a generic anti-discrimination statement that sidestepped any and all meaningful questions: Is refusal to allow same-sex marriage discrimination? Should same-sex parents be allowed to adopt and raise children? How does the term “marriage” relate to the work of MFTs, particularly our work with same-sex couples? They don’t say.
Officially, CAMFT’s refusal to step in has been on the grounds that it is not the best use of their resources. Get caught up in this social cause, the argument goes, and you wind up caught in many more, and they distract from the mission of the organization.
This is hogwash, of course. Professional associations in mental health usually have specific policies for addressing social issues, and processes for determining which social issues to get involved with. They understand that these issues need to be addressed, because social issues inherently impact the health and well-being of individuals, families, and communities. The dilemma for CAMFT — and I’m guessing here, trying to give the benefit of the doubt — must revolve around whether to risk alienating a significant portion of their membership. MFTs come in many stripes, from those who adamantly support same-sex marriage and see it as a human rights issue, to those who just as adamantly believe marriage is a religious institution and therefore needs to be restricted. Take a stand on either side of the debate, and in an instant, you’ve shown a major portion of your membership that you do not share their value.
As a worker in an evidence-based field, I would hope that my colleagues would be willing to be guided by the best available research at the time. The policy statements of other organizations make it clear that they are trying to do just that, even over the objections of a portion of their membership. To be sure, each organization likely lost a few members when they took the stands they did. Silence, however, does not seem like the ideal answer.
CAMFT members are now pushing back, organizing petitions and trying to encourage change from within the organization — or, failing that, suggesting that therapists quit CAMFT entirely (here are just a few resignation letters to CAMFT). Since CAMFT board members were this year selected by a committee (the most recent member “election” was a perfunctory exercise, with only one candidate put on the ballot for each open position), such actions may be the only way members feel they can have a voice in the organization, short of actually serving on the board.
It is interesting that California, which was the first state to license MFTs, now houses the group of psychotherapists last to recognize the harm done by staying silent about what “marriage” means.