ethics

Proposed Ethics Code revision would remove MFTs’ social responsibility

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The proposal would eliminate three sections of the AAMFT Code of Ethics that currently call for service and responsibility to larger systems. Members have until January 31 to weigh in.
                                                                                                                                                                                                                                                                                                           

Angry Talk (Comic Style)The AAMFT Board of Directors is proposing an incremental change to the marriage and family therapy profession’s Code of Ethics, the guiding document that defines professional standards in the field. At least one of the proposed changes would drastically redefine what it means to be an MFT.

Some quick background: The AAMFT Code of Ethics was last updated way back in 2001, and much has changed in the profession since then. In particular, the emergence of new technologies for both marketing and service delivery has raised concerns about how to best manage confidentiality and informed consent. The AAMFT Board has known the Code was in need of updating, but did not want to engage in a full-scale overhaul of the Code at this time; that would be about a two-year undertaking. So, they instead are looking at smaller-scale changes. (Full disclosure: I chaired a Task Force, at the Board’s request, looking at possible changes to the Code over the summer. The Task Force was just one of several sources of input for the Board as they developed the current proposal.)

One element of the proposed revised Code is shocking to me. It would change what it means to be a marriage and family therapist. The Board is proposing removing each of the following sections from the AAMFT Code of Ethics:

6.6 Marriage and family therapists participate in activities that contribute to a better community and society, including devoting a portion of their professional activity to services for which there is little or no financial return.

6.7 Marriage and family therapists are concerned with developing laws and regulations pertaining to marriage and family therapy that serve the public interest, and with altering such laws and regulations that are not in the public interest.

6.8 Marriage and family therapists encourage public participation in the design and delivery of professional services and in the regulation of practitioners.

Together, these are the sections that place MFTs in a position of larger social responsibility and make us accountable to the communities we serve. The removal of these sections would have far-reaching implications: If MFTs no longer need to have a place at the table when laws are being developed or altered that are not in the public interest, do we simply allow others to set for us the legal standards that govern our profession? Do we now need to stay out of the same-sex marriage debate? Is it OK for us to be ignorant of major legal issues in our field, from the fight for Medicare reimbursement to the Texas lawsuit over MFTs’ ability to diagnose?

Perhaps on an even more fundamental level, we can look at the proposed removal of 6.6. Is contributing to a better community and society no longer a value of this profession? If so, I would be a lot less enthusiastic about being a part of it.

And that’s the rub. A Code of Ethics is more than just a list of behaviors that can get you in trouble in a profession; it also serves as a vital statement of what it means to be an MFT. It reflects our values and desires as a professional group. One of those values, historically, has been responsibility to the communities we serve. If nothing else, devoting some of our professional activity to services with minimal return is a clear way of demonstrating through our behavior that we truly understand systems and our role, as professionals, in those larger communities.

The Board did not provide its rationale for this proposed change (or any others). But the reasons are likely not important. These subprinciples are key to my identity as a marriage and family therapist. They set AAMFT, as an association, and MFTs as professionals apart from other professional groups. Serving the community through pro bono work and involvement in policy discussions is part and parcel to being an MFT. Isn’t it?

Members can review the full proposal of changes to the AAMFT Code of Ethics through the AAMFT web site (you will need to log in). Members can submit comments through January 31 via email; the address to send feedback can be found here. Whether you agree with me on this issue or not, if you are a member, please do weigh in on the full proposal. The more feedback AAMFT gets from members on the proposed changes (most of which are really quite good!), the better.

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If you’re wondering, the CAMFT Code of Ethics encourages (but does not require) pro bono work. It also has language nearly identical to AAMFT’s 6.7 above, about influencing laws.

Like AAMFT, I, too, appreciate your feedback. And you don’t even have to log in to give me a piece of your mind. Post a comment below, drop me an email to ben[at]bencaldwell[dot]com, or post something to me on Twitter.

On ethics and CAMFT’s record of published statements about AAMFT

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In their own words.
                                                                      
                                                                                                                                            
                                                                
All bold text is my emphasis added.

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“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.”
– CAMFT Code of Ethics, principle 3.5

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On AAMFT and AAMFT-CA’s legislative interest

CAMFT statement: “The opposition [to the LPC bill] in California from AAMFT and AAMFT-CA never surfaced until 2007 and their legislative interest was limited to this single effort – this single piece of legislation.”
– CAMFT Feature Article, The Therapist magazine, March/April 2008

Fact check 1: “Assembly bill 894, introduced last year, would create a professional counselor (LPC) license in the State of California. While AAMFT-CA has no objection to the licensure of mental health professions, we had major concerns with the content of this bill, and therefore took a position of opposition. […] I spoke to the legislature’s Joint Committee on Boards, Commissions, and Consumer Protection in November [2005] to let them know our position and the reasoning behind it.”
– AAMFT-CA newsletter, Legislative and Advocacy column, Spring 2006

Fact check 2: “Among our accomplishments in 2007, we have worked with the BBS to improve license portability into California. […] We also helped to defeat the bill that would have created an LPC (licensed professional counselor) license in California […] We are not opposed in principle to counselor licensure […] We also have been very vocal with the BBS in helping shape the new educational requirements for MFT graduate programs, which are likely to be put into legislation next year.”
– AAMFT-CA newsletter, Legislative and Advocacy column, Fall 2007

Fact check 3: “In 2007 the AAMFT experienced many successes on important advocacy initiatives. In particular, the AAMFT is pleased to announce that we were successful in obtaining participation for MFTs in the U.S. Substance Abuse and Mental Health Service Administration (SAMHSA) Minority Fellowship Program. […] Also, for the first time, the US House of Representatives passed a bill including MFTs in Medicare.”
– Membership renewal message from the AAMFT Executive Director, 2008

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On working collaboratively

CAMFT statement: “CAMFT has approached the [AAMFT-CA] division about legislative issues that CAMFT is sponsoring to involve them in joining our efforts — efforts to work together to further the interests of the profession. There has been no willingness or interest in working with CAMFT on these legislative matters.“
– CAMFT Feature Article, The Therapist magazine, March/April 2008

Fact check: “With the resources I have available [through] AAMFT, I think that a joint and collaborative effort would be valuable. If you let me know when and where the meeting is taking place, I would like to make arrangements to join you.”
– Email regarding counselor legislation from AAMFT-CA Executive Director Olivia Loewy to CAMFT Executive Director Mary Riemersma, March 27, 2007

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On AAMFT’s interest in federal legislative matters

CAMFT statement: “Historically, AAMFT, at the federal level, had no interest in legislative matters. It was actually Richard Leslie at CAMFT who pushed AAMFT, thereby turning the tide on their involvement in federal legislative matters to attempt to advance the MFT profession.”
– CAMFT Feature Article, The Therapist magazine, March/April 2008

Fact check 1: “The association not only incorporated as a trade organization in Washington, but also began a long association when it hired Steven L. Engelberg as legal counsel for Washington (federal) affairs in 1974. […] Failing to make progress in two months of negotiations with the Department of Defense [after CHAMPUS reimbursement for MFTs had been eliminated], the AAMFT sued the DoD for reinstatement on April 26 [1975].”
– William C. Nichols, The AAMFT: Fifty Years of Marital and Family Therapy, pp. 41, 63.

Fact check 2: “CAMFT contracted with Richard S. Leslie, Attorney, in 1976.”
– CAMFT Executive Director Mary Riemersma, “The building of a profession”

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On correcting false information, Part I

My correction request: “At the article’s conclusion, Ms. Riemersma writes, “No one gains by steadfastness, an unwillingness to negotiate, and casting barbs at the perceived opposition.” With this, I would agree wholeheartedly. Unfortunately, much of the Feature Article appears to be an attempt to cast barbs at AAMFT – an organization that, like CAMFT, has the best interests of the profession at heart. Even when the organizations disagree, it serves us best to present information that is clear and accurate.”
– My May 7, 2008 Letter to the Editor requesting CAMFT correct the provable factual errors detailed above

CAMFT response: “Your letter will not be printed in an upcoming issue of The Therapist due to the fact that members are troubled by the debate and do not benefit from it.”
– CAMFT response to my request

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On CAMFT informing the legislature (and its members) about a one-license future

CAMFT magazine: “I attended the AAMFT Long Beach Conference where their president Mike Bowers made a pronouncement at a conference forum of about 500 people that Mary Riemersma of CAMFT informed the California legislature that all therapists will hold the same license in the near future! I became alarmed. […] I knew Mary. This could not have been accurate. I called Mary and she quickly informed me of this misinformation.”
– Letter to the Editor, CAMFT’s The Therapist magazine, Jan/Feb 2011, p. 5

Fact check: “CAMFT states, “At some time in the future, we project that there will only be one masters level profession in California, with individuals specializing within that license. Thus, those who wish to specialize in systems work will do so; those who wish to specialize in art therapy will do so, etc. The current system with a variety of acronyms is confusing for consumers who just want to be helped and do not perceive greater value from one professional compared to the next.””
– California Senate Committee Analysis of AB1486, July 2007
– Same text appears in a CAMFT email to members, May 24, 2007

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On correcting false information, Part II

My request for correction: “Michael Bowers [is] AAMFT’s Executive Director, not its president […] It is true that Riemersma’s letter refers to “some time in the future,” and not the “near future” as the letter writer wrote – but this minor difference is an error on the part of the letter writer, not Bowers. Bowers quoted, in his speech and in his presentation slides, the exact text the legislative report quoted.”
– My Letter to the Editor again requesting CAMFT correct provable errors of fact

CAMFT response: “Your request to print the proposed correction was denied.”
– CAMFT response email

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“Marriage and family therapists treat and communicate with and about colleagues in a respectful manner and with courtesy, fairness, and good faith, and cooperate with colleagues in order to promote the welfare and best interests of patients.”
– CAMFT Code of Ethics, principle 5

The short, successful relationship?

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In the Sex and the City movie, lead character Carrie Bradshaw narrates something to the effect of “Not all great love stories are novels. Some are short stories. But they are just as filled with love.” Can a relationship with a short life span be properly labeled a success?

It’s not just a philosophical question. Marriage and family therapists must regularly wrestle with the question of how “pro-marriage” or “pro-relationship” to be with their clients. We balance the ethical requirement, to respect clients’ freedom to make their own decisions about their relationships, with the research base for our field, which shows that (1) people live happier, healthier, and wealthier lives when they stay married, and (2) a large majority of couples who stay together through difficult times report strong marital satisfaction five years later.

In my own practice, I am unabashedly pro-relationship. I tell clients who come in for Emotionally Focused Therapy that I will work to preserve and improve their relationship until they call me off, no matter how desperate the situation may seem. Final decisions on whether to stay together are always up to them, but they need to know what I believe and how I work — another ethical responsibility, this one for informed consent.

In “A Vindication of Love,” Christina Nehring argues that short, passionate relationships are no less noble, and may be more so, than the modern standard of a long-term, companionate marriage. Passionate relationships, even if brief, force one to live in the moment, to experience life in a deeper, more mindful way than is possible when planning out a long-term coexistence. Meghan O’Rourke at Slate was not convinced, and I tend to side with her.

Still, the topic leads me to think about the couples who come to me for therapy. Of course, many come in seeking to restore or strengthen their mutual sense of security and stability in the relationship, to ensure they can make it over the long term. But there are also those who seek exactly what Nehring vindicates: Immediacy, passion, feeling. These couples often have security in spades — they have a strong commitment to each other (and, often, their children). What they want is to get out of that long-term mindset and back into the intense, spinning experience that, ironically, may have led to the conception of said children.

There’s nothing wrong with either goal, of course. And as therapists, we’re able to accommodate either, though I would readily admit therapy tends more toward the restoring-security side than the restoring-passion. (With notable exceptions.) But in either case, we’re talking about therapeutic processes designed to maintain and strengthen a long-term relationship. I’ve never had a client openly tell me, “I would happily trade the security I feel now for a little excitement,” possibly because they believe it sounds immature or hedonistic. Yet that precise willingness is often reflected in their behavior, through affairs or other kinds of risk-taking that may enliven the moment but damage the primary relationship. So therapy sometimes will seek to heighten excitement or intimacy without negatively impacting the couple’s security — see “Mating in Captivity” — a trade that some couples find difficult if not impossible.

The careful balance between excitement and security is often a challenge for one person on his or her own, and becomes even more complicated when two people, whose needs change over time, are involved. A short relationship can be filled with love, and could be labeled a success if it meets the goals and desires of both partners — of that I’m sure. Whether short, risky relationships are a worthwhile goal for therapy… that’s a whole different question, and much harder to answer.