This chapter begins our discussion of ethical issues affecting the practice of marriage and family therapy. In this chapter, we examine the foundational principles and traditions that guide ethical decision making as well as selected models for resolving ethical dilemmas. We discuss broad ethical issues as well as options for documenting and clarifying ethical obligations to clients.
Essentially, this chapter introduces fundamental aspects of ethical practice that will later be expanded to emphasize the unique ethical concerns in marriage and family therapy. Our objectives for the initial chapter in this part are the following:
• • Introduce the foundational ethical principles that guide professional mental health care
• • Establish the distinctions between mandatory actions and discretionary actions as matters of compliance and value-sensitive care
• • Explore models of ethical decision making
• • Emphasize the fundamental priority of client welfare and the significance of therapist competence, due care, and impairment in fulfilling that priority
• • Discuss therapist duties related to confidentiality, privacy, and protection
• • Present elements of informed consent as well as approaches for promoting informed consent in client care
• The previous discussions about value structures, value-sensitive care, professional acculturation, and the ecology of therapy will continue to be relevant for these matters. Additionally, distinctions between mandatory (i.e., obligatory or prohibited) and discretionary actions will emerge as we examine both practice traditions and specific content of codes of ethics from various professional groups.
• Cottone and Tarvydas (1998) observed that ethical reasoning, judgment, and decision making involves a “complex interplay of morals, values, and priorities” (p. 122). Similarly, Ford (2001) noted that expressions of morality and ethics emerge in special relationships such as those involving mental health professionals.
Morality is not synonymous with ethics, though this view has long been opposed in mental health care (Brandt, 1959; Daubner & Daubner, 1970; Mowrer, 1967). As we noted previously, professional acculturation of a therapist often creates dissonance in an established worldview based on personal values of morality that may differ from the professional values of ethical care.
Intentionality in ethical actions elevates practitioners’ decisions beyond simple moral exercises for their satisfaction to the status of accountability for client welfare (Barry, 1982; Herlihy & Corey, 2006).
This distinction is particularly compelling when ethical codes or practice traditions fail to give a definitive solution to a dilemma. In those instances, the expertise and professional values of a therapist’s discretionary decisions are put to the test.
As we begin this section of the text, we consider the broad foundational ethical principles and the nature of mandatory and discretionary actions practitioners may take in the ecology of therapy.
