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The Case of Naomi

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Christine Park

on 23 February 2014

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Transcript of The Case of Naomi

Develop Ethical Sensitivity
Ethical issues at play
Not considering gender roles and systemic power hierarchy
Treating the family system in sections rather than a whole
Aligning against a member of the family
Ignoring cultural background

Autonomy, Nonmaleficence, Beneficence,
Fidelity
Clarify Facts, Stakeholders, & Sociocultural Context
Participants in family therapy: Naomi, husband, four children, Naomi's parents
Middle-class
Professional connection between Naomi and husband (details unknown)
Unknown: ages; life cycle stages; developmental or acquired disabilities; religious or spiritual practices; ethnic background; members' education levels; conception of gender roles; family of origin values/beliefs about gender; power, and hierarchy
Search Ethics Scholarship
Apply Ethical Principles to Situation
As the therapist's respected hypothetical colleagues, we recommend:
Reviewing ethical codes of conduct
Practicing within scope of multicultural competence *
Deliberate & Decide
GATHER MORE INFORMATION!
How would transition back to school would impact the family system?
Why does she want to go back to school?
Why law, out of all fields?
What has she learned about women and power growing up? What is her framework and value system?
What does it mean for the family to have her around (husband have business partner, children have mother, parents have dutiful daughter)?
THEN work with the family to find what is best for the system as a whole.
Reflect on Experience
Countertransference
Over-identification/alignment with Naomi
Unanswered questions-- What is the whole story?
"Solving" = taking away autonomy
Lacking knowledge around therapist's background, education, and experience
Balance between systems theory and feminist theory
Or holding both?
Power differentials & circular causality/holistic functioning
Define Central Issues & Available Options
Central issues:
Conflict between Naomi's wish to pursue law degree and family's resistance
Husband desires she remain “involved in his professional life”
Children want a full-time mom
Parents insist she put the family before her “selfish” pursuit
Therapist reinforces family's resistance
Implement & Document Decision-Making Process
Make recommendations and document conversation.
If no corrective action taken, then notify that appointed supervisor will be contacted.
Upon supervisor contact, express concerns around ethical dilemma, followed with the appropriate documentation kept on file
The Case of Naomi
PSYC 519 : Ethics in Family Practice
Ethical Decision-Making
Christina Campos, Sara Eisen,
Linda Holt Ayriss, Christine Park

Refer to Professional Standards & Relevant Laws/Regulations
Consult with Supervisor & Respected Colleagues
Marriage and family therapists provide professional assistance to persons without discrimination on the basis of race, age, ethnicity, SES, disability, gender, health status, religion, national origin, sexual orientation, gender identity or relationship status.
AAMFT Code 1.1 Non-Discrimination
The primary responsibility of counselors is to respect the dignity and to promote welfare of clients.
ACA Code A.1.a.
Primary Responsibility
Counselors are aware of their own values, attitudes, beliefs, and behaviors and avoid imposing values that are inconsistent with counseling goals. Counselors respect the diversity of clients, trainees, and research participants.
ACA Code A.4.b.
Personal Values
Marriage and family therapists clearly respect the rights of clients to make decisions and help them to understand the consequences of these decisions. Therapists clearly advise the clients that they have the responsibility to make decisions regarding relationships such as cohabitation, marriage, divorce, separation, reconciliation, custody, and visitation.
AAMFT Code 1.8.
Responsibility to Clients
Marriage and family therapists pursue knowledge of new developments and maintain their competence in marriage and family therapy through education, training, or supervised experience.
AAMFT Code 3.1 Maintenance of Competency
Therapist's available options:
1. Become aware of value system impacting neutrality and objectivity in counseling *
a. Seek supervision *
b. Repair damaged relationships
c. Self-education about ethical codes of conduct, privilege/power, gender role sensitivity, multiculturalism
d. Continue therapy, share knowledge, check for understanding
e. Obtain full contextual assessment of family
f. Devise treatment plan with appropriate systemic interventions to 1) change interactional patterns; 2) alleviate anxiety stress; 3) potentially agree to compromise
Counselors are aware of their own values, attitudes, beliefs, and behaviors and avoid imposing values that are inconsistent with counseling goals. Counselors respect the diversity of clients, trainees, and research participants.
ACA Code A.4.a.
Avoiding Harm
or...
2. Do not treat family due to strong countertransference or conflicts of personal values *
a. Terminate
b. Refer family to another therapist
Marriage and family therapists seek appropriate professional assistance for their personal problems or conflicts that may impair work performance or clinical judgment.
AAMFT Code 3.3
Seek Assistance
ACA Code C.1. Knowledge of Standards. Counselors have a responsibility to read, understand and follow the ACA Code of Ethics and adhere to applicable laws and regulations.
WAC 246-809-600. Licensed marriage and family therapists, licensed mental health counselors, and licensed social workers are required to have continuing education.
Refer to codes, being mindful of primary responsibility to clients to "respect the dignity and to promote welfare of clients" (ACA Code A.1.a.)
Apply ethical principles of autonomy, beneficence, fidelity, justice, and maleficence as a guide
Monitor effectiveness *
Counselors continually monitor their effectiveness as professionals and take steps to improve them when necessary. Counselors in private practice take reasonable steps to seek supervision as needed to evaluate their efficacy as counselors.
ACA C.2.d.
Monitor Effectiveness
Counselors practice only within the boundaries of their competence, based on their education, training, supervised experience, state and national professional credentials, and appropriate professional experience. Counselors gain knowledge, personal awareness, sensitivity, and skills pertinent to working with a diverse client population.
ACA Code C.2.a.
Boundaries of Competence
References
American Association for Marriage and Family Therapy. (2012). American association for marriage
and family therapy code of ethics. Retrieved from http://www.aamft.org/imis15/Content/Legal
Ethics/Code-of-Ethics.aspx

American Counseling Association. (2005). American Counseling Association Code of Ethics.
Retrieved from www.couseling.org/Resources/aca-code-of-ethics.pdf

American Psychological Association. (1975). Report of the task force on sex bias and sex role
stereotyping in psychotherapeutic practice.
American Psychologist, 30
, 1169-1175.

Baker, M. (2010). Choices or constraints? Family responsibilities, gender, and academic career.

Journal of Comparative Family Studies, 41
(1), 1-18.

Bundy, M. L. & Gumaer, J. (1984). Families in transition.
Elementary School Guidance & Counseling,
29
(1), 4-8.

Keeling, M. L., & Piercy, F. P. (2007). A careful balance: Multinational perspectives on culture, gender,
and power in marriage and family therapy practice.
Journal of Marital and Family Therapy, 33
(4),
443-463.

Larkin, M. (1991). Some ethical issues in feminist-oriented therapeutic groups for women.

International Journal of Group Psychology, 41
, 199-215.

Weiner, P. (1985). Exploring gender bias against women; Ethics for marriage and family therapy.

Counseling and Values, 30
, 9-23.

Wilcoxon, S. A., Remley, T. P., & Gladding, S. T. (2013).
Ethical, legal, and professional issues in the
practice of marriage and family therapy.
[5th Ed.]. Boston: Pearson.
Walters, Carter, Papp, and Silverstein (1988)
"Systems therapy discriminates against women by seeking balance and equilibrium for the family system as a unit, without addressing the unequal access of each individual to choice or role. The pretense that men and women are genderless cogs in the system prevents us from noticing that women are held more responsible than men for making it work, in the family and in family therapy, and that the 'complementary' roles, tasks, and rewards of the stable system are allocated by gender, unequally, to its male and female members" (as cited in Wilcoxon, Remley, & Gladding, 2013, p. 27).
Keeling and Piercy (2007)
Has therapist's cultural lens pathologized or judged the practices of this family? (p. 444).
Colonization of people’s experiences, invalidation of hierarchy, and formation of assumptions could threaten ego-ethnocentric bias of therapists, blinding them to clients’ values and constraints and increasing the risk for oppressive practices (p. 453).
Find balance between therapist's values and his clients values in an effort to be mindful and respectful of both. Therapist should balance attention to all members of the client system and attend to all perspectives in order to take into account each member’s needs and preferences (Keeling & Piercy, 2007, p. 450).
For example, “certain collectivist, patriarchal cultures may value the common good over individual choice, respect for elder decisions over self-decisions and male opportunity over female opportunity” (p. 444).
In Naomi's case, by gaining cooperation of the powerful family members, the husband and the client’s parents, and by relying on them as allies one could then build a climate of trust and strategize their work with flexible modalities.
American Psychological Association (1978)
“The client’s assertive behaviors should be respected.”

Larkin (1991); Weiner (1985)
Responsible therapists could seek exploration of bias regarding gender roles and further education to promote competence and integrity.
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