So far in the Legal and Ethics FAQ blog series, we’ve explored the first few sentences of Standard 2.2 in the AAMFT Code of Ethics in some depth. As you’ll recall, Standard 2.2 states:
Marriage and family therapists do not disclose client confidences except by written authorization or waiver, or where mandated or permitted by law. Verbal authorization will not be sufficient except in emergency situations, unless prohibited by law. When providing couple, family or group treatment, the therapist does not disclose information outside the treatment context without a written authorization from each individual competent to execute a waiver. In the context of couple, family or group treatment, the therapist may not reveal any individual’s confidences to others in the client unit without the prior written permission of that individual.
With this post, we’re going to discuss the last sentence of Standard 2.2. That sentence states:
In the context of couple, family or group treatment, the therapist may not reveal any individual’s confidences to others in the client unit without the prior written permission of that individual.
Imagine a scenario where a therapist meets with one part of the client unit individually and learns of a specific issue that could affect the treatment of the larger client unit. Or, imagine a scenario where a therapist gets between session contacts from one member of the client unit. These scenarios, and more, may cause a therapist to wonder whether they can or should share information obtained from an individual client with the larger client unit.
The importance of having a clearly articulated policy on how MFTs will manage individual confidences in the context of couple, family, or group treatment cannot be overstated. MFTs need to determine early on what their policy will be so that they can clearly communicate the policy to clients and refer back to the policy as needed during the course of their work with clients.
When choosing a policy, MFTs have various options. Some may choose to adopt a policy stating that information shared by an individual in the context of couple, family, or group treatment will not be kept confidential from the larger client unit. Some may adopt a policy stating that the therapist will determine, at their discretion, whether information needs to be shared with the larger client unit. Some therapists may adopt a policy stating that all information shared by an individual in the context of couple, family, or group treatment will remain confidential and will not be shared with the larger client unit. (See, Habrel & Oberle, 2012.)
If an MFT chooses to adopt a policy stating that information shared by an individual in the context of couple, family, or group treatment will remain confidential and will not be shared with the larger client unit, the MFT will need to be prepared to handle other issues that could arise (e.g. conflicts of interest, breaches of confidentiality, bias, risks to the therapeutic relationship, risks related to treatment progress).
For this reason, the concept of a “no secrets policy” has emerged. Under a “no secrets policy” the MFT would spell out their information sharing practices, which could include sharing all information obtained from an individual in the context of couples, family, or group treatment, or sharing information obtained from an individual at the therapist’s discretion. Typically, the decision about whether to share information would involve an analysis to determine whether sharing the information would be in the client or client unit’s best interests, whether sharing is clinically indicated, whether sharing would benefit the treatment of the larger client unit, etc. Some policies may also discuss working with the individual towards a self-disclosure to the larger client unit, while reserving the therapist’s ability to make the disclosure if the individual does not share the information.
In determining what their policy will be, it is advisable that MFTs look to applicable laws as well. When drafting policies and informed consent documents, it is advisable to work with a local attorney to ensure that all policies and documents adhere to applicable laws.
References
Habrel, E., & Oberle, K. (2012, March/April). Confidentiality and informed consent with couples and adolescents. Family Therapy Magazine, (11)2, 24-27.
