: David is a licensed professional counselor (LPC) and a licensed marriage and f

Question

: David is a licensed professional counselor (LPC) and a licensed marriage and family therapist (LMFT) working for a family counseling center. Steve, one of his adult clients, would like to begin couples counseling with his wife.

Question One: What ethical matters should David consider before beginning to see Steve and his wife?

Question Two: What special issues of confidentiality may arise in the case? How should David address these issues?

Question Three: How might differences in personal values and gender/cultural issues create ethical dilemmas in this case?

Explanation / Answer

Working with couples in a therapeutic setting can be both a challenging and rewarding endeavor. In contrast to individual therapy, the couple therapist must balance the needs of two individuals and their relationship to determine the best course of therapeutic action. In creating policies and guidelines for psychotherapy with couples, it is important to a) consider your responsibilities to both the couple and the individuals when defining who the client is, b) decide whether to hold individual sessions with each individual involved in couple therapy, and c) determine what actions to take if one member of a couple discloses information that the other partner does not know. It is vital to explain clearly at the outset of therapy that the couple’s relationship and both individuals are clients in therapy, and that the psychologist will seek to have a balanced relationship with each individual while all work together to improve the couple’s relationship. The issue of whether to hold individual assessment sessions with members of a couple at the outset of therapy is complex. On one hand, valuable information can be gathered regarding each individual’s history and commitment to the relationship and treatment. On the other hand, sometimes during these sessions, one individual will take the opportunity to divulge a secret to the psychologist, which can create an ethically difficult situation.Consistent with standards, it is vital for psychologists to clarify at the outset of therapy the nature of their relationship with each partner and how these outside contacts will be handled. If a couple therapist does hold individual assessment sessions with a couple or has outside contact with one partner, the psychologist must determine how to manage secrets or other information that has not been shared within the couple. When confronted with secret information divulged by one member of a couple, a psychologist has three main options in managing this situation. These three options are all ethically defensible, but each has its pros and cons. First, a psychologist may decide to keep all secrets confidential in order to maintain trust with each partner and respect the rights of each individual. However, this decision places the couple therapist in a precarious position when information is shared by one member that is damaging to the relationship or may undermine therapeutic work. Second, a couple therapist may make a blanket statement that all information is the property of the relationship, and therefore no secrets will be kept between partners. However, this policy may prevent partners from sharing key information or may threaten trust between partners and the psychologist. The third option, an intermediate solution, is to only keep certain information secret. Cultural differences can mean that the couple views power differently from you. However, keep in mind that cultural differences in power have developed over centuries, and while they may not be a 50-50 balance, there is some balance.Attack the problem through that vein, then in terms of what they want to teach their children who will grow up half in their culture and half in majority culture. The therapist should seek to understand his/her values regarding communication between spouses. The therapist should examine his/her own beliefs regarding a variety of marriage issues, including culturally sanctioned norms for marriage, criteria for spouses entering marriage, and expectations regarding the marriage relationship and relationships with outsiders. Assessment of a couple from a different culture should be thorough. It is important to include questions about the presenting problem and how the couple views the problem from their unique cultural perspective. Ask both spouses about their roles within the home and within their family. Inquire about the role of each spouse’s family of origin, as dictated by their cultural norms. Other areas of assessment with culturally diverse couples include a wide range of norms for the marriage relationship. The therapist should remember to ask questions regarding such issues as the customary age for men/women to marry within the client’s diversity group, expectations regarding husband/wife prior to and after marriage, basis for mate selection, responsibilities of each spouse, conceptualization of sexual relationship, and expectations for interaction with outsiders The therapist should sensitively probe for information regarding each partner’s view of help?seeking, and inquire what prompted the couple to seek help at this point in their marriage. Couples from different cultures may have much higher or lower tolerance for marital discord as viewed from an American/Western perspective, and/or may view seeking help with a greater or lesser degree of discomfort.

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