Understanding the CAMFT Organization
The California Association of Marriage and Family Therapists (CAMFT) is a nonprofit organization serving the needs and interests of marriage and family therapists in the state of California. CAMFT seeks to unify the profession, promote client welfare, provide support and continuing education for its membership, and advocate for marriage and family therapy—throughout California and across the United States. Founded in 1964, CAMFT was created to address the continually shifting landscape of medical and mental health law that impacts California therapists . Where the traditional approach to law and ethics education focuses on the history and structure of the law, CAMFT instead applies this theory specifically to California marriage and family therapists, whose practice as therapists puts them in an especially vulnerable position, subject to a variety of potentially catastrophic legal implications that do not always exist in other legal fields. CAMFT membership is available for individuals or organizations, and includes both licensed marriage and family therapists and associate members. Membership in CAMFT provides many benefits, including access to a strong network of therapists and leaders who share the same values and principles and who learn from each other to provide the best services to their clients. CAMFT also offers a free version of its Law and Ethics Training, a required three-hour course of study for all California MFT registrants.
CAMFT’s Minimum Standards for Ethical Practice
While a therapist’s ethical obligations can seem like a vague concept to some, they are in fact the core of every important decision you as a Psychotherapist are required to make for the care and treatment of your patients. It is an essential guide to how you are to interact with your patients and those around you in the office.
The key ethical standards I would like to focus on in this article are:
-Confidentiality;
-Dual Relationships; and
-Informed Consent.
CAMFT’s Code of Ethics offers the following definitions:
Confidentiality: Therapists’ must safeguard clients’ confidentiality, which includes the conversations, organic information, and digitally stored information shared between therapists and clients, as well as the information in clients’ files and the absence of information about clients from public knowledge.
For example, you as a therapist, would violate the standard of confidentiality if you were to indicate whether or not a patient had been in your office within the past five years or had been a patient of yours. In addition, confidential information can only be shared if the patient has agreed to do so (i.e, signed an authorization allowing you to provide that information), or if there is a mandated or permissive reporting requirement.
Dual Relationships: AMFT’s Code defines dual relationships as:
"The counselor-client relationship is "dual" when the therapist stands in some professional role with a client and in some other role at the same time (or a persistent role outside the therapy setting)."
Various CAMFT Ethical Standard rules apply to dual relationships. For instance, if you are a couple’s therapist, you should not have a personal dating relationship with either of the parties who you are treating.
Informed Consent: Informed consent is the process of informing a patient of the possible risks and benefits of participating in a particular course of treatment. This process should be rooted in the standard of confidentiality. When obtaining informed consent, you should be clear in your provisions and explain all reasonable risks so that you will maintain your patient’s confidence and power to decide.
Marriage & Family Therapist Fudciaries’ Legal Duties
A primary legal responsibility of marriage and family therapists under CAMFT law and ethics is the mandatory reporting of abuse or neglect to a responsible authority. Because children or elders are particularly vulnerable, Chapter 7 of the CAMFT Law and Ethics Manual includes a special section on practitioner reporting duties in those contexts. However, this duty exists with respect to any client, wherever abuse or neglect may have occurred, such as in a school setting.
In addition to mandatory reporting, CAMFT law and ethics practitioners have some voluntary reporting obligations. While reporting is not required, it may be considered professional misconduct not to report in some cases. Under Business and Professions Code Section 803(e), CAMFT law and ethics practitioners must report the surrender or restriction of a license or credential when it reasonably appears that it is due to a matter relating to the competence of the person to provide services as a licensed marriage and family therapist in California; and the surrender or restriction is due to an investigation of a complaint involving a serious matter of criminal misconduct or act of dishonesty or corruption. Both the surrender and the restriction must be permanent, unless the restriction is temporary due to a pending investigation. Requiring a temporary surrender of the license or credential pending an investigation does not trigger the reporting obligation.
CAMFT law and ethics practitioners also must voluntarily report a felony conviction of any kind within 30 days to the Board, as specified by Business and Professions Code Section 803(e).
Examining Hypothetical Scenarios for Ethics Resolution
Ethical dilemmas are common and, in fact, many times arise because the law and ethics overlap and are not always in agreement. As a clinical contributor to the CAMFT website, I have the opportunity to respond to a large number of inquiries from CAMFT members and give guidance on navigating some of the frequent ethical dilemmas that many individual marriage and family therapist face. Two categories of common ethical dilemmas that I see are: how to navigate the issues of disclosure, and how to appropriately handle termination of services.
DISCOLSURE
Marriage and family therapists are often asked by clients to provide information about their case to third parties, sometimes including insurance companies, and also by clients at termination to disclose information about previous services. Two examples of these scenarios are presented below. Both are based on actual situations from the field. Scenario 1: A client comes to therapy to address a chronic pain disorder. His chief complaint is that the pain makes him feel bad, and he wants therapy to help with the pain. At termination, he asks the marriage and family therapist to provide a letter that states his chronic pain disorder has been treated in therapy. The therapist is concerned about a breach of confidentiality, and is also concerned that the plaintiff’s attorney in a pending case against the client’s employer for negligent infliction of emotional distress following an injury to the client’s finger may use the letter in court or share it with the client’s insurance company. Scenario 2: At the time of termination, a client requests a copy of her record and also asks for a statement verifying the dates of service and confirming she was in treatment for depression.
Prior to disclosing any information, it is important for marriage and family therapists to carefully review the CAMFT Ethics Code, as well as control of client records as set forth in California Business and Professions Code 123110. Once the facts of the situation are clear, then the therapist can document the request, release any necessary information to the extent required by law, and counsel prospective clients about their rights pursuant to California Business and Professions Code 123110. It is well worth reading the Ethics Code prior to responding to a disclosure request. Many questions regarding disclosure can be addressed sufficiently by the parameters set forth in the Ethics Code, and it is important to keep in mind that consultants at CAMFT cannot provide legal advice, and they encourage members to read, understand, and apply the Ethical Standards to their practice.
TERMINATION
Apply the following steps to help navigate termination and carefully consider CAMFT case study examples based on actual situations. Scenario 3: Client consultation Scenario 4: Child consultation Both of these case studies contain practical advice for marriage and family therapists who need to terminate a therapeutic relationship with a client, and they are also available on the CAMFT website for reference.
CEUs & Practicing Ethical Therapy
A core tenet of therapist success and responsible practices, and an essential consideration in determining whether a therapist is operating in compliance with relevant practice standards and regulations for therapists, rests on the conduct of therapists and their engagement in continuing professional development. This commitment to learning and improvement not only meets licensing and credentialing requirements, but also serves as key evidence that therapists are taking the ethical and legal obligations they owe to their clients, the public, and their profession to heart.
In addition to supporting therapists as they seek out education and training necessary to achieve optimal compliance with legal and ethical obligations, CAMFT also stands in support of ongoing therapist education in topics like law and ethics to ensure therapists are knowledgeable about the changing legal landscape governing their professional conduct. For example , CAMFT regularly provides law and ethics training for members interested in becoming CAMFT Certified Supervisors, providing the required supervision, training, and mentoring services for registered associate marriage and family therapist (AMFT) associates, associate clinical social workers (ACSW), and associate professional clinical counselors (APCC). Additionally, CAMFT provides continuing education resources designed to enhance general knowledge and understanding of the ethical and legal issues therapists face through both formal and informal continuing education opportunities such as its Webinar Series and Chapter presentations. By the end of 2020, CAMFT estimates that it will have eight CAMFT webinars available through CEs4U online learning platform, which will be designed to provide therapists carrying the CAMFT Certified Supervisor designation with the much-needed training they must provide to their AMFT, ACSW, and APCC supervisees.
Consequences for Breaching CAMFT Ethics
The implications of breaking the CAMFT ethical rules are staggering. At the outset, violation of the CAMFT ethical rules can result in the loss of the CAMFT license or certification. In certain particular circumstances, this loss may even involve civil or criminal penalties. For example, if a CAMFT Licensee commits domestic violence, as defined by California Family Code section 6211, it may subject him or her not only to the loss of CAMFT privileges, but also may result in a loss of driving privileges and may subject the licensee to civil and criminal penalties arising out of the violation of Family Code section 6211. Interestingly, the loss of CAMFT privileges does not require a conviction. Rather, there’s an admission of having committed domestic violence by the individual to the Court, or a finding of guilt against that individual, the latter occurring in a criminal context.
If you are convicted of sex offenses or controlled substance violations, even where not involving dangerous drugs, the application for licensure and discipline can be a difficult process. You may lose your license.
Where acts of dishonesty, forgery, fraud, or negligent conduct occur, when delivering services to the public, disciplinary actions can result in significant restrictions on your license. For example, it could involve your license being placed on probation, suspension, or it could involve the loss of your license. This is why you need to particularly take the time to understand the rules and follow them.
Additionally, where you commit acts that breach confidentiality or do video and/or audio recording, without consent, it can result in the damage to your license.
Essential Resources for Practicing Therapists with CAMFT
Continuing education is an important component of a therapist’s professional journey. CAMFT offers a range of workshops and publications aiming to arm CAMFT members with the tools they need to navigate the complexities of CAMFT law and ethics.
CAMFT offers a six-hour daylong workshop on "CAMFT Law & Ethics" that surveys the relevant statutes and legislation, addressing topics including limits of confidentiality, advertising, licensing, etc. CAMFT members can keep themselves informed by subscribing to CAMFT eNews (another CAMFT member benefit!) and by signing up for CAMFT Connect . The CAMFT website contains a wealth of information, including FAQ on the Law and Ethics Resource page. You can also read webinars on this topic at your convenience.
CMFT is aware that technological advances can pose challenges to the legally and ethically sound practice of couples and therapists, and it runs regular workshops on law and ethics issues as they apply to evolving technology. CAMFT’s online webinars are another great resources for learning to navigate law and ethics as it applies to patient records, billing, and insurance reimbursement.