1. Ethics
Presented by:
Trudy Gilbert-Eliot, M.S., LMFT, LADC

2. Overview
 State Law
 State Regulations
 AAMFT Ethics Code
 *Understanding Ethics
 Ethical Decision-making

3. Understanding Ethics
 Handout

4. Law and Ethics
 Nevada Revised Statutes (NRS) 641A
 Nevada Administrative Code (NAC) 641A
 American Association of Marriage and Family
Therapists (AAMFT) Code of Ethics
 Case Law

5. Definition
 “Marriage and family therapist” means a person who
describes himself or herself or his or her services to
the public by any title or description which
incorporates the term “marriage and family therapist”
or “marriage and family counselor”
 “Practice of marriage and family therapy” means the
diagnosis and treatment of mental and emotional
disorders, whether cognitive, affective or behavioral,
within the context of interpersonal relationships….
services to a person, couple, family or family group or
other group of persons.
 Limitations: diagnosis/treatment of a psychotic
disorder, and assessments of intelligence,
personality, aptitude, interests or addictions.

6. Understanding Ethics
 A therapist with experience working with
adolescents received a call from a family
wanting him to work with their seven-year-old
son. What should he tell the family?

7. Grounds for Denial, Suspension, or
Revocation
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Conviction of felony
Habitual drunkenness or addiction
Impersonation
Using fraud or deception in obtaining license or
taking/passing exam
Rendering or offering to render services outside of
area of training, experience, or competence
Committing unethical practices
Unprofessional conduct as determined by the Board
Operation of a medical facility when the license is
suspended or revoked
Failure to pay child support

8. Discipline
 Probation
 Suspending license for not more than a year
 Revoking license
 Public reprimand
 Limiting practice
 Fine not more than $5000.00
 Complete another examination

9. Requirements
 Age 21 or more
 Good moral character
 Citizen of US or entitled to work in US
 Education approved by Board
 Two years postgraduate experience in MFT
 3000 hours supervised experience of which
1500 is direct contact with clients
 Undergraduate degree from accredited
institution approved by Board

10. Understanding Ethics
 A therapist had just gone through treatment
for cancer and was returning to work after a
sabbatical. She believed she was fully
recovered from the chemotherapy, including
symptoms of extreme fatigue and mental
deficits, but isn’t quite sure. What would you
tell your colleague if she came to you for
feedback?

11. Professional Responsibility
 Advertising
 Impairment
 Relationship Exploitation
 Boundaries
 Giving/receiving fees
 Consultation
 Disparaging colleagues
 Scope of practice

12. Understanding Ethics
 A client tells you that they were in therapy
four years ago and had a sexual relationship
with the therapist. What do you do?

13. Understanding Ethics, Redux
 You share an office with three colleagues and
frequently notice the comings and goings of
their clients, as they do yours. One day you
are at Starbucks to meet a friend for coffee
and you notice one of your colleagues with a
current client. He leans over and kisses her.
What do you do?

14. Professional Responsibility, Cont.
 Reporting
 Practice base
 Current knowledge
 Record keeping
 Records to the court
 Supervision/supervisee
 Board notification

15. Understanding Ethics
 A therapist had been working with XYZ
insurance company and frequently
experienced problems with them giving
accurate benefits/coverage information. A
new client attends their first appointment and
the therapist found that they had XYZ
insurance as their primary carrier. What
should the therapist do?

16. Responsibility to Clients/Others
Professionalism and Competence
Safeguard the interests of incompetent client
Deal with legal representatives of clients
Non-discrimination
Cannot misrepresent efficacy/results of
services
 Apprise of rights, risks, financial obligations
 Consultation
 Termination
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17. Understanding Ethics
 A therapist in private practice noticed that one
of his neighbors had begun to date one of his
clients. What should he do?

18. Responsibility to Clients/Others, Cont.
 Withdrawing services
 Termination/Interruption of services
 Influence
 Personal/sexual relationships
 Dual relationships

19. Understanding Ethics
 You have an intern and regularly observe or
watch video-tapes of sessions. In a recent
review you watch a video of your intern
performing a type of therapy that is not listed
on their training outline and is not one that
you have any experience with. What do you
do?

20. Unprofessional Conduct
 Intern: Performs services outside the scope
of internship plan
 Performing therapy with a lapsed license
 Failing to cooperate with an investigation
 Gross negligence
 Malpractice

21. Code of Ethics
 AAMFT Code of Ethics utilized “as a standard
for professional conduct in the State of
Nevada”

22. Understanding Ethics
 A client attends his first session clearly under
the influence of alcohol. Normally the
therapist goes through the consents in the
first session. What should this clinician do?

23. AAMFT Code of Ethics:
Responsibility to Clients
 Non-Discrimination
 Informed Consent
 Multiple Relationships
 Sexual Intimacy with Current Clients and
Others
 Reports of Unethical Conduct
 No Furthering of Own Interests
 Client Autonomy in Decision-Making

24. Understanding Ethics
 You have a client you have been seeing for
some time who is moving to a rural area of
Nevada. They want to keep ‘seeing’ you as a
therapist and suggests you set up a way to
have sessions via Skype. What are your
obligations?

25. AAMFT Code of Ethics:
Responsibility to Clients, Cont.
 Relationship Beneficial to Client
 Referrals
 Non-Abandonment
 Written Consent to Record
 Relationships with Third Parties
 Electronic Therapy

26. Understanding Ethics
 During a break in a court-ordered evaluation
for a client’s inclusion in a domestic battery
group, the therapist hears the man brag to
others he knows in the waiting room about
the crime and that he is selling drugs. Can
the therapist include this in the report to the
court?

27. Understanding Ethics
 A therapist gives a speech to a group of
colleagues and includes a case example with
occupation, family constellation, city of
residence, while other patient demographics
were disguised. The therapist shares a dream
the client had and someone in the audience
was able to identify the patient because they
had described this dream to them, as well.
What should this therapist have done
instead?

28. AAMFT Code of Ethics:
Confidentiality
 Disclosing Limits of Confidentiality
 Written Authorization to Release Client
Information
 Confidentiality in Non-Clinical Activities
 Protection of Records
 Preparation for Practice Changes
 Confidentiality in Consultations
 Protection of Electronic Information

29. Understanding Ethics
 A therapist came home early one day to find
her husband in bed with her best friend. A
large portion of her practice was conducting
couples therapy. She comes to you as a
colleague devastated and wants to know
what she should do about her work. What
would you tell her?

30. AAMFT Code of Ethics:
Professional Competence and Integrity
 Maintenance of Competency
 Knowledge of Regulatory Standards
 Seek Assistance
 Conflict of Interest
 Veracity of Scholarship
 Maintenance of Records
 Development of new Skills

31. Understanding Ethics
 An adolescent client had been in therapy and
was preparing for termination after a very
successful therapy experience. During the
second to last session she brings you a handmade necklace. Since therapists are
discouraged from receiving gifts, what do you
say? What if she was from a wealthy family
and the necklace was clearly very expensive?

32. AAMFT Code of Ethics:
Professional Competence and Integrity, Cont.
Harassment
Exploitation
Gifts
Scope of Competence
Accurate Presentation of Findings
Public Statements
Separation of Custody Evaluation form
Therapy
 Professional Misconduct
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33. Understanding Ethics
 A therapist/supervisor was having a casual
conversation with a colleague who revealed
one of her supervisees had made several
very harsh, racial comments at a recent
professional lunch. In supervision there had
never been any indication that the supervisee
held racially-biased opinions. When reporting
to the Board at the 6-month review, do you
report this information? What would you do?

34. AAMFT Code of Ethics:
Responsibility to Students and Supervisees
 Exploitation
 Therapy with Students or Supervisees
 Sexual Intimacy with Students or Supervisees
 Oversight of Supervisee Competence
 Oversight of Supervisee Professionalism
 Existing Relationship with Students or
Supervisees
 Confidentiality with Supervisees

35. AAMFT Code of Ethics:
Responsibility to Research Participants
 Protection of Research Participants
 Informed Consent
 Right to Decline or Withdraw Participation
 Confidentiality of Research Data

36. Understanding Ethics
 You work for ABC agency. A couple comes in
for couples counseling to deal with the
conflicts that have come up in their
relationship due to their daughter who is
bipolar. The couple does not have couples
therapy coverage with their insurance. The
clinic director says to bill it as individual
therapy for the child. What do you do?

37. AAMFT Code of Ethics:
Responsibility to the Profession
 Conflicts Between Code and Organizational
Policies
 Publication Authorship
 Authorship of Student Work
 Plagiarism
 Accuracy in Publication and Advertising
 Pro Bono
 Advocacy
 Public Participation

38. Understanding Ethics
 A therapist worked a part-time job in a rural
community conducting school-based
counseling for children acting out at school.
The community suffered some economic
consequences that precluded them from
financially paying the therapist so they offered
him room, board, office space and travel
reimbursement. Should the therapist agree?

39. AAMFT Code of Ethics:
Financial Arrangements
 Financial Integrity
 Disclosure of Financial Policies
 Notice of Payment Recovery Procedures
 Truthful Representation of Services
 Bartering
 Withholding Records for Non-Payment

40. Understanding Ethics
 When reviewing a publishing Website that
was advertising her very first book, a therapist
realized that they claimed that she was a
professor of psychology at a university that
she had taught at several years before as an
adjunct professor. What should she do?

41. AAMFT Code of Ethics: Advertising
 Accurate Professional Representation
 Promotional Materials
 Professional Affiliations
 Professional Identification
 Educational Credentials
 Correction of Misinformation
 Employee or Supervisee Qualifications
 Specialization

42. Understanding Ethics
 A therapist is has some questions about the
treatment of a very contentious couple who
are threatening divorce every session. She is
concerned about her objectivity and
interventions since the way they fight reminds
her of her first marriage when she was 20.
She took some notes to herself and wonders
if she should seek consultation with a
colleague. What are her obligations in
regards to record keeping?

43. Other Ethical Issues
 Domestic Violence—Child Abuse
 Emotional Abuse of Children
 Financial Abuse of Elders
 Guilty and No Contest pleas
 HIPAA
 Immunity from Liability
 Joint Legal Custody
 Record Keeping

44. Understanding Ethics
 A 16-year-old mother who is receiving State
Medicaid makes an appointment to see you
for help adjusting to parenting and dealing
with friends who have rejected her because
she kept her baby. She continues to live with
her parents who are very religious and do not
believe in therapy. Who signs the consent
forms?

45. Other Ethical Issues, Cont.
 Leaving an Agency
 Treating minors without Parental Consent
 Online therapy
 Privilege
 Billing Practices: Self and Interns
 Service of a Subpoena
 Termination
 Renewing license and Malpractice

46. Understanding Ethics
 A client leaves a series of voicemails that
articulate a desire to hurt the therapist and
the front office personnel. What are the
therapists confidentiality obligations? What
should she do? Can she terminate the
therapeutic relationship?

47. Other Ethical Issues, Cont.
 Hypnosis and Crime Victims
 CEU’s
 Violence against Therapist and Confidentiality
 Suicide and Confidentiality
 Experimental Therapies
 Referrals
 Abuse in other States

48. Understanding Ethics
 A judge ordered a convicted sex-offender to
receive weekly therapy. What obligations
does the therapist have to the court? What
obligations does the therapist have to the
client?

49. Ethical Decision Making
(Fisher, 2003)
 Step 1: Professional commitment
 Step 2: Be familiar with the ethics code
 Step 3: Gather facts
 Step 4: Understand stakeholders’
perspectives
 Step 5: Apply 1-4 to generate ethical
alternatives
 Step 6: Select and implement and ethical
course of action.

50. Contact Information
 Trudy Gilbert-Eliot, M.S., LMFT, LADC
 Nevada Marriage and Family Therapist
#0828
 Nevada Licensed Alcohol and Drug
Counselor #0127L
 458 Court Street
 Reno, NV 89501
 775-772-9017
 nvpsych@sbcglobal.net