- Center for Ethical Practice - https://centerforethicalpractice.org -

Couples in Therapy: Ethical, Legal, and Practical Issues

When working with couples in therapy, certain policies and practices can predictably create ethical dilemmas &/or lead to legal complications. Couple therapy is difficult enough without adding unnecessary complications. This workshop is designed to help you anticipate, prevent, and/or minimize risks to clients – and thus to yourself.

John Schroll

John T. Schroll, Ph.D.

Mary Alice Fisher, Ph.D.

Mary Alice Fisher, Ph.D.

   I. Ethical Standards Governing Therapy with Couples (Fisher)

 II. Legal Standards Affecting Couples Therapy (Fisher)

A. Licensing Board Standards of Practice
B. General Virginia Statutes
C. Court Case: Va. Supreme Court: Fairfax Hospital v. Patricia Curtis
D. HIPAA-Required “Notice of Privacy Practices”

III. Practical Issues and Ethical/Legal Pitfalls in Couples Therapy (Schroll)

A. Initial Contact: “The Phone Call”

Obtaining information
Providing information

B. First Session Issue #1: Informing Patients

Describing “Rules”
Describing Therapist’s Policies About Confidentiality and Its Limits

Underlying confidentiality rule
Exceptions that apply to all clients (e.g., HIPAA “Notice”)
Rules & exceptions as applied in couple therapy

Describing Therapist’s General Policies

Individual sessions vs seeing only as a couple
Expectations if couple relationship ends
Potential Legal Issues: Records, testimony, divorce, custody
Use of insurance; managed care; “identified patient”

Describing Risks – Possible Positive and Negative Outcomes

Discussing Therapist’s Therapeutic Approach

Answering Questions

C. First Session Issue #2: Making Decisions & Obtaining Consent

IV. Anticipating Pitfalls (Schroll & Fisher)

A. Dual Relationship Issues

B. Boundary Issues/Out-of-session contact: (email, phone, public encounters, etc.)

C. Complications if Couple Relationship Ends (ethical issues; legal issues; clinical issues)

D. Record Keeping, Consent Forms, Audits, etc.

V.  Ethical Problem-Solving with Clinical Vignettes (Fisher & Schroll)

Learning Goals:

1. Describe the ethical and professional standards that might especially apply in couples therapy.
2. List the state and federal laws and regulations that affect couples therapy.
3. Apply these standards when considering practical issues that arise in work with couples.
4. Name some of the avoidable ethical and legal pitfalls when providing couples therapy.