Wilcoxon Ch. 7 Summary

• Establish the importance of external factors, such as institutional traditions and values, as the context for ethical care with couples and families

 • Clarify the effects of meta-issues (i.e., opportunities, vulnerabilities, and exceptions), many of which can be only minimally altered by therapists, couples, or families

-       When there’s a choice to be made between two technically correct paths. 

-       Diversity aspects (economically, racially, situational, etc.)

o   An appreciation for the distinctions in client’s circumstances separates multicultural sensitivity from multicultural competence.  How do we become competent?

-       Vulnerability aspects

o   Are our trauma clients ready to work?  Or are we pushing our timing on them?  We need to be aware of their resistance, timing, complexity, depth, etc. 

-       Exceptions:

o   Not every client is the same.  What worked for one may not work for the other. 

 • Examine the impact of and ethical concerns associated with diagnosis and managed mental health care as contextual frameworks for therapy with couples and families

-       DSM V deals with mental disturbance that occurs within an individual patient.  Relationship and family issues are outside the domain. 

-        DSM deals with an IP, rather than a systems perspective.  If we subscribe to this so we can get reimbursed, are we really subscribing to the idea that there is always a scapegoat in the family?

-       What does releasing diagnostic codes mean? (In terms of informing our clients and getting their consent for releasing diagnostic codes)

-       “We need your help in differentiating those with legitimate mental disorders and those who simply have problems.”  In our program, we always look for a diagnosis, is this a problem?  What do you guys think?

-       Competence to diagnose requires CE and a vigilant effort to stay on top of changes. 

 • Contrast the institutional and professional value conflicts practitioners may face in their efforts to balance ethical care with compliance obligations.

-       Managed mental health care.  What is this exactly?

-       Under most managed health care systems the therapists must be competent in brief therapy with a limited number of sessions.  Could we do this?

-       Dr. Crane—how many sessions is “brief therapy”?

-       Since on page 134 they found a study reporting that brief therapy usually exacerbated people’s symptoms and had them coming back not too much later, are there any insurances that cover long-term therapy?

-       Sometimes management systems demand things that conflict with the client’s best interest, so the therapist should try to bring that to the attention of both parties and work in favor of the client. 

If a law is in contrast with the MFT Code of Ethics, we are allowed to follow the law without fear of disciplinary action by the AAMFTRB.