In marital and familial relationships, maintaining confidentiality is complicated because of the different parties that are involved. Because of this complication, the American Association of Marriage and Family Therapy (AAMFT) and the American Psychological Association (APA) recommend that polices regarding confidentiality are discussed before the onset of therapy as part of the informed consent. In specificity, section 2.2 of the AAMFT code of ethics states the following
“ When providing couple, family or group treatment, the therapist does not disclose information outside the treatment context without a written authorization from each individual competent to execute a waiver,” ( Code of Ethics , 2015 )
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The commitment of the body to confidentiality, however, is a significant challenge to the roles of marriage and family therapists. One of the issues that pops up, for example, concerns whether the therapists should contribute to keeping secretes or whether they should reveal them at some point in during their therapy sessions. The problem may be more elaborate in cases involving children since their decision-making instincts may be doubtful. Alongside the identified dilemma, confidentiality in marriage and family therapy raises some significant issues about cultural implications. This essay appraises the AAMFT code of ethics for underlying cultural principles. The essay finds that the reviewed code of ethics assumes that each individual has the capacity to make their decisions, which is pegged on the cultural values of autonomy that may vary from one setting to another, and because of this perspective, the AAMFT code of ethics may only thrive in individualistic cultures.
The Principle under Review and the Underlying Cultural Assumptions
The paper reviews the second standard of the AAMFT code of ethics, which is confidentiality. As indicated in the introductory section of this paper, a therapist is barred from making unauthorized disclosures when working with families. The primary cultural idea underpinning this principle of the code of ethics is individuality. Precisely, the principle is in tandem with the ideals of the Western world that appear to promote individualism (Kuo, 2009). AAMFT spells out that therapists should prioritize confidentiality, which is why are supposed to indicate to their clients about what would be disclosed and what would remain confidential. Consequently, it may be difficult to separate confidentiality from autonomy, since the two principles suppose that individuals have the right to make informed decisions provided they meet the legal definitions of the term (Jansen, 2007). In this case, autonomy related to the personal self-determination, which may be interpreted as the rights of the clients to take directions of their choosing, to act according to their beliefs, and to control their own lives. Studies indicate further that autonomy enshrines the freedom of action and thought provided that the actions and thoughts of the individuals involved do not interfere or threaten to interfere with the wellbeing of others (Mignome et al., 2017). Autonomy, therefore, founds confidentiality—respecting the clients’ rights to self-determination demands respecting individuals’ choices concerning the disclosures and uses of their personal information.
It is imperative noting that therapists undergo training on their ethical obligation to safeguard confidentiality in their practical experiences, which often includes the limits to confidentiality that the law defines for different jurisdictions early in their training. Consequently, the therapists come to identify confidentiality as the primary factor that promotes trust in their relationships with clients (Sametband & Strong, 2018). In their practice, marriage and family therapists develop expectations concerning the manner in which confidentiality works, as well as the benefits that it offers an individual. The underlying perception of the therapists, as Mignome et al. (2017) aver, is that family members of their clients would always respect and seek to maintain and accept the boundaries created by confidentiality. The APA and ACA, The American Counseling Association, codes of ethics have been criticized a great deal over the years because of the consideration that they place a greater value on individuality and autonomy (Atkinson, 2004). The ethical codes of the two bodies have the ethical mandates to comprehend the cultural backgrounds of their clients, which is true for AAMFT. However, because of their emphasis on individuality and autonomy, the ethical codes reflect the values, norms, and culture of the Western society (Vandecreek & Meer, 2002).
Autonomy is one of the most preferred principles in Western cultures. Extant anthropological research suggests that autonomy, especially when perceived as the actions that originate from self, is among the human universals (Pinker, 2002). The cited literature may infer that regardless of the society, culture, and country in which people reside, they always have a clear idea that a number of their actions can be and should be regulated by themselves, and that a number of their behaviors could be regulated by forces operating outside them. In combination with other universals, such as choice making, intentions, self-is-responsible, and self-control, the universals results in a vivid picture of the comprehension of autonomy that may be viewed as a psychological state that entails the intents to act that originate from the self, and which happen when people make choices among alternatives (Wulff, St George, & Besthorn, 2011). If choices are autonomous, it follows that the self has the responsibility of this action, which regulates the self-determined actions of persons in accordance with their moral perspectives and the views of the world in which they live. Nevertheless, the perceptions need to be internalized and deeply incorporated into an individual’s self in order for the perceptions to be guidelines of actions done autonomously (Abrahams & Salazar, 2005). The logic founding this reasoning results in the deduction that autonomy is an element of human nature, and that every individual may practice it under favorable conditions.
The code of ethics at AAMFT inclines further on the principle of confidentiality and autonomy because of the constructionist perspective of the term and its meaning. According to Wulff, St George, & Besthorn (2011), autonomy should be perceived from a constructionist standpoint, which holds that the term refers to a moral value that is a product of social construction in the network of meanings and practices of a specific culture and society. Viewed as a socio-cultural development, alongside with other moral values, including individualism, human rights, and others, is not culturally common, and that it is relative.
The preference for autonomy by the West is not surprising. According to Abrahams and Salazar (2005), autonomy is the primary factor that contributes to individualism, which Hofstede (2001) identified as a system of cultural practices and presentations in which priority is given to the preferences, goals, and needs of an individual as opposed to those of a group. Western societies perceive individualism as a series of cultural practices, meanings, and values, which has been developed throughout the history civilization. The patterns, researchers suggest, have offered persons with the guidelines and standards for the processes of decision making in their conduct (Krumm, 2009). The cited author posits that individualism is among the several cultural value systems that are distributed among different countries, ethnic groups, and societies. As a moral value, autonomy is one of the foundations of individualism, which informs the argument that it is bounded by cultures, which practice and propagate the principles of individualism. However, when autonomy is perceived as a universal and natural tendency of people to execute their actions willfully and to endorse the actions in which they engage fully, they the tendency becomes a universal attribute of people living in any society regardless of their cultural values.
It could be that the West favors the universal approach to the definition of autonomy. For example, in Western societies, the value of autonomy is treated carefully to the extent that it now informs some of the policies of social wellbeing (Krumm, 2009). In some countries, especially the US, the law provides many statues that guarantee autonomous actions of individuals, and autonomy is secretly considered one of the universal rights of people. In the context of marriage and family counseling, autonomy implies that therapists do not reveal confidential information without following the defined procedures, such as those that the code of ethics such as those outlined by the AAMTF. In practical terms, Western societies allow children, spouses, and relatives to enter into contracts with marriage and family therapists without the knowledge of their families, and expect that they might manage to keep their undertakings a secret.
Potential Conflict that would Result after Applying the Principle in a Different Culture
While the idea of confidentiality may apply to the Western context, it may fail and result in an ethical dilemma in other cultures, including south Asia. Notably, problems may arise when therapists fail to critique the appropriateness of these values in the cultural context of south Asia as well as other clients from different cultural backgrounds that are defined by collectivism and interdependence. Counselors who view personal autonomy as an indicator of maturity in the development of people may misunderstand or misdiagnose the experiences of a south Asian late adolescents or adults who want, or are at least responsive to, familial inputs before they make decisions (Krumm, 2009). When the conflict arises, the therapists may label their client as overly dependent or immature, which communicates the need for practitioners to understand the cultural implications of codes of ethics. Any therapist seeking to develop cultural comprehension while upholding the values of individualism and autonomy at the same time might face ethical conflicts and concerns.
Comprehending the conventional south Asian view of the world is critical in knowing the way in which the concepts of confidentiality and autonomy are perceived by this group. Typical south Asian clients, as reported by Abrahams and Salazar (2005), are more comfortable and familiar with the ideas of family interdependence and collectivism. Nevertheless, it is useful not to presume that every individual in this context values the concepts equally—the levels of acculturation of the clients affects where they lie in the continuum of independence and interdependence. Consequently, it is always prudent for therapists to assess the worldview of their clients before beginning the process.
One of the most important issues for therapists to note is that marriage and family counseling is not widely acceptable in south Asia. Instead, a significant proportion of the populace prefer deferring issues to the authority figures of the family and the extended families as the primary method of marital conflict resolution (Wulff, St George, & Besthorn, 2011). The cited literature identifies that clients from south Asia perceive that the process of decision making is prerogative of the head of the family and the household, which is mostly the eldest male. In this case, the clients do not make decisions by upholding their personal needs exclusively. Instead, what is best for the clients is often what is considered the best solution for the family. The collectivist model of thought translates to the realm of counseling. It is common for members of the family of adult south Asian clients to demand or expect that they be consulted and included during the treatment sessions. In most cases, it is highly unlikely that the family members would approve of one of them moving outside the extended families and communities to seek for help of any type. According to Abrahams and Salazar (2005), concerns, issues, and problems are always considered family business. When a problem emerges, the family decision makers unilaterally decide the course of action that should be taken, and their authority is never questioned. The decision makers are respected through the depiction of obedience for what they perceive to be the best outcomes for their families.
As illustrated in the following case study, a counselor who is not accustomed to the worldview of clients from south Asia may encounter unethical challenges with respect to confidentiality and autonomy that is stressed in the AAMFT code of ethics.
Damia is an eighteen-year-old high school senior student who sees her school counselor for an issue that she has been struggling with for a long time. She indicates that she is not happy with his parents because they forbid her to data. It is understood that Damia’s parents are immigrants from Malaysia where dating is considered a taboo, and her parents are staunch in their respect for the social norm. The extended and immediate family of the client will embark on the process of searching for a lifelong mate for her as soon as she shall attain the right age. Damia’s family will most likely not solicit her ideas concerning her spouse. In addition, Damia will be expected to abide by the choices of the family concerning her future.
Damia also indicates that she is not able to confide in her friends from Malaysia or any person in her extended and immediate family. Family members and friends would be shocked and appalled that she was contemplating these thoughts, and they would not hesitate to report her to her parents who would be angered and chastise her for bringing shame to the family. Sharing her family details with other people is discouraged and shunned in the conventional Malay culture, which makes Damia to feel that she is trapped.
The school counselor is limited in her understanding of the culture of south Asia. She considers referring Damia to outside therapists, but he comprehends that her father may not be happy with the idea. For instance, the family may ponder how the school counselor discovered that their daughter needs counseling. On the other hand, speaking to the family concerning Damia’s situation may put his client in a compromising condition with the rest of her family members. The therapist opts to be a Damia’s sounding board for his client and he explores different avenues with her. He comes up with different situation. First, he contemplated suggesting that Damia applies for a scholarship that would enable her to study in an institution outside her hometown and develop autonomy. He also considers encouraging Damia to engage in extracurricular activities in the school that would allow her to socialize more and meet people from other backgrounds. The third idea that the therapist develops is that he empowers his client to develop assertiveness and voice her concerns while at home. Lastly, he thinks that it might be right for his client to get her family in the dialogue. Sadly, Damia does not consent to any of the four options that the therapist had.
Because of the outcomes of his session with Damia, the counselor develops frustration since he considers that independence is more important as a developmental milestone than most other aspects. He wonders why the family did not value autonomy and responsible behavior among their children. The therapist ends up thinking that Damia lives in an oppressive family, but she feels that she has nothing to offer. The therapists is at crossroad, and he wonders whether disrupting the family norms would be proper for his client.
The cases study indicates the need for counselors to be sensitive to the cultural implications of their practice. Mostly importantly, the code of ethics that govern their practice should depict sensitivity to this aspect. It would be important for therapists to examine and make their philosophical assumptions of ethics and culture explicit. They may also want to examine alternative philosophical presumptions that would lead them into adopting more inclusive strategies. The case study also informs the need for counselors to work towards comprehending the way in which culture is relevant to counseling. The therapist also needed to have developed complex thinking skills that are pegged on creativity. Lastly, it is imperative for the therapists to develop emotionality through multicultural competence.
Suggestion to Improve the Code
The implications of cultural believes on the ethical codes of conduct suggests the need for improvement. The AAMFT, for example, needs to lessen its stance on confidentiality and consider that it is not a standard for successful therapy sessions. One idea that would benefit the institution’s code of ethics would be to change the process of informed consent to avoid stating that the information shared between the client and the therapist would be confidential. To avoid the thought that the suggestion would violate the legal provisions on the same, it would be important not to assume that the proposal would replace the standard practice that is common in western culture. Therefore, during the informed consent process, AAMFT practitioners should make it a priority to customize the processes to the needs of the client through an exercise of flexible disclosure policies. That is to mean that therapists should seek to understand the cultural backgrounds of their clients and what would be best for them instead of imposing confidentiality and autonomy principles on everyone.
Conclusion
Cultural practices have significant implications on the development of codes of ethics in marriage and family counseling. The literature and examples used in this essay have indicated the importance of therapists’ understanding of the cultural backgrounds of their clients if they are to deliver effective counseling sessions. As much as the AAMFT code of ethics acknowledges cultural diversity, this paper has found that it seeks to promote the element of autonomy, which is characteristic of the individualistic cultural orientations of the West. The principle seeks to promote independence among community members with the perception that they are legally responsible for their actions. However, individualism appears to conflict with the family ideals of people from other cultures that uphold collectivistic ideologies. The case study of south Asian culture, for example, indicates that while the West prefer using therapists, people from this culture use the heads of their families in conflict resolution. Consequently, a therapist who sticks to principles of autonomy may struggle in the south Asian context because their principles may appear to interfere with the family setting, especially through promoting the concealment of secrets between couples and the rest of the family members. The AAMFT may want to be more culturally relevant to people in diverse cultures through lessening its stance on confidentiality, and by adopting a flexible principle during the consent process.
References
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