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Ethics and Alternative Therapies:

An important aspect of professional ethics within a professional organization is

protecting its members. Professional organizations often put in place self regulation,

in the form of ethics, which adds to their credibility and adds a layer of protection to

the public. As stated in the Preamble of the American Association for Marriage and

Family Therapy (AAMFT) Code of Ethics, “Both law and ethics govern the practice

of Marriage and Family Therapy. When making decisions regarding professional

behavior, marriage and family therapists must consider the AAMFT Code of Ethics

and applicable laws and regulations.”

Considerations

for Competent

Therapists

When therapists consider incorporating alternative therapies into their clinical practice, it is important to reflect on the ethical implications. Working outside commonly acceptable clinical practices increases responsibility on the therapist and makes them vulnerable to liability. With this in mind, this article will offer an ethical lens through which to consider the value and liability of adding alternative therapies to your practice.

A historical look at our field reveals that our profession was at one time, and may be viewed currently by some, as an alternative approach to mental health treatment. It was the creativity of people like Don D. Jackson, MD, Murray Bowen, MD, Nathan Ackerman, MD, Milton Erickson, MD, Jay Haley, Gregory Bateson and others who questioned the wisdom of their day and challenged the psychiatric view of mental illness as something residing within an individual to one that viewed symptomatic behavior as an outgrowth of interactional patterns between people, primarily family. It is only through research, data collection and the replication of outcome results that the field of MFT has moved from an alternative approach to a mainline approach.

One definition of “alternative therapies” can be found at the United States Department of Health and Human Services–Substance Abuse and Mental Health Services Administration’s National Mental Health Information Center for Mental Health’s Web page, which states: “An alternative approach to mental health care is one that emphasizes the interrelationship between mind, body, and spirit. Although some alternative approaches have a long history, many remain controversial.” Kennedy, Mercer, Wohr and Huffine (2002) define alternative therapies as: “…unvalidated treatments (UTs) are therapies for physical or mental health problems that are used in the absence

of empirical or theoretical support for their effectiveness, despite substantial evidence that they are worthless or harmful. They are frequently based on assumptions that are at odds with paradigms generally accepted by professionals working in related areas. UTs are often described as ‘unconventional,’ ‘unorthodox,’ or ‘alternative’ approaches.”

As therapists consider integrating alternative or unvalidated treatments into their practice, they incur additional liability, due in part to the lack of peer reviewed clinical data supporting the effectiveness and validity of the method. This risk, from an ethical standpoint, is greater between an approach’s inception and the dissemination of multiple peer reviewed outcome studies supporting the effectiveness of the alternative treatment.

As you consider incorporating alternative therapies into your clinical practice, keep in mind the following ethical points. While not an exhaustive list, this will provide fundamental guidelines.

Principle 1.2 Marriage and family therapists obtain appropriate informed consent to therapy or related procedures as early as feasible in the therapeutic relationship, and use language that is reasonably understandable to clients. When using alternative therapies, it is important to inform clients of any potential risks associated with the treatment, as well as information regarding the validity of the proposed treatment. This “informed consent” should include information regarding the lack of research or clinical support for a type of treatment, if such exists. Keep in mind that if you have to persuade the client to gain consent, you have violated this principle.

Peter D. Bradley, PhD Lee Greenwood, JD

they have recently graduated from a training program, or therapists with a qualifying master’s degree listing a PhD and referring to themselves as “doctor” only to find out the doctoral degree is in something other than a mental health discipline. While it should be clear that these choices violate principle 8.1, it may be more difficult for people seeking professional help to make sense of the litany of letters after a therapist’s name, or the statements of expertise or certification in an unfamiliar treatment method. It is the member’s responsibility to be forthcoming and to represent the facts regarding clinical competencies, level of training and the clinical evidence supporting alternative therapies.

Principle 8.8 Marriage and family therapists do not represent themselves as providing specialized services unless they have the appropriate education, training, or supervised experience.

This principle should simplify the decision process of a member considering the use of an alternative therapy. Before a member integrates alternative therapies into his or her practice, a few questions should be asked. Does the alternative therapy have a clearly defined educational process that is shown to equip the therapist with the appropriate level of skill and competence to practice? Does peer reviewed research exist that substantiates the effectiveness of the alternative therapy? Does peer reviewed research exist that may indicate contradictions or cautions related to the alternative therapy? Are peers or supervisors available for consultation who have achieved an advanced level of skill, training and experience utilizing the alternative therapy?

Ethics, by its very nature, is the attempt to make black and white out of gray. It is a difficult process, with ethical decisions made by the AAMFT Ethics Committee, in conjunction with legal staff. It is the hope of the authors that this information will offer a lens through which you can make a determination, assess the risks to you and your clients, and make sound judgments as you consider incorporating alternative therapies into your practice. n

Peter D. Bradley, PhD, an AAMFT Clinical Member and Approved Supervisor, is the president and CEO of Cross

Timbers Family Therapy, PLLC, located in Flower Mound, Texas. He currently serves as chair of the AAMFT Ethics committee.

Lee Greenwood, JD, is an attorney on the AAMFT staff. His primary responsibility is in the ethics and legal risk-

management functions of the Association.

Reference Kennedy, S., Mercer, J., Mohr, W., & Huffine, C. (2002). Snake oil, ethics, and the First Amendment: What’s a profession to do? American Journal of Orthopsychiatry, 72(1) pgs 5-15.

The AAMFT’s Code of Ethics can be viewed online at http://www.aamft.org/resources/LRM_Plan/Ethics/ethicscode2001.asp.

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Principle 1.4 Sexual intimacy with clients is prohibited. One type of alternative therapy that may violate this principle is found in the literature on sex therapy. Providing therapeutic treatment as a sexual surrogate would be a violation of this principle.

Principle 1.9 Marriage and family therapists continue therapeutic relationships only so long as it is reasonably clear that clients are benefiting from the relationship. When considering an alternative therapeutic method, keep in mind that the lack of research often makes it difficult to predict therapeutic progress. It is the therapist’s responsibility to attend to the client’s needs, identify reasonable goals for therapy, and assess the progress, or lack of progress, towards these goals. If a therapist is aware that no therapeutic benefit is resulting from treatment, it is his or her responsibility to address this and alter the treatment approach. The therapist may also need to consider a referral to a therapist better suited to work with the client (Principle 1.10).

Principle 3.1 Marriage and family therapists pursue knowledge of new developments and maintain competence in marriage and family therapy through education, training, or supervised experience. As individuals consider advanced degrees in the field of mental health, they quickly realize that training as an MFT requires a greater time commitment to obtain a qualifying degree than most mental health professions. The Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE) has historically set the bar high with both course work and clinical experience. While most counseling programs require less than 50 graduate credit hours of course work, it is generally expected that COAMFTE masters programs will require more than 60 graduate credit hours, as well as 500 client contact hours and 100 hours of supervision. It is this same quest for knowledge that should drive a member’s decision to integrate alternative therapies into their practice.

Principle 3.7 While developing new skills in specialty areas, marriage and family therapists take steps to ensure the competence of their work, and to protect clients from possible harm. Marriage and family therapists practice in specialty areas new to them only after appropriate education, training, or supervised experience. Protecting clients from possible harm should be at the forefront of every therapist’s mind. When a member considers integrating an alternative therapy into his or her practice, this goal should become even more apparent. One step in this process is for the therapist to inundate themselves with relevant, peer reviewed research on the alternative therapy. It is through this objective and comprehensive study that a therapist can achieve a level of competence in a new treatment modality or be equipped to judge the alternative therapy inappropriate for their clients’ care.

Principle 8.1 Marriage and family therapists accurately represent their competencies, education, training, and experience relevant to their practice of marriage and family therapy. It is common to read bios of therapists representing themselves as having many years of experience “helping people and families” only to discover