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Critiquing Disciplinary Meeting Minutes
Haley Thompson
MFT 5102: Legal, Ethical, and Professional Development in Marriage and Family Therapy
Dr. Leonard Bohanon
November 12, 2023
2
Critiquing Disciplinary Meeting Minutes
Marriage and family therapists are held to the highest professional and ethical standards,
and are committed to helping others and working towards the betterment of society. They are
dedicated to providing care, advocating for others, and creating a safe environment that
encourages others to heal, learn, or discover a new perspective on life. Furthermore, marriage
and family therapists are focused on the creation of laws and regulations related to therapy that
promote the welfare of society. They are also dedicated to amending any existing laws and
regulations that do not align with the public's best interests (AAMFT, 2015). Legal and ethical
codes are the cornerstone to best practice, and therefore are top priority for any therapist to learn
and abide. This paper will address a few ethical pitfalls for therapists, examine code violations in
two states, and discuss common disciplinary actions taken by regulatory boards.
I am a Marriage and Family Therapy student currently preparing for licensure in Florida.
However, as a military spouse, I have lived in many places and will realistically need to plan
ahead for transferring my license to another state in the future. The most likely place we will
return to is New Mexico so I will be examining the most frequently occurring ethical violations
and disciplinary actions in those two states over the last 10 years. Generally, both states had
similar results regarding violations, but there were noticeable differences in how they addressed
discipline; for instance, many cases in Florida resulted in license surrender or revocation with a
permanent ban while New Mexico allowed the vast majority of its violators to reapply for
licensure after 5 years and other conditions were met. I found these differences intriguing and
will address them in more detail presently.
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Code Violations
In Florida, the most frequent regulatory code violations I found were
456.0635,
491.009(1)(k), 491.009(1)(r), 491.009(1)(w), and 491.0111, Florida Statutes (2019). Section
491.009 pertains to behavior that can result in disciplinary actions:
491.009(1)(k)
Committing any act upon a patient or client which would constitute sexual battery
or which would constitute sexual misconduct as defined pursuant to s. 491.0111.
491.009(1)(r)
Failing to meet the minimum standards of performance in professional activities
when measured against generally prevailing peer performance, including the undertaking of
activities for which the licensee, registered intern, or certificate holder is not qualified by training
or experience.
491.009(1)(w)
Violating any provision of this chapter or chapter 456 (Health Professions and
Occupations: General Provisions), or any rules adopted pursuant thereto.
491.0111
Sexual misconduct.
—
Sexual misconduct by any person licensed or certified under this
chapter, in the practice of her or his profession, is prohibited.
456.0635
Health care fraud; disqualification for license, certificate, or registration.
Though more in depth, the Florida Statutes line up well with the AAMFT Code of Ethics (2015),
in which the most frequent code violations were: 1.3 (Multiple Relationships), 1.4 (Sexual
Intimacy with Current Clients and Others), 3.12 (Professional Misconduct). Standard 3.12 is
quite broad and seems to act as a catch-all for actions that will lead to membership termination
such as committing a felony or misdemeanor, or facing discipline from state regulatory bodies
(AAMFT, 2015). These code violations align with findings from past research that show the
most common violations are unprofessionalism, dual relationships (sexual and non-sexual), and
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“other legal arrests” (Wilkinson et al., 2019). The results were largely the same for New Mexico,
however there seemed to be more cases regarding unethical billing practices than in Florida
(New Mexico Regulation & Licensing Department [NMRLD], n.d.).
Key Risk Areas
Looking at the most prevalent code violations in Florida and New Mexico, alongside the
overall trends of most other states (Wilkinson et al., 2019), it seems the key ethics risk areas are
management of appropriate relationships with clients and health care fraud. Therapy by nature is
an intimate practice that requires the trust and honesty of all parties involved. This intimacy
carries a risk of blurring the boundary lines between therapist and client and as the plethora of
reports show, therapists are not always proactive in the management of those boundaries.
Second, at least in Florida, it seems conspiracy to commit and committing health care fraud are a
significant problem for the state’s mental health clinicians. Determining the reasons for and
solutions to this problem is beyond the scope of this paper, nonetheless it is an ethical risk area
that needs to be addressed at the lower levels of education and nipped in the bud before it is
allowed to bloom to fruition at the licensed practitioner level. Some other potential trends not
directly found in the reports might include an increased focus on technology-based therapy since
the Covid 19 pandemic in 2020, and an increased focus on ethical violations concerning cultural
humility and diversity.
Discipline
Regarding the violations mentioned above, the most common disciplinary action taken by
the ethics boards was requiring the therapist to pay a fine along with taking a set amount of
5
continuing education (CE) classes. In some cases, the therapists also had to attend a certain
number of therapy sessions to address the violation. The therapist’s license is suspended until
these requirements are met and a number of years (usually 5) have passed until they are eligible
to reapply or reinstate their license. These actions align with data from previous studies where
fines, mandatory continuing education, and reprimands make up the majority of disciplinary
actions (Ahia & Boccone, 2017). As stated previously, Florida enacts harsher punishments and it
is more common for a therapist’s license to be revoked or voluntarily surrendered, both with the
stipulation that the therapist is barred from ever reapplying or practicing counseling in the state
again (Florida Department of Health [FDOH], 2023).
The ethics board’s decision to take disciplinary action is typically based on several
different factors, including the nature and severity of the violation, the impact on the client(s),
and the therapist’s cooperation with the board on addressing and correcting the issue (Florida
Statutes, 2019). The goal of the board’s decisions is to protect the client(s) and ensure adherence
to ethical policies by taking actions that uphold both the law and the established ethical
principles.
Avoiding Violations
To avoid ethical violations, therapists should
s
tay informed about state licensing
regulations and the AAMFT Code of Ethics (even if they are not a member). It is always
essential to maintain clear boundaries with clients, this point is highlighted by the frequency of
violations for dual relationships. This can be achieved proactively during the initial consent
process by explaining rules, expectations, and boundaries up front with the client, and then
continuing to maintain or re-establish those boundaries as necessary. Supervision and peer
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consultation are good tools to use here as well as both a support and an outside lens of the
relationship. Not committing health care fraud seems like an obvious answer, but to avoid any
type of legal missteps it is wise to maintain supervision or professional relationships with
colleagues to help keep each other responsible and accountable. When in doubt, seek the advice
of the ethics board and/or the practice lawyer to ensure the action is both legal and ethical before
proceeding. Taking continuing education courses, especially those geared towards ethics and
morality are a great way to stay up to date on best practice. Additionally, staying involved in
professional organizations like AAMFT and local MFT organizations can provide great resources
to help therapists stay updated on ethical practices.
Finally,
it is crucial to conduct regular self-
assessment, seek ongoing supervision, and be open to feedback to ensure ethical practice.
Case Example
I have been seeing a client, who is a teacher, for 18 months and have established a strong
therapeutic relationship, and the client has made great progress toward her goals. However, the
new school year is approaching and I have just discovered that my child was placed in the
client’s class. Following the
Practitioner’s Guide to Ethical Decision Making
I must decide how
to resolve the dilemma of a dual relationship with the client while upholding the principles of
autonomy, justice, beneficence, nonmaleficence, and fidelity (Forester-Miller & Davis, 2016). I
have identified this as an ethical problem (step 1) and acknowledge it potentially violates both
the AAMFT Code of Ethics and Florida’s ethical guidelines (step 2). Now I must consider the
nature of the dilemma (step 3) and determine which principle to prioritize. In this case, I believe
beneficence and fidelity are key; as such, my decision needs to be most beneficial to the client,
and I need to be open and honest about the dilemma during a discussion with the client over the
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1. Identify the problem
2. Apply the relevant
Code of Ethics
7
issue. I see two main options in this case (step 4, 5), I can recuse myself from therapy, provide
my client with ample resources, and continue to support her through the transition of care. This is
the safer option as far as ethical violations go; however, it could potentially harm the client and
her progress by terminating the relationship that has been building for 18 months. Or, I can
continue to see the client, but will need to review consent, document all interactions, and set firm
boundaries between our professional relationships to ensure confidentiality and ethical practice.
This option is riskier, but is potentially beneficial for the client should she want to continue
therapy with me while acknowledging the risks and complications of also being my child’s
teacher. Consulting with my supervisor or more experienced colleagues will likely help me in
this dilemma as well. There is a third option of just requesting a change of teacher through the
school but for the sake of this paper we will pretend that is impossible. Of those two options, I
feel that transitioning the client to another therapist and supporting her through the transition
would be the best decision (step 6). I will have a thorough discussion with her about the issues
and explain my position as the therapist and my ethical obligations, being mindful of her
autonomy and showing respect my being open, honest, and including her in the decision (step 7).
Moving forward it will still be complicated to maintain the boundaries of prior client/child’s
teacher, but if all is documented well and boundaries maintained then I feel this is the most
beneficial solution for all. If issues should arise from this decision, then they can be addressed
and the advice of the ethics board may need to be consulted.
Practitioner’s Guide to Ethical Decision Making
3. Determine the nature
and dimensions of the
dilemma
4. Generate potential
courses of action
5. Consider the potential
consequences of all
options and determine a
course of action
6. Evaluate the selected
course of action.
7. Implement the course
of action
8
References
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Ahia, C. E., & Boccone, P. J. (2017). Licensure board actions against professional counselors:
Implications for counselor training and practice.
VISTAS Online.
counseling.org/knowledge-center/vistas
American Association of Marriage and Family Therapy. (2015).
AAMFT Code of Ethics
.
https://www.aamft.org/Legal_Ethics/Code_of_Ethics.aspx
Florida Department of Health. (2023).
Discipline & administrative actions.
Retrieved from
https://mqa-internet.doh.state.fl.us/MQASearchServices/EnforcementActionsPractitioner
Florida Statute. Title XXXII § 456 (2019).
https://www.flsenate.gov/Laws/Statutes/2018/Chapter456/All
Florida Statute. Title XXXII § 491 (2019).
https://www.flsenate.gov/Laws/Statutes/2018/Chapter491
Forester-Miller, H. & Davis, T. E. (2016).
Practitioner’s guide to ethical decision making.
American Counseling Association. Retrieved from
https://www.counseling.org/docs/default-source/ethics/practioner's-guide-to-ethical-
decision-making.pdf?sfvrsn=0
New Mexico Regulation & Licensing Department. (n.d.).
Counseling and therapy practice:
Discipline and enforcement
. Retrieved from https://www.rld.nm.gov/boards-and-
commissions/individual-boards-and-commissions/counseling-and-therapy-
practice/discipline-and-enforcement/
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Wilkinson, T., Smith, D., & Wimberly, R. (2019). Trends in ethical complaints leading to
professional counseling licensing boards disciplinary actions.
Journal of Counseling &
Development, 97
(1), 98-104