CAPS Panel on Ethical Conflicts in Marital Therapy

Yesterday at the CAPS national conference I participated in a panel chaired by my colleague at Regent, Dr. Jennifer Ripley, on Ethics in Couples Interventions. The other panelists were Ev Worthington (Virginia Commonwealth University), Toddy Holeman (Asbury Seminary), and Bill Berman (Christian Family Institute). We had several interesting discussions on a range of topics in marriage therapy. The topics included use of forgiveness protocols, dealing with violence in relationships, confidentiality when working with couples, managed care and billing, and working with same-sex couples.

Ev Worthington discussed his work on forgiveness, and all of the panelists shared how they might introduce the concept of forgiveness, challenges when people come at forgiveness with different assumptions, distinguishing forgiveness from other concepts, such as reconciliation or exoneration, and so on. We also discussed a number of clinical issues, such as timing, the misuse of Scripture, etc.

On dealing with violence in relationships, we discussed again the potential misuse of Scripture to rationalize violence (as justified by some abusers to establish authority or maintain order), issues with the use of separation, what it means for the offender to repent, and so on.

The discussion about confidentiality recognized different models for handling it with couples: (1) not keeping secrets, (2) keeping secrets said in an individual session/phone, and (3) using clinical judgment about whether specific information is kept secret (but not promising to hold secrets). Emphasis was placed on working with the disclosing spouse to share information that the other spouse should know (that they themselves would want to know if their roles were reversed), as well as discerning when disclosing a secret is for the good of the marriage or to get a weight off of the disclosing spouse’s shoulders.

The managed care discussion centered on how to treat individual psychopathology in a marital context. One panelist discussed providing services individually with the other spouse present, while others discussed treating individual psychopathology systemically by improving the marital relationship. Still others discussed having couples pay out of pocket if there is no identifiable disorder that can be diagnosed.

In the discussion about Christian mental health professionals working with same-sex couples, the panelists reflected on the challenges some Christians have faced in whether or not to provide services, issues related to professional competence, and value conflicts. A few current cases were mentioned, including the Ward case at Eastern Michigan University. There was some disagreement among panelists on how Christians can (or should) respond to these issues, with one voice emphasizing more of the issue of religious rights and competence, while another voice emphasized value conflicts being normal and occasionally rising to the level of a referral. The panelists discussed different options for Christians in practice, as well as relevant training concerns and what is in the best interest of the client seeking services.

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