•American Association of Marriage and Family Therapists (AAMFT)
•American Board of Examiners in Clinical Social Work (ABE)
•California Association of Marriage and Family Therapists (CAMFT)
•Federation of Societies for Clinical Social Work
•National Association of Social Workers (NASW)

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Excerpted from a presentation at the CICSW convocation on Ethics, June 2002

In order to discuss our various codes of ethics, I have looked at five codes governing our respective professions. One immediately observes that while they all cover much the same ground, there are some interesting differences. For example, a fundamental principle that all the codes have in common is Responsibility to Clients (or Patients). Glancing at this section of each code, you get the impression that they have a great deal in common. On closer examination, they differ in remarkable ways. The ABE and Federation codes cover this area using general value-based principles of behavior. The AAMFT code organizes this section into eleven standards to cover the ground, while the CAMFT code includes no fewer than thirty-one standards of conduct.

These differences can be best understood in the light of the distinctly different histories each profession experienced as each became licensed and inevitably regulated. For social work the codes developed during a time when the concept of values was emphasized. Those codes speak more about the general idea of values. The two MFT codes, which were initially prompted by legal concerns, and developed in a more litigious time, emphasize prescriptions and prohibitions for the practitioner.

A Historical Review

Clinical Social Work

Clinical social work is grounded in the larger profession of social work with its long-held values and traditions. Social workers historically provided psychotherapy as psychiatric social workers and as outpatient therapists in independent social service agencies such as Family Service of America. By the early 1960s in California, a small number of social workers were well established as solo practitioners. In 1966, the trend toward independent social work practice became more apparent and the State Board of Medical Examiners, representing psychiatrists, succeeded in persuading the Attorney General of California to issue an opinion saying that the use of the terms psychotherapy and psychotherapeutic measures to describe professional work was exclusively the right of licensed physicians.

A small group of social workers in independent practice, feeling our professional lives profoundly threatened, banded together under the leadership of Robert L. Dean. Borrowing a term from the Veteran’s Administration (Dean, 1997), Bob declared our practice to be "clinical social work," defined as the practice of psychotherapy of a non-medical nature. By 1969 we convinced the State Legislature to license the practice of clinical social work.

Using the momentum developed in the licensure struggle, a small group of social workers founded the first Society for Clinical Social Work, thus inspiring a national movement to license clinical social workers and to found societies for clinical social work. Eventually, this led to the Federation of Societies for Clinical Social Work, and subsequently the American Board of Examiners in Clinical Social Work. The codes of ethics, though recent, continue to be based on the traditional values and ethics of social work.

Marriage and Family Couseling

The code for this profession was affected by certain practical realities in our society: increased use of legal intervention and the influence of "third party payers".

Prior to MFT licensure, marriage counseling had been practiced informally by people who had a variety of educational backgrounds. In the 1950s and early 1960s, there was a series of incidents associated with practitioners of marriage counseling involving what we would now call ethical abuses, resulting in increasing publicity in the press. When a California legislator was personally the victim of what he considered professional abuse by a marriage counselor, he moved to regulate the practice with licensing legislation. Thus, the process of creating licensure regulations for the profession of marriage, family, and child counseling originated and was prompted by community reaction against behavior on the part of certain practitioners. In addition, the influence of the standards set by third party payers has been growing during the time the code has been evolving. These standards, an effort to operationalize measures of professional work, emphasize specific behavior and definitions of success. The CAMFT code is detailed and concrete in its prohibitions and prescriptions of behavior, as if to anticipate every imaginable contingency and meet it with a standard.

ABE

The ABE Code also reflects its history and raison d’etre and concerns for current cultural attitudes. The ABE came into being to create an advanced certification for clinical social workers for use in negotiations for professional parity and the inclusion of clinical social workers in insurance vendorships. Therefore the ABE is concerned with establishing the professional standing of clinical social workers and the prevention of fraud and deceitful business practices. For example, the ABE code emphasizes that in the first interview the clinical social worker must specifically address such things as the therapist’s education, training, and extent of experience, the nature of the services offered, and the obligations of both parties to one another. It is hard to imagine doing all that in a first interview without regard to the client’s immediate needs. I was also struck by the fact that the ABE code is the only one that doesn’t explicitly forbid sexual involvement with clients, though it is certainly implied in their broad treatment of the issue of dual relationship.

The Federation

The Federation code is the only code that gives recognition to the power of the transference/counter transference relationship (without using those words), and the necessity to seek personal therapy if there are potentially destructive countertransference reactions to the specific needs of specific clients one is treating. It also gives attention, more than any other code, to the ethical dimensions of dealing with third party payers and establishes the principle of client advocacy in the event of unjust treatment of the client by the insurance carrier. The Federation code is also distinguished by including in ethical practice the responsibility to participate in activities that lead to improved social conditions.

Evolution of Ethical Codes

Ethical standards and their codifications evolve over time, so, just as we now have a codification of standards that didn’t exist a relatively few years ago, it is probably safe to assume that the present codes will change over time. Perhaps the most obvious and familiar behavior that has only gradually been lifted to the level of ethical violation is sexual relations between therapist and client and, along with that, marriage or committed partnership between therapist and client. When I started out as a therapist in the early 1960s, a therapist becoming sexually involved with clients was always a little shocking and certainly seemed unwise and potentially destructive, but I don’t remember the word unethical arising. This behavior hadn’t yet risen to the level of ethics and was not explicitly forbidden by codes of ethics. When it was destructive and clients wanted redress, the offending therapists were often protected by their professional organizations. Now such so-called dual relationships are expressly forbidden.

Feminism was the major historical current that brought about this shift, with its critique of the power dynamics of the patriarchy, together with greater numbers of women in the psychology and psychiatry professions. Another historical current, of course, was our deepening understanding of trauma and victimization.

The development of relationality and the intersubjective paradigm in contemporary psychoanalysis has occurred in roughly the same period that our codes of ethics have become so explicit about not concretizing the intense feelings that can develop in the intersubjective field. Perhaps the increased safety for therapists in having such unequivocal ethical guidelines has made it possible to go more deeply into personal subjectivity in relation to clients and to relate so much more authentically. The new ethical standards support symbolization and mitigate against concretization.

The evolution of our codes of ethics does not stop here. Relationality and intersubjectivity in clinical practice imply a whole new frontier for the development of an ethical paradigm. Over time, ethics could come to have an equally important line of responsibility for patients added to the traditional ethical responsibilities of the therapist. Whatever the paradigm, its central tenet will no doubt be the same as the current paradigm: do no harm. It is the definition of what is harmful that continues to evolve.

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Gareth S. Hill, M.S.W., Ph.D., a graduate of CICSW, is the current Dean. He is in private practice in Berkeley.

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