Legal and Ethical Issues couple family therapy fiduciary duty

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The answer Last edit of this page 06/03/2011 Legal and Ethical Issues in Couple's Therapy Below are two versions of a hypothetical case based on a number of client situations. The coincidence of all these events in one case (a perfect storm) is improbable but not unlikely, as I have discovered over the last 40 years. Following this is a beginning discussion of the duty owed clients and supervisees. I recommend Chapter 26 of the 'Clinical Handbook of Couple Therapy' 4th Edition by Gottlieb, Lasser and Simpson entitled: 'Legal and Ethical Issues in Couple's Therapy'. I have archived it on this link (3.2mb). The authors come at the problem from a systems perspective whilst answering the challenges from a wide range of perspectives. They list 7 complex and vexing dilemmas that individual therapists do not encounter in quite the same way, if at all. They describe the problem, deal with alternatives and then make recommendations for each. The seven areas are: 1. who is 'the client'. 2. confidentiality. 3. therapeutic neutrality. 4. iatrogenic risk including unwitting coercion, strategic and paradoxical strategies and not knowing. 5. change of format - from individual to conjoint. 6. live supervision. 7. legal issues including dealing with subpoenas for commingled records and court testimony. I also recommend "Documentation in Mental Health Practice: Ethical and risk mangement challenge" by Frederic G. Reamer, Ph.D." for best practice in these areas. SHORT VERSION Bernie is the initial client of psychologist CP. He is married to Aisha. He is in an intimate relationship with Dianne. Dianne is not a client of CP nor known to him. Bernie and Aisha employ CP for couple's therapy. During that time Dianne conceives a child with Bernie. The pregnancy is not known to Aisha nor to psychologist CP until quite late in the treatment. Despite it or perhaps because of it, CP succeeded in facilitating a beneficial change in the marriage such that they did not separate. This is contrary to the understanding Dianne had been led to rely on by Bernie when he gave her his reason for going into therapy with his wife. Dianne experienced this as a betrayal but held off applying pressure, such as disclosing her existence and the pregnancy to his wife Aisha, believing he was using marital therapy to ease his wife out of the marriage. As a consequence of the marriage surviving, Dianne believes she is denied both a spousal relationship with him and a live-in father for their child. The paternity is not in dispute. She complains to the Human Rights Commissioner about the service CP provided Bernie and Aisha on the basis that as a result of CP's alleged unprofessional practice, CP's service has resulted in harm to the child of the affair and irreparable distress for her at a vulnerable time. She claims that CP pressured Bernie to stay (unwitting coercion); that CP breeched confidentiality when, learning about the affair, he changed format from individual to couple sessions and implicitly drew on information about the affair disclosed in individual sessions, and that CP was not neutral in his dealings with the couple allegedly taking a pro-marriage stance rather than the best interests of the child of the affair. It turns out that Bernie had kept Dianne up to date about the discussion in his marital therapy sessions. At the same time he denied there was any contact with Dianne. He later claims he did so in order to manage his exit from the affair but on reflection, he admitted he may have been keeping the exit to his affair open in case the marriage proved unsalvageable. The detail of her complaint leaves the Commissioner with no alternative but to investigate. CP receives an initial letter setting out the complaint and procedure to follow. CP approaches his insurer and is later appointed a lawyer. At the same time Dianne and her new born child's attorney take the matter to the Family Court. Their case rests on the fact that two years had elapsed from first intercourse to the end of a well documented affair, and thus she was in a de-facto relationship with him for at least 2 years, if not longer. She asks the court for a property settlement following dissolution of the affair. This would potentially include a claim on his superannuation, property and income that is also marital property. For more information on children conceived in affairs go here. LONG VERSION Psychologist CP is in private practice in a large regional center. His clinical psychology supervisor Angela is a hospital based team leader of a multi disciplinary Oncology unit, with a broader interest in pain management, and a small private practice of mostly supervision clients. CP share's her passion for children with cancer and pain management. Both provide couple and family counselling to families with a cancer patient. Neither have specialist training in evidence based couple's therapy. Angela has a hospital compensation case-weary habit of keeping two records for each of her chronic pain patients - one the brief medical record and the other a private, meticulous, working document, which she keeps at home. CP had seen Bernie, a pharmacist aged early 40's, on his own for a number of sessions. Bernie reported feeling depressed about his marriage to Aisha with whom he owns a pharmacy in town. At the end of the second session, Bernie disclosed that he was also in a clandestine relationship with Dianne, the manager of a family medicine practice in town. In the previous five years Aisha and Bernie had been trying to fall pregnant. In the last two years they had pursued an exhausting, fruitless, and thus distressing assisted reproduction program. Bernie consummated the affair with Dianne after he and Aisha had begun the in vitro fertilization (IVF) program. In his mind it was recreational relief from reproductive failure and 3 years of mechanical sex timed to ovulation. The IVF clinic provided a referral service, through which Bernie found CP. Aisha agreed he needed support. She had thought his mood swings and changed behavior were due to depression but had asked if he was having an affair. He denied it strenuously. Four individual sessions later Bernie asked CP if he and Aisha could come for couple's therapy. CP agreed whilst urging him to end the affair and disclose the fact that it was over to Aisha before their first couple's session or at least by their second or third couple's session. Bernie agreed but did neither. By the fourth couple's session, hearing nothing of the affair CP felt in a bind and took the case to supervision, careful to refer to them as the 'pharmacy couple' and the affair partner as a 'receptionist'. Angela suggested CP invite Bernie in for another individual session and raise his concerns about the affair. Bernie was happy to do so and said he had finished the affair as CP had advised but did not want to discuss it in couple sessions, which were 'going well for them both'. Some time later Dianne conceived a child with Bernie. The existence of the child was not known to Aisha, nor to the psychologist until quite late in their couple therapy treatment. One day, exasperated with Bernie's lying to she and Aisha, Dianne turned up at their pharmacy. She asked Aisha to let Bernie go as he was just playing for time in the marriage in order to keep the business, and was in love with and committed to building a family with her. This was the first Aisha had heard of Dianne's hidden place in their lives, though she had met Dianne in the course of business. She was shocked, betrayed and publicly humiliated. She was traumatized by this event. It was, in effect, an assault comprising a critical incident at work. Aisha would later put in a work place compensation claim and be referred to a trauma therapist. Bernie found Aisha on the toilet floor inconsolable. She threw everything at him that she could lay her hands on. The blood left his face and he wet his pants. A crisis session with CP was called. Afterwards CP arranged for a supervision session with Angela. The next morning Angela woke with a start when all the pieces of the jigsaw fell into place with a sickening thud. Dianne (the affair partner) was the Practice Manager for Angela's GP and had casually asked her a year or so ago, for a referral for relationship trouble one of the clinic's patients was having with a 'married, in quotes "drug rep" in town'. Angela had suggested one of the counsellors she supervised at Relationships Australia, wondered about the in quotes signal and then filed it at the back of her mind. This counsellor later brought the case up in a supervision session referring to Dianne not by name, but as the pregnant receptionist Angela had referred her. At the time, Angela feigned to know who she was talking about but was confused. Angela's partner was a family lawyer. Over breakfast that morning listening carefully to Angela's awakening to the fall of jigsaw pieces and thinking how those breaches could be interpreted in a legal framework, she told Angela to drop the case like a ton of bricks. Angela took out her private files on both supervisees and put all stories together. Later that morning she decided to take her partner's advice. She called Harry, a colleague who was a specialist in marriage and family therapy. He worked in their capital city, about two hours drive away. She asked if he would be willing to provide supervision to CP for his work with the 'pharmacy couple' where she had just discovered she was in a dual role. He was willing to provide supervision using skype if that was required, and asked if CP kept a video record of his couple sessions, which Harry could watch beforehand and then reflect on during supervision. CP did not. Angela then wrote an email to CP referring to her conflict of interest without betraying the involvement of her other supervisee, and asking him to take that case to their colleague as arranged. She assured him he was welcome to continue in supervision with his other cases as before. CP decided to 'soldier on' without the specialist supervision of the case on offer. Despite the impact of Dianne's catastrophic and public humiliation of Aisha or perhaps because of it, CP facilitated a beneficial change in their marriage over the following year such that they did not separate. He diagnosed the impact on Aisha of Bernie's multiple betrayals (including conceiving a child) and Dianne's public humiliation of her, as resulting in Post Traumatic Stress Disorder (PTSD). Her referred her to a specialist whilst continuing in couple's therapy with she and Bernie. By the end of couple's therapy, when Bernie & Dianne's baby was a few months old, Bernie told Dianne that he was staying in the marriage with Aisha. This outcome was contrary to the understanding Dianne had been led to rely on by Bernie, when he gave her his reason for going into therapy with his wife. He had asked Dianne to give him time so that he could leave gracefully without the affair or pregnancy becoming an issue. Dianne had experienced Bernie going to couple's therapy as a betrayal. However, she held off disclosing her existence and the pregnancy to Aisha, believing Bernie and understanding that he was using marital therapy to ease his wife out of the marriage and come to an arrangement about the business. As a consequence of the marriage surviving, Dianne realized she was denied a spousal relationship with Bernie that had allowed her to continue with the pregnancy, as well as a live-in father for their child. The paternity was not in dispute. Dianne makes a formal complaint to the Human Rights Commissioner (HRC) about the service CP provided Aisha and Bernie. She also claims, whilst accepting her assumption of risk in forming the relationship with Bernie, that as a result of CP's unethical practices, CP's service had resulted in harm to the child of the affair and irreparable damage to Dianne at a vulnerable time in her life. Her counsellor, Angela's supervisee, supports Dianne's claim and diagnoses PTSD with depression. Though Dianne was not ever a client of CP's, in her complaint she quotes Section 39(1)(vi) and sections 48(2) and (3) of the Human Rights Commission ACT 2004 that does not prevent the Commissioner from investigating a complaint by a person who has not received a health service from a practitioner but has reason to complain about a service they have provided to another. As a practice manager, Dianne has some knowledge of medical negligence. In her complaint she claims that CP pressured Bernie to stay in the marriage (unwitting coercion); that CP breeched a fiduciary duty he owed Bernie's relationship with her. When he learned of the affair, CP changed format from individual to marital sessions without revealing to Aisha his knowledge of the affair. He kept a secret from Aisha and thus could not have obtained informed consent from Aisha. She claims that CP did not satisfy himself that Bernie's relationship with her may have been a 'de-facto marriage'. Thereby CP acted in a way that risked causing harm to her and did not act in a way that would benefit her or Bernie's welfare nor that of their child. Dianne also claimed that CP was not neutral in his dealings with Aisha and Bernie, advocating saving the marriage at all cost. Finally, that in his advice to Aisha & Bernie toward the end of treatment, CP did not give sufficient weight to the best interests of their then newborn child. It turns out that Bernie had kept Dianne informed of the process and content of he and his wife's couple therapy sessions. Bernie later claimed he did so in order to manage his exit from the affair fearing Dianne's volatile reactions but also admits he may have been keeping on good terms with Dianne, in case the marriage proved unsalvageable. The gravity and detail contained in Dianne's complaint about the service CP rendered Aisha and Bernie, leaves the Commissioner with no alternative but to investigate. CP receives an initial letter setting out the complaint and HRC procedures. CP approaches his insurer and is later appointed a legal team, who require all his records and a day long, face to face exploration of the case with him. After receiving Bernie's initial response, carefully worded by his lawyers, the Commissioner requests a peer review of the case. Based on the information Dianne alleges Bernie gave CP, and on CP's response to the complaint as well as using the APS guidelines applicable at the time, the reviewer finds that CP erred ethically in the process of moving from individual to couple sessions. The definition of 'the client' required informed consent about the change in confidentiality and the fiduciary duty then owed to Aisha & Bernie as a client couple. The reviewer also found that CP had increased the iatrogenic risk to both his clients namely 'Bernie', and the couple client 'Aisha and Bernie' and possibly to Bernie's child. That CP did not give sufficient weight to that increased risk in deciding to work with them as a couple, despite the fact that the treatment was 'successful' and they had no complaint. The reviewer also queried CP's practice of keeping co-mingled records of couple sessions, from which he submitted information in his defense, after redacting all references to his client's wife Aisha but including those to Dianne. CP's lawyers mount a strong defense to each of the peer review's findings, referring to law, ethics and the 'successful' outcome. They also quote his supervisor in his defense to clarify the ethical conflict inherent in CP maintaining the confidentiality of Bernie's secret and what course of action Angela recommended. A year later the Commissioner refers the case to a disciplinary hearing, citing concerns about the welfare of the child and the complex legal and ethical issues the case presents. All CP's records and emails regarding all parties in the case are subpoenaed. His supervisors records regarding all the parties in the case are also subpoenaed. Whilst the case was slowly progressing through the HRC, Dianne and her child's attorney separately take the matter to the Family Court. Her case rests on the fact that two years had elapsed from first intercourse to the end of a well documented affair, and thus she was in a de-facto relationship with Bernie for at least 2 years, if not longer. She asks the court for a property settlement following dissolution of the affair. This would potentially include a claim on Bernie's superannuation, property and income that is the shared property of Aisha and Bernie. The child's attorney asks the Court for child maintenance given that a condition of Bernie staying in the marriage and keeping the business is that he have no contact with his child. Questions: Since CP's first client was Bernie, does his duty extend equally to Dianne and Aisha as his partners? If so what ought he to have done when he became aware of Dianne and later of their child? How could he have demonstrated that he considered the welfare of Dianne's child? Ought he to have expected that Bernie would lie to him as easily as he had to Aisha about the ongoing affair? How is 'soldiering on' without supervision a risky practice? If so, how could he have better handled the initial disclosure and the later agreement to take Aisha and Bernie on as clients? In what ways were CP and Angela triangulated? To whom does Angela owe a duty? Just to CP or does it extend to Dianne and her child through both supervisory relationships? What was Angela's best course of action once she knew she was in a dual role? Should she have recused herself from supervising Dianne's counsellor rather than CP, or both? How could Angela's conflict of interest have been avoided? Could Angela have breached confidentiality by talking to her partner about the cases? Are her private notes a confidential health record in the meaning of the National Privacy Legislation 1998 and can they be subpoenaed? Is it best practice to make recommendations on the fly in general, and in particular as Angela did in referring 'a patients of' Dianne's practice to a counsellor Angela supervised? Conclusions: extreme caution in transiting individual sessions to their couple sessions informed consent at each stage (see more on this below) make the implicit explicit provision of evidence based couple's therapy excellent record keeping and retention for the mandated period legally informed intake questionnaires understanding the ethical and legal contexts of clinical practice in your location case appropriate clinical supervision - a trained couple's therapist supervisor of couple's therapy session forensic or battle tested boundaries of both supervisor and clinician particularly in a small town or close urban community. Should I destroy video or digital recordings of couple's sessions? As an active elder in the practice of clinical psychology (40 years) here is my lengthy note of caution to the widespread practice of destroying video of client sessions that were recorded for the sole purpose of training or supervision. Usually client's will sign a consent form to have the session recorded, and maybe to have it destroyed after use. That would be in everyone's best interests. In British Columbia and California for example, practitioners can make a distinction between training and therapy, and do both concurrently, provided there are two separate consents. One consent for the therapy that requires a permanent record, and one for the video or audio record used for training purposes, the record of which is destroyed after its specified use. In any federal and state jurisdiction and local professional environment I caution practitioners to: (a) Take care in ensuring that your method of obtaining informed consent is an ongoing process not a static moment in time. For more on this subject read the section below (b) Consider how you differentiate the records of a treatment session used concurrently for training. Is reference to the intended and consented purpose agreed to at the outset by all parties, sufficient in your particular legal and ethical environment? (c) In your location could the video of a session become part of the public record in divorce, termination of parental rights, or child custody proceedings? If so, might that harm the client, couple or their children? If it could do so would you be in breach of your duty to them were you to use it in your own defence? (d) "Almost all medical negligence cases are won or lost by what is contained, or not contained, in the medical record. It has been my experience that mental health notes, particularly in the outpatient setting are more often than not deficient …. Inadequate notes leave the clinician at the mercy of a plaintiff's attorney, especially when he is asked years later to recall an event that is poorly documented, if at all." F.G. Reamer If our clinical practice is evidence based then it is proven likely to have a therapeutic impact. That goes to foreseeability - i.e. ought we to have known at the outset that although we have consent to using a record of this session for training purposes, which is not part of 'the clinical record', it may become part of their clinical record because of the expected therapeutic impact of the session? Having an expected or even an unintended therapeutic effect locates the transaction between the 'client' and the researcher/trainee/therapist in the fiduciary duty of the doctor/patient, therapist/client or clergy/parishioner relationships. This is a greater duty than that of the duty of care. Our fiduciary duty (including of good faith and fair dealing; to do no harm; to provide benefit; to not exert undue influence, and to act solely in the best interest of the client) is not diminished by their consent to it being for research or training purposes, nor by our conforming to standard practices defined by the professional association. Where harm occurs to the client or couple, whatever they consented to, it matters little that we worked to the highest standards of our profession. We can be held to account for the unexpected harm. The clinical record including an audio or video recording, can be called as evidence in many jurisdictions. In the spirit of caution, considering your reason for destroying your evidence: will it help or harm you were you called upon to defend your judgment in doing so? Once a doctor/patient relationship is established in law, we are bound to maintain records that document how the 'standard of care was met in evaluation, diagnosis, and indications for treatment'. Source You might want to consider keeping a video or digital recording to protect yourself in the unlikely event that you were called before a professional or licensing hearing as a result of a complaint by the couple whose session you recorded or a related third party who may have grounds to claim harm. In Australia a person who has not received a health service can complaint about the service provided to another. Other health professionals are mandated, in certain circumstances, to report malpractice were it to come to their attention. The resulting health complaints procedure can lead to a lengthy and forensic examination of the whole of a therapist's practice. Much as an internal revenue or tax audit will do, in order to establish if there is any foundation for the complaint. This examination is necessary because of the consequence of up to 10% of therapists at any one time experiencing high stressful involvement and low healing involvement in their work. Their resulting disengagement from and inattention to their clients' needs can go undetected within their profession for years until a patient or client complains. Many therapist work in isolation but even in a group or corporate practice the break down in best practice of one therapist may not be noticed by the others until a customer complains. The resistance to attending to the complexity of psychotherapists' lives is not only reflected in the lack of comprehensive analysis (of the impact on their families), but also by the American Psychological Association's governing board and membership's reticence to set up a nationally coordinated program to identify and treat distressed psychologists and prevent burnout. Psychologists, psychiatrists, and counselors have been instrumental in the development of employee assistance programs tailored to serve the needs of other distressed or impaired professional employees. In contrast to psychotherapists, the American Medical Association (AMA) and the American Bar Association (ABA) as well as national organizations of dentists, attorneys, nurses, and pharmacists long ago established avenues for distressed professionals who are seeking help (Kilburg, Nathan, & Thoreson, 1986; Laliotis & Grayson, 1985). The reasons for this lack of attention to the hazards of the profession are open to speculation. Many therapists claim that their professional lives have no bearing on their personal lives. Therapists may possess a prejudicial sense of grandiosity and invulnerability; they may assume they are capable of helping other professionals, but be incapable of recognizing that they themselves need help. Kottler (1987) attributes their resistance to the illusion that psychotherapy is the pure application of "scientifically tested principles and reliable therapeutic interventions" (p. 26). Other psychologists admit their reasons for not studying themselves stem from defensiveness and the professional practice of focusing all investigations on the patients (Farber, 1983). Source Offer Zur As a consequence, it is a significant event for a regulatory authority to receive a complaint about a therapist. He or she may turn out to be one among those 10% of practitioners whose professional life has been in trouble for a number of years. Again as a note of caution, if you have destroyed a recording that was only held for training or research purposes of a client who subsequently complains, will it help or hinder your defence? For how long should I keep these records? Depends on the regulatory environment you work and the legislation and regulations that apply to your practice. In Australia 7 years is mandated. As I have learned from colleagues of good repute caught in this dilemma, not their employer nor their funding research body nor their training organizations are held accountable for the harm. The buck stops with the therapist and to a lesser extent their trainer/supervisor. It's your certification or licensure that is up for grabs not the organization's. Before we get to that unlikely and unhappy place we all need to be experts in informed consent. There is no way out of this if you are asking your clients for consent. I strongly recommend this site for its wide ranging resources on Informed Consent from which I have drawn these quotes (my bolding): This fundamental concept can trip us up if we are not careful. Nothing blocks a patient's access to help with such cruel efficiency as a bungled attempt at informed consent.... The doors to our offices and clinics are wide open. The resources are all in place. But not even the most persistent patients can make their way past intimidating forms (which clerks may shove at patients when they first arrive), our set speeches full of non-informative information, and our nervous attempts to meet externally imposed legalistic requirements such as the Health Insurance Portability and Accountability Act. A first step is to recognize that informed consent is not a static ritual but a useful process. Psychologists should also consider and understand the potential impact of diversity on this process, such as the role that language, age (and developmental level), cultural background, and other factors may play in affecting the informed-consent process. Clinical work with individuals, couples, families, and groups each presents unique challenges with regard to informed consent, as do third-party requests for services, clinical supervision, research, and teaching. Knowing how best to address these challenges is of great importance for protecting clients' rights, promoting their autonomy, and working to achieve the best possible outcomes in the professional relationships we form with them. While most therapists recognize that negotiation can clear up clients' misconceptions, fewer recognize that negotiation is also a vehicle for clearing up the therapist's misconceptions. An open dialogue can make the therapist aware of features of the case that depart from both the therapist's model and his or her previous experience, and thus it serves as a corrective to the representativeness and availability biases. Source Fiduciary Duty In the doctor patient relationship This article at focus.psychiatryonline is a good starting point for learning about this duty in the mental health field. Though it is about psychiatry in the context of USA common law, the principles may equally apply to other mental health professionals in other jurisdictions. In any event, they provide a framework for thinking about our relationship with clients and third parties. Here is an overview from that article: "The establishment of the doctor-patient relationship is the legal predicate to the recognition of a professional duty of care owed to a patient. Because a medical malpractice claim demands proof that a doctor breached the duty he or she owed to a patient, the existence of a doctor-patient relationship and the duty of care it demands is a core issue in every malpractice claim. As a general rule, a psychiatrist in private practice is not required to accept anyone who seeks treatment and may choose whomever he or she wishes to treat (American Medical Association 1989; Gross v. Burt 2004). Similarly, psychiatrists have no legal obligation to provide emergency medical care to someone with whom they do not have a preexisting doctor-patient relationship, absent any contractual or statutory obligation (e.g., emergency department). Once a psychiatrist has agreed (explicitly or implicitly) to accept a patient, however, tort law anticipates continuity of care until the relationship is appropriately terminated. On termination: Abandonment - tortiously failing to attend a patient absent the proper termination of the doctor-patient relationship - may be either overt or implied (e.g., failure to attend, monitor, or observe the patient). Many courts have widened the concept of abandonment to include situations in which delay and inattention in providing care caused the patient injury, termed constructive abandonment (i.e., as though actual abandonment had occurred [Mains 1985]). The following have all been construed by the courts as negligent acts amounting to abandonment: Failure to provide patients with a way to contact the psychiatrist between sessions Failure to maintain reasonable contact with a hospitalized patient Failure to provide adequate clinical coverage when away from practice." Source On role conflicts: One facet of the doctor-patient relationship policed by tort law is that of the fiduciary role the doctor is expected to play and the corresponding professional duties that arise (i.e., given the trust a patient places in his or her psychiatrist, a doctor owes duty of trust and candor). A psychiatrist is expected to act in good faith in his or her relations with a patient. This obligation is implicit within the consensual arrangement that gives rise to the relationship and inherent in all psychiatrist-patient relationships as an ethical and legal duty. Persons acting as a fiduciary are not permitted to use the professional relationship for their personal benefit. Thus, for example, psychiatrists must be particularly careful not to exploit transference for their personal gain. Double-agent role problems frequently arise when psychiatrists attempt to serve simultaneously the patient and an agency, institution, or society. Source On curbside consultations: Informal advice given in response to a colleague's question, are not categorically excluded from the recognition of a duty of care enforceable in a medical malpractice claim because of their location, reimbursement, or informality. Rather, in the event of a malpractice claim, each consultation will be judged by the court on its own facts, applying the criteria generally applied for recognition of a doctor-patient relationship. Thus the law's expectations for consultations do not countenance a sliding competence scale for discounted opinions. Source SUPERVISOR-SUPERVISEE RELATIONSHIPS AND LIABILITY This section is too important to cover in an excerpt so I recommend you go to the Source article and read it carefully. Fiduciary duty in marriage 'Thus, transactions between spouses arise in the context of a confidential relationship. “This confidential relationship imposes a duty of the highest good faith and fair dealing on each spouse, and neither shall take any unfair advantage of the other. This confidential relationship is a fiduciary relationship subject to the same rights and duties of unmarried business partners, including the right of access to records and information concerning their transactions.” “Because of this, our courts have long held that when an interspousal transaction advantages one spouse, public policy considerations create a presumption that the transaction was the result of undue influence. A spouse who gained an advantage from a transaction with the other spouse can overcome that presumption by a preponderance of the evidence.” ' Source References & further reading: 'Legal and Ethical Issues in Couple's Therapy', Chapter 26 of the 'Clinical Handbook of Couple Therapy' 4th Edition by Gottlieb, Lasser and Simpson. Informed Consent in Psychotherapy & Counseling: Forms, Standards, Guidelines & References. Extensive articles and resources on Ethics, Standard of Care & Risk Management by Ofer Zur. Documentation in Mental Health Practice: Ethical and risk mangement challenge by Frederic G. Reamer, Ph.D.. 'The Doctor Patient Relationship' Simon & Shuman. Focus 5:423-431, Fall 2007 American Psychiatric Association. The big list of cognitive biases and specifically, the representativeness and availability biases on wikipedia. At least one of the list comes into play in every client therapist transaction. 'The Great Ideas of Clinical Science. 17 principles that every mental health professional should understand'. Edited by Scott O. Lilienfeld and William T. Donohue (Routledge 2007). Reviewed here. Human Rights Commission ACT 2004. The Australian Clinical Psychology Association Code of Ethics. Australian Psychological Society Code of Ethics. Health Practitioner Regulation National Law Bill 2009 Explanatory Note. Attachment injuries in couple relationships: A new perspective on impasses in couples therapy Journal of Marital and Family Therapy , Apr 2001 by Johnson, Susan M, Makinen, Judy A, Millikin, John W. Sexual Infidelity - general information .pdf Infidelity - extensive reading on site. Beyond the Trauma of Betrayal: 'Reconsidering Affairs in Couples Therapy' Michelle Scheinkman Healing the wounds of infidelity through apology and forgiveness. Disclosing Secrets: Guidelines for Therapists Working with Sex Addicts and Co-addicts By M. Deborah Corley and Jennifer P. Schneider Sexual Addiction & Compulsivity 9:43-67, 2002. Forgiving the unforgivable by Beverly Flanagan her diagram of the pathways of healing. Hooked! Buddhist writings on greed desire and the urge to consume . EMDR: An Approach to Healing Betrayal Wounds in Couples Counseling Frederick Capps, Helena Andrade, and Rochelle Cade. Implicit Communication. Strategic family therapy. Triangles: A Study in Three Parts. Magill v Magill [2006] HCATrans 163 (7 April 2006) - a marital case which is 'plainly within the law of deceit'. Narcissistic borderline couples implications for mediation. Narcissistic Personality Disorder - on site. The Powers of Horror by Julia Kristeva "Approaching Abjection" This is most of chapter one of Kristeva's book, Powers of Horror © Ziji Fox 2010, 2011 All Rights Reserved peterfox.com.au Disclaimer The information in this web site is provided as a free service. 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