In recent weeks, we have received a significant number of inquiries about the California Association of Marriage and Family Therapist’s (CAMFT) revised Code of Ethics (CoE) and what it means for the licensing exams (California MFT Law & Ethics and Clinical). We are well aware that exam-related changes often cause anxiety. In an effort to quell some of your anxiety, we thought it would be helpful to provide an overview of the changes and explore how these changes will affect the content of your licensing exam. In brief, the most important thing to know about the changes to the Code of Ethics is, you do not need to worry! We will break this into a 3 part series to avoid overwhelming you with information. Today is part 1 of 3.
In December, 2019, CAMFT published their revised Code of Ethics. It is the product of a multi-year effort, which resulted in many minor, yet positive changes, as well as a few more substantive ones. We have taken the time to review, compare, and contrast the former and current versions so you don’t have to. Upon completing our review, we do not believe these changes will have a significant impact on your exam questions or how you would answer most ethical questions.
Two important logistical pieces of information:
- The BBS was set to incorporate CAMFT's new CoE into their MFT law & ethics and clinical exams in July. CAMFT is still waiting to hear if this plan is delayed due to COVID.
- Any questions based on the revised CAMFT CoE in the exam cycle starting July will be pretest questions. These questions will not count for or against you.
Structural Changes:
In comparing the newest CoE to the prior version, there are a handful of new additions. The most significant changes center around two themes, language and organization.
Language:
As therapists, we know that words matter, and it appears CAMFT recognized the importance of this as well. We found that many of the changes were designed to address inclusivity, neutrality, and, in other instances, to provide greater clarity or flexibility. A few key examples include:
- Change from “patients” to “clients/patients.” Many in our profession prefer to use the term “client” to avoid pathologizing those who seek treatment.
- Sections addressing diversity are more inclusive. The biggest change is the addition of “ethnicity,” “indigenous heritage,” and “immigration status,” in the non-discrimination section.
- Words such as “assure,” have been replaced with softer words like, “intend.” We believe these minor, yet significant, changes recognize that therapists can do everything right. Our intentions may be positive, yet, we cannot guarantee the outcome.
Reorganization:
This is probably the biggest change.
- Several sections, including Informed Consent, Dual/Multiple Relationships, and Telehealth were previously scattered throughout various sections of the CoE but are now stand alone sections and fleshed out (this will be further addressed in the corresponding sections).
- Includes a roadmap to easily identify additional sections of the CoE that are relevant to the initial subject. For example, at the end of the Non-Discrimination subsection, the following is in parentheses,“See also sections 3.2 Therapist Disclosures, 3.7 Therapist Professional Background, and 5.11 Scope of Competence.”
Changes by Section (Preamble - Section 3):
Ethical Decision-Making
This section is completely new to the CAMFT Code of Ethics. It provides a framework for how we can behave in ways that align with the goals and professional standards of our profession.
- This addition would not fundamentally change how we answer questions regarding our ethical responsibilities.
Section 1
Responsibility to Clients: The main themes addressed in this section remain very much the same. The greatest changes center around 1. greater inclusivity; 2. clarification; and 3. the interconnectedness of the different sections of the Code of Ethics.
- 1.1 Non-Discrimination as noted above, this subsection now includes “ethnicity, indigenous heritage, and immigration status,” which were not part of the prior versions.
- 1.4 Termination the language regarding termination due to conflicts has changed from, “in order to avoid an ethical conflict or problem,” to “due to an otherwise unresolvable ethical conflict or issue.” This change speaks to the ethical decision-making process therapists should strive to use when determining if termination is necessary.
- 1.5 Non-payment of Fees the language changed to clarify that therapists may terminate treatment due to non-payment of fees, but must terminate in a way that is “clinically appropriate.”
- 1.10 Treatment Planning the content of this section of the new CoE was previously under the section entitled Patient Choice. Again, the main difference is around language and the desire to place an emphasis on treatment planning in clinical practice and the collaborative nature of treatment planning.
**Exam Implications: Insofar as a test question asks how the therapist should clinically manage their ethical responsibilities or specifically asks about the therapist’s ethical obligations, we do not believe that the changes herein would alter how you should answer an exam question.
Section 2
Confidentiality: The introduction to this section is essentially unchanged and the subsections, with one exception, also remain the same.
- 2.4 Employees--Confidentiality the only difference between the old and newly revised CoE was the addition of the words, “business associates.” This terminology was included to better align with the language used for HIPAA.
**Exam Implications: We do not believe this addition would change how you would answer an exam question. We will always take appropriate steps to protect our client’s personal health information.
Section 3
Informed Consent and Disclosure: This section is new, although many components of it were pulled from other sections of the previous CoE as part of reorganization and to place a greater emphasis on the importance of informed consent with clients.
- 3.1 Informed Decision-Making this was formerly under the Responsibility to Clients section. The language changed to emphasize the basic right clients have to make informed decisions throughout the course of their treatment.
- 3.2 Therapist Disclosure also previously under the Responsibility to Clients section. The new language emphasizes that therapists self-disclose “personal values, attitudes and/or beliefs,” only if they are a “prejudicial factor in diagnosing or limiting treatment provided” to clients. It also provides an alternative option of assisting the client in connecting to appropriate referrals for continuity of care.
- 3.11 Treatment Alternatives this combines what was formerly Advocate with Third Party Payers and Treatment Alternatives. Interestingly, it removes the sentence that specifies the requirement to challenge denials of care or payments to clarify therapists may choose to do this in appropriate circumstances.
- 3.12 Documenting Treatment Rationales/Changes this change is one of the more important ones for the exam. The language regarding documentation of suspected child/elder/dependent abuse has been removed to better align with the law. Therapists have discretion on whether or not to document their decision-making process when reporting.
**Exam Implications: We believe several of the changes in this section could affect how you answer exam questions.
- 3.2 Therapist Disclosure: Ethically, we only need to disclose personal values, attitudes and/or beliefs that are deemed prejudicial and we may choose not to self-disclose, but instead ensure continuity of care elsewhere.
- 3.11 Treatment Alternatives would change an ethical obligation to an ethical consideration for challenging denials of pay or services with third party payers.
- 3.12 Documenting Treatment Rationales/Changes would change an answer that asks about our ethical obligation to document our decision-making process when making a mandated report of abuse/neglect. This is no longer an ethical obligation.
As you can see, the recent changes will not have a significant impact on your exam prep. There is no reason to worry!
Therapist Development Center can help you learn the CAMFT Code of Ethics and how this information could be tested! Our California MFT Law & Ethics and Clinical exam prep courses give you everything you need to pass your exam! We prepare you for all aspects of the exam without overwhelming you! Coaches are available to help you along the way. TDC has helped thousands of MFTs across California PASS their exams. Are you next?