COUPLES THERAPY AND IATROGENIC RISK

INTRODUCTION
Practitioners who opt to deal with couples face difficult ethical questions and particular legal
difficulties that are exclusive to this therapy approach.

FIG: THERAPUETIC PROCESS OF COUPLES THERAPY

The work of professionals is beneficial to individual and society, and we reward

society’s expectations of us with good work. Though, our work is not a benign process and
may involve some discomfort and distress, entailing iatrogenic risks i.e- some discomfort that
is unavoidable even when treatment is provided competently, this must be anticipated by the
practitioner.
When a therapist agrees to treat a couple, iatrogenic factors become more complex and
therapist has two tasks, to make a risk-benefit assessment for each member of the couple;
secondly, if outcome for both is favourable, then therapist must perform a similar analysis
based on interactional factors.

TARGET AUDIENCE
Our target audience is most importantly practitioners who must be assured that inspite
their maximum potential, some form of discomfort may be caused to the client. It is also
important to make the client realise how their therapist is competent and well-read, but they
may still face situations that may cause them trouble and distress.

ETHICAL PRINCIPLES
The ethical issues faced by couple therapists may be greater than those faced by
individually focused therapists, but standards of behaviour and ethics have not always
provided clear guidance. The concepts frequently appear to lack the precision necessary to
fully address the current problems.
Competency to practise
A core ethical responsibility to clients is the promotion of beneficence: doing good on the
client's behalf. This is reflected in a number of professional areas, but starts with the
therapist's competence to practise.

Confidentiality
Arranging for individual consultations within relational work raises a myriad of difficulties.
While it can be important for assessing dynamics such as abuse, it also provides opportunities
for disclosures that will significantly shape the work ahead.

Neutrality and dual relationships

Frequently couples will ask for assistance when on a covert level they want a referee or a
judgment about the behaviour of the other. Individual sessions and phone calls can be
invitations to take sides, and neutrality can be called into question. There are complex issues
around being engaged to ‘save relationships' and then having notes subpoenaed for divorce
proceedings. Besides the feelings this can evoke for the therapist, there are invitations into
conflicting roles, e.g., couple/family therapist versus advocate in court.

The individual versus the collective

Working with systems means being able to hold the relationship in mind over and above
individual contributions: the notion that the sum is more than its parts. However, one still has
to attend to:
Individual responsibilities for pain and suffering, and for the stressors of addiction,
mental health or family of origin trauma for example. How to address this in a
relational context without pathologising one member and getting them off-side can
be tricky.

Ethics Checklist
 Are you trained in couple/family intervention?

What is your role going to be? Individual or relationship therapist, not both.

How are you going to communicate effectively with all family members?

How are you going to obtain informed consent?

What is your plan to manage multiple alliances and diverse needs?

How often do you take ethical issues to supervision?

CASE STUDY
An MFT saw a couple for six sessions to address issues in their
marriage. The therapist also saw their 8-year old son children at the
request of both parents to help the child cope with their arguments and
frequent separations. When the couple decided that the marriage was
unsalvageable, one of the spouses subpoenaed the therapy records to
support their argument for custody of the son. Included in the records
were the psychotherapy notes of the sessions with the son in which he
stated that they would like to live with one parent, if they divorced. The
therapist was called to testify, and agreed to render an opinion on the
matter. The therapist was asked if the children’s preference would be
the most suitable. The therapist supported the children’s choice as the
more appropriate and competent parent of the two, given the progress
of therapy.
 ANALYSIS

Though, the therapist specialises in couple therapy, the decision to be made

here involves the couple as well as their child. To decide over the custody of
the child, the therapist supports the choice of the child while disregarding
the therspist. Hence, totally ignoring the ethical principle of
RESPONSIBILITY TO CLIENTS. This also poses a question about the
professional competency and integrity of the therapist because he has not
taken into consideration the opinions and feelings of the clients. The value
system of the therapist is crucial in formulation of definition of problems.
The couple therapist needs to agree not only on the specific limitations of
confidentiality mandated by law but also to those family practitioners may
establish for effective treatment. NEUTRALITY AND DUAL
RELATIONSHIPS have also been compromised in this case. The therapist
has been focusing on INDIVIDUAL rather than the collective family as a
whole. Hence, these and many more ethical principles have been
compromised in this case.

ETHICAL DILEMMAS

• Family Versus Individual Members

A marriage therapist must establish a rapport with each member while also taking into
account each person's viewpoint. It may become challenging for the therapist in marriage
counselling to choose between what's best for an individual and what's best for the couple as
a whole.

• Excluding Family Members

The morality of treating a couple without both of its members present is frequently contested.
The extent of voluntary participation in this can also have a significant impact. A member
cannot be forced to attend sessions if they merely choose not to.

• Manipulative Therapeutic Strategies

It is the responsibility of therapists to control their sessions, which always entails

manipulating clients in an effort to effect change or personal development. When to employ
this manipulative power is a decision that the therapist must make. Even though lying is the
simplest or most efficient path of action, it may not be regarded as morally acceptable.

• Personal Values Versus Ethics

When it comes to his work, objectivity is essential, and therapists must take into account the
ethical principles of their clients as well as the clients' personal beliefs, which may or may not
coincide with those ideals. This could also imply that the client's welfare is not being
protected because they are acting unethically.

LAWS RELATED TO COUPLES IN INDIA

1) The Protection of Women from Domestic Violence Act, 2005 also includes the right
of partners in a live-in relationship to receive protection from domestic violence and
abusive relationships.
2) The Special Marriage Act, 1954

The special marriage laws are applicable to citizens of India irrespective of their religion,
caste or culture. Under provisions of the Act, people from a different religion, caste or
community are allowed to get married, provided certain conditions are met:

• Marriage registration in India is compulsory to solemnize a marriage under this Act.

A family lawyer can be hired to complete marriage registration in India
• The age of both bride and groom must be 18 and 21 years respectively

3) The Indian Christian Marriage Act, 1872

As per the Act, the solemnization of the wedding takes place in the presence of priests,
clergymen or ministers in a church and as per the defined regulations of the Indian Christians
community. The conditions needed to be fulfilled for a valid marriage under Christian
marriage laws are:

• The age of bridegroom and bride should be 21 years and 18 years respectively
• Both bride and groom must give their consent voluntarily and under no compulsion
from anyone
• Both the parties to the marriage should not have an existing partner from any former
marriage at the time of marriage
OVERLAP IN FAMILY THERAPY AND LEGAL SYSTEM
The legal system makes a lot of crucial judgments that affect families and marriages. Even
when one "wins" a case, the adversarial nature of this system frequently causes relational
damages for clients. According to others, the family court system is imperfect but well-
intentioned, and marriage and family therapists with a focus on law are in a unique position
to help facilitate recovery (Brooks & Madden, 2012; Madden, 2008). However, research
indicates that fresh graduates from marriage and family therapy schools may not have the
necessary legal knowledge when they graduate (Nelson & Graves, 2011). This suggests a
need for alternative training.

EXAMPLE: Jeff and Ann Carter attended a couple's counselling session. Both people
lamented their ongoing disputes. Jeff said that Ann was growing too independent and
unconcerned with his requirements, while Ann reported that Jeff was easily irritated about
trivial issues. The therapist took the decision to assist by enhancing their communication, but
after a few weeks, they had made little progress. The therapist didn't become suspicious that
Jeff was physically abusing Ann until he made a casual remark, despite the fact that she
hadn't told him about the abuse. It's a troubling case where the therapist might have
unintentionally encouraged Jeff's abuse and coercion. However, since couple therapists lack
clairvoyance, it can be challenging to spot IPV at the beginning of therapy. The ethical
dilemma here would be whether to report to legal authorities or not

PRACTICE
Spouses must agree to participate in marriage counselling, just like any other sort of
treatment. They should have made the choice on their own to work on their marriage and deal
with the issues that have developed rather than calling it quits There are iatrogenic risks
inherent in all therapeutic approaches, and systems-oriented couple therapy is no exception.

CONCLUSION
From this brief discussion, it should be clear that there is no way to avoid all of these pitfalls.
Rather, one must be alert to the specific iatrogenic risks that exist within one’s practice niche
and take appropriate steps to avoid or mitigate them when they arise or are suspected. Being
alert for IPV, monitoring one’s resentful feelings toward a couple, and offering concrete
recommendations, where indicated, are all prudent ways to minimize risk and enhance client
welfare.
 REFERENCES
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