In Case6.4, the therapist experienced an ethical dilemma over the wife’s con- fidential dilemmas. The therapist considered the ethical implications and took a call on not addressing issues related to wife’sfirst extramarital relationship that ended long ago as this had no immediate relevance to their relationship. When a partner discloses an extramarital involvement (EMI), it is advisable to provide space for individual sessions so that the involved partner can weigh the options in a secure environment (Agrawal and Shah 2009). In the present case, concurrent sessions helped the wife understand husband’s anxiety and distress over her EMI. The wife was encouraged to discuss the pros and cons of disclosure as well as concealment of this information. Concurrent sessions with husband helped him realize that his wife has to be comfortable to discuss her involvement. He was helped to understand that his insistence could ruin the chances of reconciliation and he waited till his wife was ready to discuss. The wife waited till she felt confident to disclose details of her EMI. She requested the therapist to facilitate this discussion with the husband. By addressing the concerns of both spouses, the therapist was able to effectively manage the confidentiality issue.
In the process of couple therapy, one spouse could make disclosures that require a careful ethical decision-making process. The assurance of confidentiality enables clients to share personal and intimate experiences (Younggren and Harris2008), but the exceptions to confidentiality, including information that may be shared without the client’s consent, must be spelt out during the informed consent process (Avasthi and Grover2009; Bennett et al.2007). Circumstances that involve reporting abuse, protecting lives of clients and intended victims, may warrant sharing of confidential information without consent.
Case 6.5
Mr. and Mrs. IB sought therapy to deal with constant quarrels and domestic violence. This was the third marriage for Mrs. IB andfirst for Mr. IB. On two occasions, the wife had lodged a complaint against her husband for domestic violence which she subsequently withdrew. A week before consultation, the couple had an altercation which involved physical violence towards the wife.
The wife threatened to lodge a complaint of domestic violence against her husband and seriously pursue it this time. During the intake session, she expressed that she wanted to work on the marriage and avoid another divorce.
The husband also expressed his commitment to the marriage. The conjoint sessions were full of arguments and so concurrent sessions were held with the husband and wife. In the concurrent sessions, the husband revealed that his participation in therapy was based on legal advice aimed at forestalling the domestic violence complaint and that he planned to initiate divorce pro- ceedings later at the right time. The husband would repeatedly call the therapist and request help in convincing the wife not to press charges.
94 H. Sobhana et al.
In Case6.5, it was clear that the husband had come with a hidden agenda to use therapy to escape legal consequences for his actions and was trying to manipulate the system as well as the spouse. At this juncture, the therapist brought this matter up for discussion in a conjoint session and took the decision to terminate couple therapy.
The practice of family therapy in a patriarchal society, where power and gender inequality is deeply ingrained, presents compelling challenges to maintaining confidentiality of less powerful members in the family. A mother-in-law could insist on knowing information shared by the daughter-in-law; or a father could be persistent on being‘updated’about his son’s‘revelations’in individual sessions.
The sharing of information or lack of it could result in an adverse event for the person concerned. Often, if the powerful member in the family feels excluded and sidelined, he or she could thwart the progress of therapy and pose emotional or physical threats to the weaker member. Hence, the practitioner should tread care- fully and sensitively and make an ethical choice. It is true that a pre-stated therapy policy on confidentiality can, to an extent, help navigate this situation.
Case 6.6
Mrs. M, employed in a privatefirm, approached the therapist seeking help in negotiating with her parents-in-law on several family matters. Mrs. M’s husband was the only child of an ageing couple and was still financially dependent on them for major expenses. His parents had strong opinions about how their grandchildren had to be brought up and disapproved of their daughter-in-law’s approach. The couple was not allowed to make indepen- dent decisions and the husband was unable to influence his parents to change their stance. The wife could not openly express her emotions in the family sessions in the presence of the in-laws. Separate conjoint couple sessions with her and her husband were initiated.
In Case6.6, Mrs. M and her husband did not want to relocate away from the husband’s parents and sought solutions that would not alter the current family structure. She was aware of her position in the family and did not want to challenge the power hierarchies in the family. The parents-in-law disapproved of therapy but were willing to participate. Although confidentiality issues were discussed at the outset, they continued to insist on knowing what was discussed in the couple sessions. When the therapist refused to divulge this confidential information, they then demanded disclosures from the couple after their sessions.
This posed a great challenge in the smooth conduct of therapy and such situa- tions reflect the cultural perception of a marital system in India. It is not uncommon tofind the couples who are structurally nuclear but functionally extended. Most often, cross-generational subsystems like that of the parent–son allegiance takes precedence over the husband–wife relationship. Couple therapists in India often
6 Ethical Issues in Working with Couples and Families 95
find that there are more than two members in the marital system (Nath and Craig 1999). The process of couple therapy may often pose a threat to the power hier- archies and seek redefinition of the traditional structure of the family. A culturally sensitive and ethical perspective in family therapy accounts for concerns of all members (including the parents-in-law in this case) and empowers members or subsystems in a planned manner (Tamura and Lau1992; Almeida1996).