| Multisystemic treatments (MST) have become a significant force in the mental health community over the past decade. Yet, scant literature is available in regards to differing ethical considerations that may arise when working outside of a traditional office setting. The current research reviewed key ethical issues within the therapeutic relationship (i.e., confidentiality, dual roles), and extended the discussion to pertinent, often unrecognized issues endemic to in-home service modalities (i.e., confidentiality, role confusion, client diffusion, and unintentional witnessing).;More specifically, this research examined whether certain ethical violations are perceived to occur less frequently in outpatient settings compared to in-home settings. It was hypothesized that in-home therapists would report more possible hypothetical experiences with these kinds of violations than their outpatient therapist counterparts. A survey was mailed to agencies that employ both outpatient and in-home therapists in the states of Pennsylvania and Eastern Ohio to test this hypothesis. The therapists had a minimum educational level of a Master's degree.;The study examines those therapists that worked with children under the age of eighteen, using in-home or multisystemic therapy (MST). Likewise, office-based therapists who treated the same age-group were sought to offer balance for data interpretation. Hence, the comparison between office-based and in-home therapist's ethical dilemmas were the primary focus.;Ninety-seven therapists completed the survey and some of the results showed significant differences in both ethical perceptions and supervision standards. In-home therapists noted significantly higher perceived instances of confidentiality (p=.003) and role confusion (p=.04) ethical quandaries than their office-based colleagues. In addition, in-home therapists stated that they received significantly less individual supervision (p=.01) than office-based therapists, used clinical consultation less frequently (p=.01) and were more likely to withhold information from their direct supervisors (p=.03). Years worked in the field, state licensure, and whether or not a therapist had taken an ethics course did not appear to be significant in terms of observing ethical dilemmas in their work. |
