The Results of the 2021 Student Ethics Competition Are In!


In 2021, AAMFT held the sixth annual Student Ethics Competition. This competition is designed to encourage MFT students to foster an interest in ethics issues and enhance their ability to analyze and respond to the various ethics issues that they will undoubtedly encounter throughout their careers. In this team competition, participants submitted an essay analyzing and responding to a hypothetical scenario.

The submissions were scored by current and former members of the Ethics Committee and current and former members of the Judicial Committee. After the final review of the score, the winning teams have been announced. Winners received a cash award and a plaque.

The first-place winners will be recognized during the 2022 Leadership Symposium. Join AAMFT in congratulating the winning teams on their excellent work!

First place: Tahlia Harrison, Midori Ferris-Wayne, and Monica Maragos (Lewis and Clark Graduate School Education and Counseling)

Tahlia Harrison
Midori Ferris-Wayne
Monica Maragos

Second place: Carson Outler and Patrick Tremaglio (Mercer University)

Carson Outler
Patrick Tremaglio

Third place: Ronald Asiimwe and Jennifer VanBoxel (Michigan State University)

Ronald Asiimwe
Jennifer VanBoxel

The first place team’s essay is included here:

The hypothetical presented here follows Josephine, a licensed marriage and family therapist of two years working with Marcus, a 12-year-old boy referred by a child and adolescent psychiatrist for presenting concerns related to his diagnosis of attention-deficit hyperactivity disorder (predominantly inattentive). After working with Marcus in a traditional in-person therapy setting, Josephine is confronted with how the global pandemic has changed the context within her practice, Marcus’s presenting concerns, and realignment of telehealth to the boundaries and expectations set forth previously with Marcus’s parents. Josephine is not unique in these circumstances; the pandemic disruption created an unprecedented shift which has forced many clinicians to adapt quickly to offering telehealth services with flexible interventions to meet the moment, while simultaneously adhering to shifting professional ethics codes (Harris, 2021). Unsurprisingly, Josephine’s intention to be creative and adaptable in her practice and to address her clients’ presenting concerns landed her in situations requiring further investigation of her ethical responsibilities with each decision.

Method for ethical action guidance
When considering ethical implications in family therapy practice, clinicians and supervisors share an obligation under the binding expectations of the AAMFT Code of Ethics (2015) to maintain familiarity with principles and application to our professional services. At the onset of treatment, it is also imperative for therapists to choose clinical interventions that promote welfare and minimize harm to the family and any members within the therapeutic relationship (Zygmond & Boorheim, 1989). Given the complexity that clinical decision-making entails, evaluation of an ethical dilemma stands to benefit from consultation with multiple resources alongside the active professional codes, and consideration of a decision-making framework which accounts for the intricacy involved. For example, Kitchener’s model of ethical decision-making acknowledges that ethical decisions are contextually nuanced (Kitchner, 1986), and considers personal and group values, clinical decisions, and context to create effective action guidance (Zygmond & Boorheim, 1989).

Using current resources examining ethical decision making (Miller & Springer, 2020) and the Kitchener model (1986) as a reference, we will identify and review the ethical issues that are in violation of the AAMFT Code of Ethics (2015) and of the law and will indicate alternative actions that may have been taken in the hypothetical case study. For the purposes of this evaluation, we will assume that Josephine is treating Marcus as the identified client. Additionally, since the location of the client and his family are undisclosed, we will assume the AAMFT Code (2015) as a higher standard than the law in their governing state and will adhere to the commitment required of the AAMFT Code (2015) to resolve conflict responsibly.

Evaluation of adherence to AAMFT Ethical Code of Ethics
Standard I: Responsibility to Clients. The first standard of care listed by the AAMFT Code of Ethics (2015) is the therapist’s responsibility to prioritize clients’ welfare. Josephine’s decision to incorporate video games as part of Marcus’s new treatment plan may have been implemented to increase her own comfort and sense of competence as a therapist at the expense of previously expressed treatment goals from his parents. Josephine does not appear to have prioritized Marcus’s wellbeing, particularly since Marcus’s parents reported concerns that Marcus’s symptoms were worsened by video games. Increasing reliance on technology that has previously been identified as problematic for the family has significant ethical implications and may even indicate negligence (Young, 2009). Josephine does not appear to have assessed for internet gaming disorder, the presence of which would provide contraindication for incorporating video games into therapy. Additionally, ethical concerns expressed by researchers about video gaming conditions replicating online gambling reward systems suggest that an adolescent whose gaming behaviors already pose parental concerns may even be at greater risk for future mental health problems (Torres-Rodriguez et al., 2018). Given these concerns, regardless of whether Marcus’s parents provided informed consent, the use of video games in therapy would need careful consideration and monitoring for efficacy and therapeutic value.

Due to Marcus’s status as a minor (in most states), informed consent is to be obtained from his parents, encompassing adequate and significant information concerning Josephine’s treatment processes and procedures (S1.2). Initial parental involvement in Marcus’s treatment suggests that Josephine complied with informed consent collaborating with the family around treatment planning and was also in consideration of Marcus’s mom’s concerns around the use of video games. Marcus has come to therapy as a referral from a third-party practitioner (psychiatrist) whom Marcus’s mom has been contacting with concerns about his progress in therapy. Initial informed consent should have identified the nature of the relationship to this referral and addressed the limits of confidentiality within (S1.13). Without touching base with either parent since the onset of the pandemic and moving to telehealth, Josephine’s feeling that her informed consent needs updating is accurate. With precedent for concern in the context of screen time and video games, initiating the use of these formats without prior consent is out of bounds with the families’ expectations and therefore represents an ethical violation.

Since moving to telehealth, Josephine employed methods without generally recognized standards; updated informed consent forms and ongoing consent for implementing new treatment processes must communicate the potential risks and benefits of new treatment methods and be approved by Marcus’s parents (S1.2). Without established consent for using new modalities, and with Josephine’s growing concern around her difficulty connecting with clients online, the relationship may no longer be beneficial to the client; (S1.9) consultation is needed, and if appropriate, referrals to another clinician (S1.10) to ensure non-abandonment (S1.11) must be adhered to.

Standard III: Professional Competence and Integrity. Josephine has continued to see Marcus weekly through telehealth services and has found herself struggling to connect to the children she sees online as clients. To adapt to the new format, Josephine first tried some interactive interventions through arts and crafts, though found them ineffective. With her increasing frustration, it is evident that she was questioning what would be within her scope of practice as an effective intervention. This indicates some awareness of the possible ethical concerns in continuing the therapeutic relationship with this client.

Josephine has also been resistant to consultation, and the professional status of the friend who gave her the recommendation, as well as the source of the one-hour webinar on incorporating video games in therapy, are unknown. To comply with maintenance of competency (S3.1), Josephine may pursue knowledge of new developments through something akin to this training, though she has not been seeking assistance around the struggles she is experiencing as a clinician (S3.3) or considering if this training adheres to ethical and professional standards (S3.2). Offering a new skill after one-hour of training without supervised experience in a specialty area may not be the appropriate education to ensure competence, creating a risk of harm to the client (S3.6). Without seeking professional assistance for the issues Josephine experiences around her work performance and clinical judgement (S3.3), she is at risk of treating problems outside recognized boundaries of competency (S3.10); along with providing a service that is in conflict with Marcus’s parents’ boundaries around video games (S3.4). Standard II: Confidentiality and VI: Technology Assisted Professional Services. Josephine moved her practice during the pandemic from an office space to her home working in a shared kitchen space, changing her methods for maintaining confidentiality. These changes were not disclosed and updated for her clients to review to inform the family of specific risks and limitations inherent in technology assisted services (S2.1, S6.1, S6.2). The use of third-party platforms and online games may change the security of confidentiality, requiring disclosure (S2.1), written authorization if client information must be released (S2.2), and changes to protocol in the protection of records (S2.5). Josephine has been initiating platform changes when there are technical difficulties without disclosing the platforms and their limitations of protections to the clients and consideration of best current technology practice (S6.3, S6.6). Alongside these changes, the shift from family therapy to individual sessions with Marcus indicates a shift of role required to be communicated by the ACA ethics code (A.6.d), making it ambiguous which client is to be protected and considered in confidentiality. Although Josephine would like to revert back to family therapy, she has not consulted whether the laws in her location, and Marcus’s father’s location (when out of state), allow for technologically-assisted means to practice across those state lines (S6.5).

In the context of the global COVID-19 pandemic and the need to transition to telehealth for family therapy, ethical dilemmas might be considered par for the course. However unprecedented the situation, Josephine could still have navigated this rocky territory more effectively and avoided ethical pitfalls related to her obligations regarding responsibility to the client, professional competence and integrity, and special circumstances involving confidentiality and technologically-assisted means to practice. By seeking outside resources, she could have learned there are comparable outcomes and benefits of family teletherapy to in-person therapy (de Boer et al., 2021), and read updated research to expand competency in telebehavioral health specific to family therapy practice (Hertlein et al., 2021). Proceeding now with supervision will give Josephine the necessary guidance around her ethical responsibility to update informed consent and fulfill the appropriate competency requirements before continuing new methods of clinical intervention (S4.4) with Marcus. Rather than disregarding her intuition and avoiding consultation, Josephine may also benefit from building awareness of her own values-based actions in order to reflect more carefully on clinical decisions supporting her clients’ values and best interests (Wilcoxon et al., 2013). Moving forward, continuing supervision and maintaining her familiarity with the AAMFT codes, alongside adopting a decision-making framework, while exploring outside ethics concepts, like virtue ethics, Josephine may gain the insight needed to prevent future ethics violations while refining her core values around “goodness in ethical practice;” attending to the humanity of clients through protecting clients from harm, an element that can be considered core to clinical and ethical competence (Miller & Springer, 2020).


American Association for Marriage and Family Therapy. (2015). Code of ethics. Retrieved from www.aamft.org/coe

American Counseling Association. (2014) ACA code of ethics. Retrieved from  https://www.counseling.org/Resources/aca-code-of-ethics.pdf

de Boer, K., Muir, S. D., Silva, S. S., Nedeljkovic, M., Seabrook, E., Thomas, N., & Meyer, D. (2021). Videoconferencing psychotherapy for couples and families: A systematic review. Journal of Marital and Family Therapy, 47(2), 259–288. https://doi.org/10.1111/jmft.12518

Harris, S. M. (2021). Introduction to the special issue on telehealth. Journal of Marital and Family Therapy, 47(2), 223-224. https://doi.org/10.1111/jmft.12521

Hertlein, K. M., Drude, K. P., Hilty, D. M., & Maheu, M. M. (2021). Toward proficiency in telebehavioral health: Applying interprofessional competencies in couple and family therapy. Journal of Marital and Family Therapy, 47(2), 359-374. https://doi.org/10.1111/jmft.12496

Kitchener, K. S. (1986). Teaching applied ethics in counselor education: An integration of psychological processes and philosophical analysis. Journal of Counseling and Development, 64, 306-310.

Miller, B. J., & Springer, P. (2020). Ethics-based training for clinicians: Moving beyond ethical decision making models. Contemporary Family Therapy, 42(4), 370-380. https://doi.org/10.1007/s10591-020-09537-7

Torres-Rodríguez, A., Griffiths, M.D, & Carbonell, X. (2018). The treatment of internet gaming disorder: A brief overview of the PIPATIC program. International Journal of Mental Health and Addiction, 16(4), 1000-1015.

Wilcoxon, S., Remley, T. P., & Gladding, S. T. (2013). Ethical, legal, and professional issues in the practice of marriage and family therapy (Updated fifth ed., Merrill counseling series). Pearson.

Young, K. (2009). Understanding online gaming addiction and treatment issues for adolescents. The American Journal of Family Therapy, 37(5), 355-372.

Zygmond, M. J., & Boorheim, H. (1989). Ethical decision making in family therapy. Family Process, 28(3), 269-280. https://doi.org/10.1111/j.1545-5300.1989.00269.x

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