Semester

Fall

Date of Graduation

2006

Document Type

Dissertation

Degree Type

PhD

College

Eberly College of Arts and Sciences

Department

Psychology

Committee Chair

Roy Tunick.

Abstract

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.

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