Ethical Thinking in Music Therapy

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Thorough exploration of professional ethics for the music therapist. Topics covered include: the music therapist as professional and person; clients’ rights and therapists’ responsibilities; confidentiality; boundaries and dualrelationships; multicultural and gender perspectives; research and publication; financial and advertising issues and responsibilities to the public; responsibilities to colleagues, employees, employers, and the professional association; educationand supervision; and promoting ethical behavior.

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Visit westmusic.com to purchase a print copy of this book. 

Ethical Thinking in Music Therapy By Cheryl Dileo, PhD, MT-BC

574 pages

Thorough exploration of professional ethics for the music therapist. Topics covered include: the music therapist as professional and person; clients’ rights and therapists’ responsibilities; confidentiality; boundaries and dualrelationships; multicultural and gender perspectives; research and publication; financial and advertising issues and responsibilities to the public; responsibilities to colleagues, employees, employers, and the professional association; educationand supervision; and promoting ethical behavior.

 

TABLE OF CONTENTS

_____________________

Copyright Page/ ii

Dedication/ iii

Acknowledgments/ iv

Table of Contents/ v

About the Author/ xiv

Preface/ xvi

Chapter 1: Introduction to Ethical Thinking/ 1

Introduction/ 1

Ethical Thinking/ 2

Terminology/ 3

Background: Early Research/ 5

Principle Ethics and Theories of Ethics/ 6

Models of Ethical Development/ 11

Codes of Ethics/ 13

Interface of the Law and Ethics/ 15

How Therapists Make Ethical Decisions/ 18

Models of Ethical Decision-Making/ 18

Characteristics of the Decision-Maker/ 19

Ethical Sensitivity/ 19

Reflexivity/ 20

The Analytic/Reflexive Model (ARM) of Ethical Decision Making/ 22

Threats and Deterrents to Ethical Thinking/ 32

Ethics Competencies/ 38

Teaching Ethics/ 39

Additional Learning Experiences/ 42

Chapter 2: The Virtuous Music Therapist/ 47

Caring/ 49

Empathy/ 52

Courage/ 53

Prudence/ 55

Humility/ 55

Additional Learning Experiences/ 56

Chapter 3: Ethical Issues in Multicultural Music Therapy/ 59

Introduction/ 59

The Eurocentric Worldview/ 62

Sources of Bias, Privilege, Power and Oppression/ 64

Therapist Racism/ 65

Intersectionality/ 66

Racism/ 68

Microaggressions/ 70

Ableism/ 76

Sex, Gender and Sexual Orientation Oppression/ 80

Classism/ 85

Ageism/ 86

Social Justice/ 86

Cultural Competence/ 91

Cultural Humility/ 92

Multicultural Competence in Music Therapy/ 94

Musical Cultural Competence/ 945

Implications: Competent Multicultural Music Therapy Practice/ 9

Multicultural Assessment/ 96

Considerations for Music Therapy Practice/ 98

The Therapeutic Relationship/ 100

Boundaries/ 102

Self-Disclosure/ 103

Music Practices/ 104

Addressing Client-Therapist Differences/ 105

Evidence-Based Practice/ 106

Research/ 107

Theory/ 107

Multicultural Education and Supervision/ 108

Ethical Problem Solving/ 109

Recommendations for the Field of Music Therapy/ 110

Dilemmas/ 112

Additional Learning Experiences/ 117

Additional Resources/ 125

Chapter 4: The Music Therapist as a Professional and Person/ 129

Professional Competence/ 129

Types of Competence/ 130

Competence Standards/ 131

Maintaining and Advancing Competence/ 135

Special Circumstances/ 135

Group Music Therapy/ 135

Innovative Practices/ 136

Emergency Situations/ 137

Small or Rural Communities/138

Personal Competence/ 138

Psychological Vulnerability and Impairment/ 140

Burnout/ 142

Moral Distress/ 144

Self-Care/ 145

Legal Aspects of Competence/ 147

Competence: Who is Responsible?/ 148

Final Note on Competence/ 149

Personal Values/ 149

Negotiating Conflicts in Values/ 151

Ethical Bracketing/ 155

Values and Religion/Spirituality/ 156

Recommendations/ 160

Political Values/ 163

Personal Behavior/ 165

Dilemmas/ 166

Additional Learning Experiences/ 170

Chapter 5: Clients’ Rights and Therapists’ Responsibilities/ 175

Introduction/ 175

Informed Consent/ 175

Client’s Rights and Therapist’s Responsibilities/Therapeutic Alliance/ 179

The Therapeutic Relationship/ 180

Communication/Dignity/Respect/ 181

Non-Judgment and Acceptance/ 182

Facilitating Clients’ Autonomy and Responsibility/ 183

Responsibilities in Working with Groups/ 184

Responsibilities with Difficult Clients/ 185

Responsibilities Regarding Setting for Therapy/ 186

Responsibilities Regarding Music Products/ 187

Responsibilities to the Law/ 188

Laws Relevant to Music Therapy/ 188

Responsibilities in Preventing Harm to Clients/ 189

Endangered Therapists/ 192

Termination of Therapy/ 195

The Termination Process/ 196

Effective Termination/ 197

Forced and Premature Terminations/ 198

Client Transfer and Referrals/ 200

Discriminatory Referrals/ 201

Therapists’ Reactions to Termination/ 202

Termination with Groups/ 202

Dilemmas/ 202

Additional Learning Experiences/ 207

Chapter 6: Ethical Thinking and Confidentiality/ 211

Confidentiality/ 211

Definitions/ 212

Legal and Ethical Conflicts/ 213

Limits to Confidentiality/ 213

Duty to Report/ 213

Child Abuse/Neglect/ 214

Elder Abuse/ 215

Duty to Warn and Protect/ 216

Protecting Clients from Harm/Suicide/ 217

Risk Assessment/ 218

Prevention/ 219

Resources/ 221

HIPAA/ 221

Special Circumstances/ 224

Home-Based Therapy/ 224

Therapist’s Home Office/ 225

The Treatment Team/ 225

Referrals/ 226

Consultation/ 226

Supervision/ 227

Deceased Clients/ 227

Bill Collection Agencies/ 227

IRS/ 227

Special Groups or Communities 227

Persons with HIV/AIDS/ 227

Minors/ 229

Group Therapy/ 231

Family and Couple’s Therapy/233

Small Communities/ 233

Prisons/ 233

Record Keeping/ 234

Content of Records/ 234

Maintaining Confidentiality of Records/ 235

Release of Records/ 238

To Client/ 238

To Family/ 239

To Third Parties/ 239

Subpoenas and Court Orders/ 240

Record Retention/ 240

Dilemmas/ 241

Additional Learning Experiences / 245

Chapter 7: Boundaries and Multiple Relationships/ 247

Boundaries/ 247

Boundaries in Therapy/ 248

Boundary Crossings/249

Boundaries in Music Therapy/ 250

Use of Touch/ 25

Client’s Perspective/ 251

Types of Touch/ 252

Cultural Factors/ 253

Contraindications/ 253

Guidelines/ 253

Gift-Giving/ 255

Bartering/ 258

Setting for Therapy/ 259

In Clients’ Homes/ 259

Therapists’ Home Offices/ 260

Dress and Language/ 260

Therapist Self-Disclosure/ 261

In Addictions Treatment/ 263

In Feminist Therapy/ 263

In Music Therapy/ 264

Guidelines for Use of Self-Disclosure/ 265

Multiple Relationships/ 265

Introduction/ 265

Definition and Types/ 266

Non-Sexual Multiple Relationships/ 267

Social Relationships with Clients/ 267

Multiple Roles with Family/Friends/ 269

Multiple Relationships in Music Therapy/ 268

Post-Therapy Relationships/ 269

Professional or Business Relationships/ 270

Small/Rural Communities/ 270

Unexpected Encounters with Clients/ 271

LGBTQIA+ Communities/ 272

Criminal Justice System/ 272

Addictions Treatment/ 272

Referral Sources/ 273

Sexual Multiple Relationships/ 273

Definition/ 273

Sexual Harassment/ 273

Sexual Exploitation/ 274

Incidence and Effects/ 274

Characteristics of Those Who Exploit/ 275

Sexual Relationships w/ Former Clients/ 275

Avoiding Sexual Exploitation/ 275

Prevention/ 275

Guidelines for Dealing with Multiple Relationships/ 276

Dilemmas/ 278

Additional Learning Experiences/ 284

Chapter 8: Ethically Important Moments in Music Therapy Research/ 289

Background/ 290

The Institutional Review Board/ 291

Ethical Principles/ 291

Ethical Reflexivity/ 293

Informed Consent/ 294

Vulnerable Populations/ 296

Completeness of Information/ 296

The IRB Application/ 299

Injury to Participants/ 300

Anonymity and Confidentiality/ 301

Legal Requirements/ 302

Audio/Video/Pictorial Data/ 303

Limits to Confidentiality/ 303

Deception/ 305

Maintaining Records/ 306

Ethics in the Research Process/ 3046

Focus Groups/ 307

Snowball Sampling/ 307

Content of Questionnaires/ 308

Quantitative Designs/ 308

Control Group Design/ 308

Randomized Designs/ 309

Baseline/Treatment Designs/ 310

Longitudinal Designs/ 310

Online Surveys/ 310

Non-Quantitative Designs/ 311

Qualitative Research/ 311

Feminist Research/ 313

Covert Observation/314

Philosophical inquiry/ 315

Historical Research/ 315

Research with Special Groups/ 316

General Cultural Considerations/ 316

Older Adults/ 318

Children/ 317

Persons Experiencing Violence/ 321

Prisoners/322

Persons at the End of Life/323

Persons Experiencing Bereavement/ 324

Social Justice Issues in Research/ 324

Ethical Issues in Publication/ 325

Writing and Publishing Clinical Material/ 326

Assigning Authorship/ 328

Multiple Publications/ 330

Ethics of Peer Review Process/ 330

Research Misconduct/ 331

Dilemmas/ 333

Additional Learning Experiences/ 336

Chapter 9: Private Practice, Financial & Commercial Activities, and Responsibilities to the Public/ 339

Private Practice/ 339

Literature/ 340

Informed Consent/ 340

Fees/ 341

Missed Sessions/ 342

Fee Payment/ 342

Fee Increases/ 342

Handling of Debt/Termination/ 343

Pro Bono Services/ 343

Fee Splitting/ 344

Collections/ 344

Third-Party Reimbursement/ 345

Confidentiality/ 346

Conflicts of Interest/ 346

Fraud/346

Other Private Practice Issues/ 346

Setting for therapy/ 346

Competence/ 347

Employee Relations Issues/ 347

Dispensing Products and Equipment/ 347

Selling a Private Practice/ 348

Advertising and Marketing/ 348

Where and To Whom/ 349

Content 350

What to Avoid/ 351

Testimonials/ 352

Free Sessions/ 352

Professional Relationships/ 352

Commercial Activities/ 353

Responsibilities to the Public/ 354

Competence/ 355

Accuracy o Information/ 355

Control of Information/ 358

Television/Radio/ 358

Misrepresentation of Information/ 358

Treatment Through the Media/ 359

Self-Help Materials/ 359

Recommendations/ 360

Dilemmas/ 361

Additional Learning Experiences/ 365

Chapter 10: Responsibilities to Employers, Employees, Colleagues, and the Professional Association/ 367

Responsibilities to Employers/ 367

Responsibilities to Employers/ 369

Responsibilities to Colleagues/ 369

Sexual Harassment/ 37

Others Who Use Music Interventions/ 372

Concurrent Music Therapy Services/ 374

Letters of Recommendation 374

Responsibilities to the Professional Association/ 376Dilemmas/ 377

Additional Learning Experiences/ 380

Chapter 11: Ethical Issues in Music Therapy Education & Supervision/ 383

Ethical Issues in Music Therapy Education/ 383

Advertising and Recruitment/ 384

Admissions/ 385

Course Syllabi/ 386

Curriculum/ 387

Academic Advisement/ 387

Competent Teaching and Supervision/ 387

Clinical Competence in Teaching & Supervision/ 389

Multicultural Competence/ 390

Personal Competence in Teaching/Supervision/391

Confidentiality/ 391

Ethical Issues Unique to Internship/ 392

Competency/ 393

Application Process/ Informed Consent/ 393

Quality of Internship Experience/ 393

Student/Supervisee Evaluation/ 393

Dealing with Difficult Students/ 394

Problematic Professional Competence/ 394

Student Dismissal/ 397

Due Process/ 398

Ethical Issues in Supervision/ 398

Roles and Responsibilities of the Supervisor/ 399

The Supervisor/Supervisee Relationship/ 401

Informed Consent in Supervision/ 404

Supervisor Self-Disclosure/ 404

Supervision vs. Therapy/ 405

Peer Supervision/ 405

Multiple Relationships in Education and Supervision/ 406

Personal and Social Relationships/ 407

Business Roles/ 408

Graduate Students/ 408

Multiple Therapy Relationships/ 408

Multiple Sexual Relationships/ 409

Dynamics/ 409

Experiential Training in Music Therapy/ 412

Description/ 412

Requiring Experiential Training/ 413

Leadership and Multiple Relationships/ 414

Confidentiality/ 414

Boundaries/ 414

Safeguards/ 415

Informed Consent/ 418

Dilemmas/ 419

Additional Learning Experiences/ 426

Chapter 12: Ethical Issues Involving Technology and Social Media/ 429

Music Therapy Telehealth/ 429

Definitions/ 429

Literature/ 431

Potential Advantages/ 432

Potential Disadvantages/ 432

Assessment and Contraindications/ 433

Boundaries/ 434

Privacy and Confidentiality in Record Keeping and Storage/ 435

Competence and Legal Issues/ 437

Training/ 438

Legal Jurisdiction/ 438

Emergency Situations/ 439

Informed Consent/ 440

Text communication: Email, Texting, and

Messaging/ 441

Conclusion/ 442

Social Media/ 443

Benefits/ 444

Risks to Privacy and Confidentiality/ 444

YouTube/ 445

Blogs/ 445

Boundaries and Multiple Relationships/ 446

Recommendations/ 447

Social Media Policy/ 449

Online Dating/ 450

Other Aspects of Social Media/ 450

Patient-Targeted Googling/ 451

Resources/ 452

Dilemmas/453

Additional Learning Experiences/ 457

Chapter 13: Promoting Ethical Behavior/ 461

Those at Risk for Ethical Violations/ 461

Informal Resolutions/ 462

Formal Resolution of Ethics Violations/ 465

Actions, Resolutions, and Sanctions/ 465

Conflicts Between Law and Ethics/ 467

Litigation against Therapists/ 468

Responding to a Lawsuit or Ethics Violation Charge/ 469

A Model for Ethical Practice/ 469

Additional Learning Experiences/ 471

References/ 473

Appendix/ 541

Code of Ethics/ American Music Therapy Association/ 541

Code of Professional Practice/CBMT / 546

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