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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
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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