General Principles

PURPOSE: This rule provides the ethical principles governing the practice of marital and family therapists. (1) The ethical standards (hereinafter standards) shall apply to the professional conduct of licensed marital and family therapists (LMFTs), supervisors, provisional licensed marital and family therapists (PLMFTs), supervised-marital and family therapists (SMFTs), and applicants for licensure and supervision (hereinafter therapist or therapists). Professional practice includes, but is not limited to, the practice of marital and family therapy as defined in section 337.700(7), RSMo, research, teaching and the supervision of students, supervisors, PLMFTs, and S-MFTs. A violation of these standards constitutes unprofessional conduct and is sufficient cause for the state committee to deny an application for licensure or for supervision and is sufficient cause for the state committee to discipline a license. (2) Client or patient (hereinafter client) is a person, group, or any other recipient of marital and family therapy as defined in section 337.700(7), RSMo, or the client’s legal guardian. A corporate entity or other organization can be a client when the professional contract is to provide services that benefit the organization as well as the individual or group. (3) The therapist shall limit the practice and the supervision of others to the areas in which competence has been gained through formal education, training derived through an organized and integrated sequence of study, and supervised professional experience in marital and family therapy. If important aspects of a client’s issues fall outside the boundaries of the therapist’s competency, the therapist shall assist the client in obtaining additional professional consultation. A licensed marital and family therapist shall not permit a PLMFT, S-MFT, or a supervisor receiving supervision to represent him/herself as capable of providing or to provide services that are beyond his/her level of training. (4) The therapist shall maintain competency in the practice of marital and family therapy through continuing education, consultation, training, or any combination of these, in conformance with current standards of scientific and professional knowledge relative to the field of marital and family therapy. (5) When developing competency in a new service or technique, the marital and family therapist shall engage in ongoing consultation with other therapists or relevant professionals and seek appropriate education and/or training in the new area, service, or technique. The therapist shall inform any client whose treatment will involve a newly developing service or technique of its innovative nature; the known risks associated with the new service or technique and the client’s right to freedom of choice concerning services received. (6) The therapist shall make or recommend referral to other professional, technical, or administrative resources when that referral is clearly in the best interest of the client. The well-being of the client shall be the primary consideration in the referral process. Referral for the purposes of financial gain shall be in violation of the ethical standards. (7) The therapist providing marital and family therapy as defined in section 337.700(7), RSMo, shall maintain client records that include: (A) The presenting issue(s); and (B) Any evaluative results and any test data from which the results were derived; and (C) The date and description of each contact or service provided or pertaining to the client; and (D) The nature, type, and goals of any interventions; and (E) The fee arrangement; and (F) A copy of evaluative reports or correspondence prepared as part of the client-therapist relationship; and (G) Notation and results of consultation with other providers; and (H) Notation of referrals given or recommended to the client; and (I) Informed consent as defined in 20 CSR 2233-3.020(1)(A)–(H). (8) Within the limits of the law, a client’s records shall be maintained by the therapist for a period of not less than five (5) years after the last date of therapy. (9) A therapist shall not undertake nor continue a client-therapist or supervisory relationship when the competency of the therapist is or could reasonably be expected to be impaired due to mental, emotional, physiologic, pharmacological, or substance abuse conditions. If such condition develops after a client-therapist or supervisory relationship has been initiated, the therapist shall terminate the relationship by notifying the client, supervisor, PLMFT, or S-MFT in writing of the termination and providing references for obtaining services from another licensed mental health practitioner. (10) The therapist shall not undertake or continue a client-therapist or supervisory relationship when the objectivity or competency of the therapist is or could reasonably be expected to be impaired because of the therapist’s present or previous familial, social, sexual, emotional, financial, supervisory, political, administrative, or legal relationship with the client, marital and family therapist under supervision for licensure, or a person associated with or related to the client, PLMFT, or S-MFT. (11) In interacting with any marital and family therapist under supervision for licensure, supervisor, student, current client, or person to whom the therapist has provided therapy for the treatment or amelioration of emotional distress or behavioral inadequacy, the therapist shall not— (A) Engage in sexual intercourse, which includes any genital contact of the therapist with the client or the client with the marital and family therapist. This specifically prohibits sexual intercourse, sodomy, oral, anal copulation, or both; or any penetration of the anal opening by any one (1) part or object; or (B) Engage in kissing with the mouth, lips or tongue of the marital and family therapist with the client or the client with the marital and family therapist; or (C) Touch or caress either the marital and family therapist or client of the other person’s breasts, genitals, or buttocks; or (D) Engage in any deliberate or repeated comments, gestures, or physical contact of a sexual nature that exploits the professional relationship with the client; or (E) Terminate a relationship with a client or student for the purpose, expressed or implied, of having a sexual relationship with that person; or (F) Expose one’s self or encourage another to expose him/herself for the purpose of sexual gratification. (12) The therapist shall not exploit, sexually or otherwise, the relationship with clients, PLMFTs, S-MFTs, students, employees, research participants, or others. (13) Whenever therapy is terminated, the therapist shall provide alternative sources of treatment or assistance when indicated and shall not exploit clients by providing unnecessary therapy. The therapist shall terminate a clienttherapist or supervisory relationship when it is reasonably clear that the client or supervised therapist is not benefiting from the relationship. (14) The therapist shall not impose on the client any stereotypes of behavior, values, or roles related to age, gender, religion, race, disability, nationality, or sexual preference which would interfere with the objective provision of therapy. (15) The therapist shall not request or induce any client to solicit business on behalf of the therapist. (16) In deciding whether to offer marital and family therapy to a person already receiving similar services elsewhere, the therapist shall carefully consider the treatment issues and the potential client’s welfare. The therapist shall discuss these issues with the client to minimize the probable risks of confusion and conflict, and proceed with caution and sensitivity to the therapeutic issues. (17) When providing therapy as part of a team or when interacting with other appropriate professionals concerning the welfare of the client, the therapist may share confidential information about the client provided the therapist takes reasonable steps to assure that all persons receiving the information are informed about the confidential nature of the information and abide by the rules of confidentiality. (18) The therapist shall limit access to client records and assure that all persons working under his/her authority comply with the requirements for confidentiality of client records. (19) The therapist shall not mislead or withhold from any client, prospective client, or third-party payer, information about the cost of his/her professional services. (20) The therapist shall not exploit a client or responsible payer by charging a fee that is excessive for the therapeutic services performed. (21) The primary obligation of the therapist employed by an institution, agency, or school is to persons entitled to services through the institution, agency, or school. A therapist shall not accept a private fee or any other form of remuneration from those persons unless the policies of a particular institution, agency, or school make explicit provision for private work with its clients by members of its staff. In those instances, the client or guardian shall be fully apprised of available services and all applicable policies, prior to entering into a client-therapist relationship with the therapist. (22) The therapist shall use, administer, and review assessment techniques competently and shall maintain current knowledge about research developments and revisions concerning the techniques that are used. AUTHORITY: sections 337.700 and 337.730.2(15), RSMo 2016, and section 337.727(6) and (10), RSMo Supp. 2019.* This rule originally filed as 4 CSR 233-3.010. Original rule filed Dec. 31, 1997, effective July 30, 1998. Moved to 20 CSR 2233-3.010, effective Aug. 28, 2006. Amended: Filed June 27, 2008, effective Dec. 30, 2008. Amended: Filed Nov. 15, 2011, effective May 30, 2012. Amended: Filed Sept. 5, 2019, effective March 30, 2020. *Original authority: 337.700, RSMo 1995, amended 2007, 2008, 2010; 337.727, RSMo 1995, amended 2009, 2010, 2018; and 337.730, RSMo 1995, amended 2009.