APPENDIX

APPENDIX

Statement of Practice

for

Licensed Marriage and Family Therapists

A. Each licensed marriage and family therapist/MFT intern in Louisiana shall write a statement of practice incorporating the following information to provide to all clients. Licensed marriage and family therapists also licensed in other mental health professions may need to add additional information required by that licensure. This statement is subject to review and approval by the advisory committee. Sample statements of practice are available from the board office:

1. your name, mailing address, and telephone number;

2. qualifications:

a. degrees earned and institution(s) attended;

b. your LMFT licensure number, noting that the board of examiners is the grantor of your license. Include the address and telephone number of the board;

c. other licensure numbers, including the name, address, and telephone number of the grantor;

d. an MFT intern must use this title and include the name and address of his/her approved supervisor and a brief explanation of how supervision affects the therapy provided.

3. specify the type(s) of clients you serve;

4. specialty areas:

a. list your specialty areas such as family of origin, parenting, stepfamilies, adolescents, marriage, etc.;

b. list your national certifications;

5. what clients can expect from therapy:

a. briefly describe the theoretical orientation and the type of techniques and/or strategies that you use in therapy;

b. briefly describe your philosophical view of therapy, including clients' input for treatment plans;

c. briefly describe your general goals and objectives for clients;

6. note any expectations that you have for clients:

a. Clients are expected to inform you before and during the therapy about seeing another mental health professional or professional in another discipline because of the possible impact upon therapy.

b. Clients are expected to inform you on their intake form and during therapy of their general physical health, any medical treatments that may impact their therapy and any medications that they are taking;

c. You are required to include that clients must make their own decisions regarding such things as deciding to marry, divorce, separate, reconcile, and how to set up custody and visitation; that is, you may help them understand the consequences of various decisions, but your code of ethics does not allow you to advise a specific decision.

7. Code of Ethics:

a. state that you are required by state law to adhere to The Louisiana Code of Ethics for Licensed Marriage and Family Therapists; and

b. that a copy is available on request;

c. you might want to specifically note some of the provisions in the code of ethics that you would like clients to be aware of;

8. describe the rules governing privileged communication for licensed marriage and family therapists. You may use your own language, but need to cover all the areas included in the sample statement and 8 (a-c).

a. include instances where confidentiality may be waived. This includes, but is not limited to danger to self or others, suspected child abuse/neglect, elderly abuse/neglect, or disabled adult abuse/neglect;

b. include the information that when providing couple, family or group treatment, a licensed marriage and family therapist cannot:

i. disclose any information outside the treatment context without a written authorization from each individual competent to ecute a waiver; and

ii. may not reveal any individual's confidences to others in the client unit without the prior written permission of that individual;

c. if you audio- or video-tape sessions, include information specific to their use;

d. see Chapter 39 and the Code of Ethics in the Appendix for rules on privileged communication;

9. state your policy for emergency client situations;

10. fees, office procedures, insurance policies:

a. list your fees and describe your billing policies;

b. state your policy on insurance payments;

c. describe your policy on payments, scheduling and breaking appointments, etc.;

11. adequately inform clients of potential risks and benefits of therapy. You may use your own language and are not required to use examples given in a-f;

a. clients may realize that they have additional issues that they were not aware of before the therapy as a result of the therapy;

b. making changes through therapy may bring about unforeseen changes in a person's life;

c. individual issues may surface for each spouse as clients work on a marital relationship;

d. making changes in communication and/or ways of interacting with others may produce adverse responses from others;

e. marital or family conflicts may intensify as feelings are expressed;

f. individuals in marital or family therapy may find that spouses or family members are not willing to change.

12. briefly add any additional information that you believe is important for your clients to be informed about your qualifications and the therapy that you provide;

13. end with a general statement indicating that the client(s) have read and understand the statement of practice, providing spaces for the date, client(s)' signatures, and your signature. MFT Interns need to have a line for their
LMFT-approved supervisor's signature.

B. Provide clients with a copy or copies of the signed statement of practice.

C. A Licensed Marriage and Family Therapist/MFT Intern must have a copy of his/her statement of practice on file in the board office. An MFT Intern must include a copy of his/her statement of practice with his/her registration of supervision. The code of ethics can be duplicated for clients and additional copies are available at www.lpcboard.org or from the board office.