APPENDIX
Statement of Practice
for
Licensed Marriage and Family Therapists
A.
Each licensed marriage and family therapist/MFT intern in Louisiana shall
write
statement of practice incorporating the
following information to provide to all clients. LMFT’s
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.
For example, clients:
i.
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 these decisions, but your code
of ethics does not allow you to advise a specific decision.
ii.
must notify you before beginning therapy of any other ongoing
professional mental health relationship or other professional relationship that
might impact the therapy
iii.
must inform you during the therapy before being seeing another mental
health professional or professional in another discipline that might impact the
therapy.
iv.
are expected to follow through on homework assignments;
v.
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.
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:
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 execute 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. For
example:
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.
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.
AUTHORITY NOTE:
Promulgated in accordance with R.S. 37:1101-1122.
HISTORICAL NOTE:
Promulgated by the Department of Health and Hospitals, Licensed
Professional Counselors Board of Examiners, LR 28: