Ethical Dilemmas Kristen Bryant October 2, 2011 Argosy University

Ethical Dilemmas Abstract The case study that we were given seems to have some ethical dilemmas and we were given the task of picking out the three and discussing them. Well I think there are four and I will be discussing them, because I might be wrong on one and this way I dont get points off for one I put in that didnt necessarily need to be there, but it will be good reading. The first thing that I see a problem with is that James wants to return to his hometown, which is a rural community, where everyone knows everyone kind of place and open a private practice. This can be an issue, because, first off, is James confident that people he knows and grew up with are going to come to him and tell him their problems and secrets. Are these people going to trust him enough to tell him things in confidence knowing its a small town and everyone knows everything about everyone else? Plus ACA code(s) A.5.c. Non Professional Interactions or Relationships (Other Than Sexual or Romantic Interactions or Relationships) states that, Counselor-client nonprofessional relationships with clients, former clients, their romantic partners, or their family members should be avoided, except when the interaction is potentially beneficial to the client. Plus APA Codes 3.05 Multiple Relationships, which states A psychologist refrains from entering into a multiple relationship if the multiple relationship could reasonably be expected to impair the psychologists objectivity, competence, or effectiveness, in performing his or her functions as a psychologist, or otherwise risks exploitation or harm to the person with whom the professional relationship exist. APA Code 3.06 Conflict of Interest states, Psychologists refrain from taking on a professional role when personal, scientific, professional, legal, financial, or other interests or relationships could reasonably be expected to

(1) Impair their objectivity, competence, or effectiveness in performing their functions as psychologists or (2) Expose the person or organization with whom the professional relationship exists to harm or exploitation. Plus, James wants his dad to run an ad in the newspaper for him, when he moves home, to get things started. APA code(s) 5.01b Avoidance of False or Deceptive Statements that states, Psychologists do not make false, deceptive, or fraudulent statements concerning (1) their training, experience, or competence; (2) their academic degrees; (3) their credentials; (4) their institutional or association affiliations; (5) their services; (6) the scientific or clinical basis for, or results or degree of success of, their services; (7) their fees; or (8) their publications or research findings. These codes tie into the second dilemma, which we will now discuss. James arrives at the Center for his internship and finds that his ex-girlfriend is going to be his supervisor and right away he starts asking for favors. James wants her to put Licensed Professional Counselor after his name before he graduates and before he gets his license. He also wants her to continue to council him when he moves and opens his practice until he gets his license. To top it all off, James has no experience and wants to get started seeing clients right away, so he can open up his practice right away when his internship is over. If, we look at ACA Code (s) C.2.a. Boundaries of Competence, that states, Counselors practice only within the boundaries of their competence, based on their education, training, supervised experience, state and national professional credentials, and appropriate professional experience. Counselors gain knowledge, personal awareness, sensitivity, and skills pertinent to working with a diverse client population. ACA Code C.3.a. Accurate Advertising that says, When advertising or otherwise representing their services to the public, counselors identify their credentials in an accurate manner that is not false, misleading, deceptive, or fraudulent. ACA Code F.3.d. Close Relatives

Ethical Dilemmas and Friends which says, Counseling supervisors avoid accepting close relatives, romantic partners, or friends as supervisees. The APA Code(s) 5.01(b) Avoidance of False or Deceptive Statements, which was described above, is relevant here also. As well as, APA Code 2.01(a) Boundaries of Competence which states, Psychologists provide services, teach, and conduct research with populations and in areas only within the boundaries of their competence, based on their education, training, experience, consultation, study, or professional experience. Then James assumes that his ex-girlfriend is going to keep supervising him after his internship when he moves home and opens his private practice. Is that even possible? Will he still in the same state or moving to another state? Will his supervisor even have time to continue to watch over him once he leaves the center and is that even allowed? James has not even considered what the rules might be for when he is out on his own. Our next dilemma seems to occur when James meets his first client, Lisa for the first time. Because he was running late, James doesnt get to all of his in-take paper work and just puts them to the side. Maybe one of those papers is on confidentiality or her copy of HIPPA. What if some of those papers were her Rights and Responsibilities forms. What if James never got around to explaining to her about confidentiality or her rights as a patient? He is not only violating the Centers codes and professionalism, but also ACA Codes A.2.a. Informed Consent which clearly states, Clients have the freedom to choose whether to enter into or remain in a counseling relationship and need adequate information about the counseling process and the counselor. Counselors have an obligation to review in writing and verbally with clients the rights and responsibilities of both the counselor and the client. Informed consent is an ongoing part of the counseling process, and counselors appropriately document discussions of informed

consent throughout the counseling relationship. ACA Code A.2.b. Types of Information Needed, which says, Counselors explicitly explain to clients the nature of all services provided. They inform clients about all issues such as, but not limited to, the following: the purposes, goals, techniques, procedures, limitations, potential risks, and benefits of services; the counselors qualifications, credentials, and relevant experience; continuation of services upon the incapacitation or death of a counselor; and other pertinent information. Counselors take steps to ensure that clients understand the implications of diagnosis, the intended use of tests and reports, fees, and billing arrangements. Clients have the right to confidentiality and to be provided with an explanation of its limitations; to obtain clear information about their records; to participate in the ongoing counseling plans; and to refuse any services or modality change and to be advised of the consequences of such refusal. There are also APA Codes 3.10a Informed Consent that states, When psychologists conduct research or provide assessment, therapy, counseling, or consulting services in person or via electronic transmission or other forms of communication, they obtain the informed consent of the individual or individuals using language that is reasonably understandable to that person or persons except when conducting such activities without consent is mandated by law or government regulation or as otherwise provided in this Ethics Code. APA Code 4.02a Discussing the Limits of Confidentiality which says, Psychologists discuss with persons and organizations with whom they establish a scientific or professional relationship (1) the relevant limits of confidentiality and (2) the foreseeable uses of the information generated through their psychological activities. If this is James only client, how could he forget to talk with his supervisor about her symptoms and possible diagnosis. Does this mean he also forgot to take notes and document this in her chart? This first session

Ethical Dilemmas should never have even happened without Lisa having signed those papers and James not explaining all her rights and confidentiality. It doesnt say he finished the paperwork in the other sessions either. Our last dilemma surfaces when Lisa tells James that when she was 7years old she caused a mans stroke and ultimately his death. James dilemma is what to do now. Theres a no statute of limitations on murder, but she was just a child and a victim. 14 years have passed for Lisa and evidently it must bother her or she wouldnt have said anything to James. I am not sure what code this falls under because Lisa is not trying to hurt herself or others the deed was done 14 years ago and she was the one being hurt. She didnt know what she was doing at the time and if James documents her past history and mental state at the time and follows ACA codes B.2.c Court Ordered Disclosure that says, When subpoenaed to release confidential or privileged information without a clients permission, counselors obtain written, informed consent from the client or take steps to prohibit the disclosure or have it limited as narrowly as possible due to potential harm to the client or counseling relationship. Code B.2.d. Minimal Disclosure that says, To the extent possible, clients are informed before confidential information is disclosed and are involved in the disclosure decision-making process. When circumstances require the disclosure of confidential information, only essential information is revealed. How do we rectify each dilemma? Well, lets take each one step by step and break it down. With the first problem, James is going to have a rough time of making a go of it with a private practice in a small town where people know him. Plus, he wont get the diversity that he is

Ethical Dilemmas looking for in a small town. Plus even when he moves, James wont have his license right away so it might be better for him to stay where he is and get more experience. In addition, he will have to spend money on a place to live and rent an office space and get a license for a business and I do not think James has thought this through. Where is he getting the money? Students are poor. An alternative could be that James doesnt move home to open a private practice and finds a place in the city. He will get a more multicultural and diverse option with clients, which would give him much more experience with clients and he could work with someone until he is ready to open a place by himself. At that time, James could decide if he wanted to move back home or stay where he is just a new location. The advantages of not going home right away is that James gains experience he otherwise would not get in a small town and to be truthful, his private practice may not work out, only a small percentage actually make it. James would also be limited in a small town with the clients he sees. In the city, James would get all kinds of clients and if he worked with someone he would gain insight and knowledge from their supervision. Lets move on to the second dilemma. James and the ex-girlfriend have broken some codes by putting a false title by his name that doesnt belong there. James doesnt have a license and he shouldnt say that he does, because that is misleading people and cant the supervisor lose her job over that. I think she deserves to if she went along with that. James is an intern and not yet a graduate and should be treated as such and not allowed to be pushed ahead, because he knows the supervisor better than everyone else. Also he shouldnt just assume that she is going to keep supervising him later when he moves. He should discuss it with her ahead of time, because she could say no and in that case, he might need her to recommend someone for him. So, to fix all this, when James first came to the center and found out that he would be working with his ex-

Ethical Dilemmas girlfriend, one or both of them, should have requested a different supervisor to neutralize the situation. They could have met and talked about it, saying this is an awkward situation and it might be an ethical violation so how about I go to another department or supervisor. From there, James then could have asked his new supervisor to oversee him in his practice if that was allowed. I am also sure that this supervisor would not break any ethics codes and put false titles after his name. This way he can still chit chat with his ex-girlfriend and catch up with her and neither one of them will feel guilty about their relationship or what used to be and maybe James will pick up a few pointers from her, but this way James is treated like other interns and there are no special favors or oversights. The alternative we chose was to put James with another supervisor, whom he could not ask favors of and be treated like all other interns. This has its advantages because in the long run, James will make less mistakes and he will have the supervision for the ones that he does make. If he had been allowed to stay with the ex-girlfriend as his supervisor, I think mistakes would have been made and James would have tried to cover them up and eventually the supervisor would have taken the fall. Our next dilemma was in dealing with important but neglected paperwork. James had pushed it to the side and told Lisa it was just paperwork required by the Center. Sooooooooo Sad. As I said before, it could have been really important paperwork. What college did he go to? How can we rectify this situation? First off, James should have been on time or even better early. He should have been organized and ready to explain everything to Lisa. He, then, would have had time for counseling if he planned it right. Everything that happens in those sessions rests on Lisa having signed the proper documents, like the confidentiality clause and the HIPPA forms along

Ethical Dilemmas with the patients Rights and Responsibility and a few other forms that each facility has for their own protection. But if James never went over these forms, it could create a serious problem for the Center and the patient and for James. Another way to fix this problem is for James to be on time or early and to be an observer. The psychologist may let James explain the paperwork, at least most of it, and listen in when it came to the Centers part and then if the client gave permission for James to be in the room, he could take notes on the session and discuss them with the psychologist. Our alternative solution may have actually saved James from being fired, which if I were his supervisor, I would have fired him. He is conducting sessions without proper paperwork and consent. Who wouldnt be upset? Anyway, the alternate solution has him on time and taking notes and being supervised by the psychologist in charge of the session. James can still discuss each case and learn even if they arent his clients and he gains knowledge and experience since he has none at this time. If he had been left the other way, he might have made several mistakes with Lisa that could have been damaging to the client and to the counseling relationship without even realizing what he was doing. He had no experience with clients, didnt do the intake papers correctly, didnt speak with the supervisor about her symptoms, and she murdered someone. James has already messed up. We are trying to fix that. For our last dilemma, James listens while Lisa tells him that at age 7 she killed someone, although unintentionally, she did kill a man. Lisa was a victim at age 7 of sexual trauma and noone would help her not even her mother. So, she tried to help herself, by putting a medication into the mans drink. It gave him a stroke, which he later died from. The cops found that it was a medication in his drink that caused him to stroke and then to die. Lisa is troubled by this and

Ethical Dilemmas doesnt know what to do. James should do proper documentation of what she told him and of her mental state now and then. James should discuss all options with Lisa before doing anything. Letting her know that confidentiality might have to be broken and what steps he might have to take. Then, he should go to his supervisor and find out what steps need to be taken next. He is just an intern, this will have to be turned over to someone else, but he can request to stay with her so as not to break the counselor/client relationship. It has been 14 years since this happened and she is just now telling someone about it. Something made her bring it up or maybe she blocked it out and something triggered a memory. James should continue to talk to her about this and find out why Lisa brought this up now, why at this particular time? We talked about the alternative steps that James should take, but I think after talking to the supervisor, I would call the detective involved in the case, if he is still around, and ask about the case. Is there a case? What are the circumstances? See if the case is still open and then report back to the supervisor. Do whatever we can to help Lisa before breaking confidentiality and maybe having to turn her over to the police. Maybe the case has been closed and they no longer pursue anyone for the mans death. Of course, they may want Lisa to come in and give a statement anyway and hold her til they try and verify her story. She could still get off, if her mother verifies what she says or they find the school teacher. A girl of 7 wouldnt necessarily know what kind of medication she was putting in a drink. Lisa could be released in a matter of days. The eight Steps of Ethical Problem Solving: 1. Describe the parameters of the situation

2. Define the potential ethical-legal issues involved

3. Consult ethical-legal guidelines available that might apply to the resolution of these issues 4. Evaluate the rights, responsibilities, and welfare of all affected parties 5. Generate a list of all alternative decisions possible for each issue 6. Enumerate the consequences of making each decision. Evaluate the short-term, ongoing long-term consequences of each possible decision. 7. Present any evidence that the various consequences or benefits resulting from each decision will actually occur 8. Make the decision. Consistent with the code of ethics, helpers accept responsibility for the decision made and monitor the consequences of the course of action chosen. (Adapted by Jacob-Timm and Hartshorne, 1998) (Originally articulated by Keith-Spiegel & Koocher, 1985) (Parsons, R. D.)

References
ACA code of Ethics. As approved of by the ACA Governing Council 2005 American Counseling Association. www.txca.org/images/tca/Documents/ACA

APA Ethical Principles of Psychologists and Code of Conduct 2010 Amendments www.apa.org

Parsons, R. D. The Ethics of Professional Practice 2000