● What if the mechanic never shows up on time and causes the therapist to miss appointments? ● How might this situation spill over into the treatment room? ● After the car was supposedly fixed, would it be tempting to give a below standard treatment if the automobile problem resurfaced? (Riedell, 2005) Professional ethics require accountability to do no harm and dictates the obligation to help clients to the best of our ability. Nina McIntosh, author of The Educated Heart, suggests asking the following questions to determine if any action taken is ethical: ● Does the action keep the focus on safety and well-being of the client? ● Are you being respectful of the power imbalance and/or the transference effect? Or are you using this power imbalance to your own benefit? ● Does the action create a dual relationship and make the therapeutic boundaries less clear? Case study 8 The therapist had been working with a seventeen girl for a year following a car accident that caused a back injury. The teen felt comfortable with the therapist and they had built a trusting therapeutic relationship. During a visit she confided to the therapist that she was pregnant and begged the therapist not to tell her parents because they would try to force her to have an abortion. During the session, the mother called but the therapist was working with the client at the time. The therapist asked the teen how she would like her to respond to the mother’s call since it would have to be addressed that day. The client was aware that her mother knew something was wrong and recognized and that the therapist must return the call to the mother. The client promised to confide in her school counselor and to arrange to visit an obstetrician to confirm the pregnancy and start receiving prenatal care. The client hinted to the therapist that she would like the therapist to be with her when she confronted the mother. The therapist did not respond to the client’s hint. Before the therapist was able to return the call to the mother, the manager called the therapist into his office to inform him that the mother had called him directly. She was angry and believed that the therapist was interfering with the appropriate medical care of her daughter. The therapist informed the manager that the client had confided her suspicion that she was pregnant and, not being a medical doctor, the therapist was unable to confirm the pregnancy but believed the teen wanted to keep the baby and was taking the appropriate steps to seek assistance from the counselor and obstetrician. The therapist also explained the client’s fear that the parents would insist that she have an abortion .The manager, upon hearing the details and the clients plan of action, realized that the therapist had not interfered with the client’s care but was concerned about whether or not the therapist was obligated to communicate the daughter’s condition to the mother. Analysis This presents a number of potential conflicts in terms of client care, treating minors, obligation to parents, and the difference in perspectives of the client, parent, therapist and manager. This case points to the difficulty the therapist faces in practice when they must balance the confidentiality, their fiduciary role, and client rights. The pregnant teenager, even as a minor has certain mandated privileges, according to state and federal law Case study 9 A massage therapist and his receptionist were working in a small private massage and bodywork practice in an upscale community. The therapist recently began treating a major television celebrity who had a stained back due to an injury from playing golf. The receptionist asked if the client was Mr. ___, who was the star of a TV show and the therapist supplied
● Does the action remain within the original contract with the client or does it exceeding either the area of expertise or the client’s informed consent? ● Does the action create a safer environment for the client or detract from it? ● Could the action lead to future problems in the therapeutic relationship? ● Does the action establish a sense of safety and reassurance, or it could it make clients feel uneasy, apprehensive and uncomfortable? (McIntosh, 2016) It cannot be stressed enough that appropriate boundaries, in terms of the type of interaction, setting, level of personal involvement and intimacy, and risk and benefits to clients, must be maintained at all times. These must be communicated and agreed upon with clients during the initial contact and revisited as change dictates, to preserve an ethical therapeutic relationship. Review Standard III on Confidentiality and Standard V on Roles and Boundaries. that entitle her to a variety of medical care services without the consent or even the knowledge of her parents (Adam, 2012). Here are some questions to consider: ● How does the therapist resolve conflicts between the parent’s values and rights and those of their minor child? ● What does it mean to respect the family’s values? ● What harm may come to the child as a result of disrupting a stable system of social support provided by the family? ● What does an individual do if he or she, as the therapist, has a conflict with the course of action chosen by a patient or a parent or, on the other hand, if the employer has a conflict with the course of action the therapist deems appropriate? (Adam, 2012) The therapist’s fiduciary responsibility consists of transparent competent care that is free of coercion. In this case, the professional duty to the client for confidentiality was in potential conflict with the duty to tell the parent the information given during treatment. Depending upon the conditions of the consent form, the therapist may have a legal obligation to inform parents but a moral obligation to protect the client’s privacy (Adam, 2012). In this case, if the parent initialed or signed consent to allow the teen to be in the treatment room alone with the therapist, there would be a case for allowing those conversations to remain confidential. On the other hand, the client is still legally a minor so depending upon the state of practice, there may be an obligation to inform the parent. States vary considerably on the age that requires consent of the parents concerning reproductive issues so the therapist would need to consult state law and other resources such as employer or agency policy. In some states the 17 year old’s communication would be protected by privacy and confidentiality law. The therapist was not obligated to accompany the client when confronting the parents about her situation. Because the parent immediately called the manager, it may be important to work on strengthening the lines of communication with the parents as well as a need to reset boundaries if this client continues to see this therapist in the future. Professionalism, Standard II: Legal and Ethical Requirements, Standard III: Confidentiality, and Standard V: Roles and Boundaries. his name and acknowledged he was the star of that show. The two discussed the fact that they were treating this star and began talking about the nature and severity of his injury. The receptionist asked how severe the injury was and how long he might continue sessions at the office. The therapist revealed that the diagnostic tests, including an MRI, indicated a moderate to
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