Apply a Decision-Making Model Identify the problem. This may be a multiple relationship. In addition to seeing Jane in therapy, they will also see each other on a consistent basis in social and volunteer situations. Incidental contact outside of therapy is a boundary crossing, but it does not create an ethical dilemma. In this situation, however, the counselor and client will have ongoing close contact in a nontherapy setting. All professional codes of ethics state that the clinician should not engage in a multiple relationship if it could reasonably be expected to impair the counselor’s objectivity and effectiveness. Can objectivity in therapy be maintained in this situation if there is an ongoing nontherapy relationship? Can confidentiality outside of therapy be maintained? Gather information. Review laws, rules, codes of ethics, and get consultation. There are no legislative laws that address this situation, but all of the professional codes of ethics have standards that may apply. ● APA Standard 3, NASW Standard 1.06, ACA Standard A.4.a, and NBCC Standard 17 all indicate that Dr. Smith has a primary obligation to Jane as her client over her own interests. She must resolve the situation in Jane’s best interest and in a way that minimizes or does no harm. ● APA Standard 4, NASW Standard 1.07, ACA Standard B.1.c, and NBCC Standard 19 state that Dr. Smith has an obligation to protect Jane’s confidentiality. This would be difficult in this situation. Consistent social interaction may prevent her from staying objective in her treatment with Jane. Jane is still an active client, and though she has made progress in therapy, she has not yet reached their agreed upon goal. ● APA Standard 10, NASW Standard 1.06, ACA Standard A.11.c, and NBCC Standard 22 state that therapy should be terminated if the client could be harmed by continued services. Is that the case here? Is this an avoidable multiple relationship? What is the potential for inappropriate therapist transparency and self-disclosure in social settings? Identify potential courses of action. a. Dr. Smith could do nothing and continue as is both professionally and socially. b. Dr. Smith or Jane could find a new church. c. Dr. Smith and/or Jane could resign from the committee but continue church attendance. d. Therapy could be terminated and Jane referred to another therapist. e. Therapy could be terminated without referral. Consider the potential consequences of actions, determine a course of action, and implement it . Dr. Smith discussed the ethical issue and her concerns with Jane at their next therapy session since the client should be actively engaged in the decision-process when a boundary crossing is considered. Would it be possible to continue with therapy and not interact socially? What would be the consequence of terminating therapy? Is it in the client’s best interest to terminate therapy? Did Jane know that Dr. Smith was on that particular committee? If so, what was Jane’s motivation for volunteering on it? ● Dr. Smith voiced her discomfort with the potential self-disclosure and her difficulty remaining objective in therapy if the choice was to do nothing. She felt that the choice to do nothing had too much risk to do harm. ● Neither wanted to find a new church since this was the only one of that denomination within a reasonable distance and both were very comfortable there.
However, the risk of accidental disclosure was great if they continued on the same committee. ● If therapy was prematurely terminated, there was the potential for Jane’s panic episodes to increase in frequency and again become debilitating. ● Jane stated that when she volunteered for the committee, she did not realize Dr. Smith was also a member. She was comfortable joining a different committee than Dr. Smith. After discussing all of the potential options, they mutually agreed to terminate therapy. Jane had made significant progress, was almost at her goal, and felt confident that she could apply the techniques she learned to control panic when it arose. Dr. Smith gave Jane the name and contact information for three qualified providers in case Jane felt she needed to return to therapy in the future. As part of the termination session, they also discussed how future interactions at church would be handled. They would both stay in the church, and although they would acknowledge each other, they would not sit together. Since Jane had not attended any committee meetings yet, she agreed that she would join a different committee since she had other interests. Review the outcome. Dr. Smith documented in Jane’s chart the decision-making process, the different possible courses of action, and their mutual discussions and final decision on an action. They were able to continue in the social situation with minimal contact, and Jane had resources available if she felt the need to re-engage in therapy in the future. This example highlights the fact that seemingly benign situations can create the potential for a boundary crossing or even an unethical boundary violation. Real-life situations that the clinician may encounter are rarely straightforward, and there are multiple facets that must be considered. Different professionals may choose a different course of action for the same dilemma. There is rarely only one right answer when faced with an ethical decision. However, if a decision-making model is followed, the professional is in a better position to be able to explain and justify the course of action taken. Self-Assessment Quiz Question #6 The formal decision-making model that is chosen for use by the clinician: a. May not help the clinician identify the problem b. Should help the clinician analyze alternative courses of action c. Usually does not provide justification for any course of action taken d. Does not include evaluation of the consequences of an action Self-Assessment Quiz Question #7 The decision-making model in the case study: a. Determined a clear course of action that every clinician would follow in the same way b. Determined one clear right answer to the dilemma c. Did not consider all facets and aspects of potential consequences d. Provided an outline for an organized, thoughtful decision-making analysis
Page 85
Book Code: PYTX1325
EliteLearning.com/Psychology
Powered by FlippingBook