Ethical Dilemma Handout

Based on the Decision Making Model:
1. Identify the Problem:
See Ethical Dilemma Handout
2. Potential Issues Involved:
• Maria is a minor
• No signed Informed Consent
• Dual Relationship/ Neighbor
• Rape
• Underage Drinking
• Possible Pregnancy and/or STD
• Self mutilation
• Rural community, cultural differences
• Maria (client) asks not to inform parent/ legal guardian for fear of his reaction.
• Father approaches therapist in an unprofessional setting and wants to information regarding his daughter.
• Maria goes to school with the rapist.
3. Review Basic Ethical Guidelines/ Laws
a. A.2.a. Informed Consent; A.2.b. Types of Information Needed; A.2.d. Inability of Give Consent: First and foremost, the therapist needs to explain
the purpose of counseling and the counseling relationship to Maria in a way that ensures that she understands purposes, goals, techniques, procedures, limitations, potential risks, and benefits of services. Also, Maria needs to understand the role her father will play in the counseling procedure as her legal guardian.
b. A.2.c. Developmental and Cultural Sensitivity: The therapist needs to communicate with Maria in a developmentally appropriate way. The therapist also needs to make sure that she is sensitive to the cultural differences that may present themselves such as the differences between rural and urban communities.
c. A.4.d Avoiding Harm: The therapist needs to sure that her actions are not inflicting any kind of harm on Maria or any individual involved.
d. A.4.b. Personal Values: The therapist needs to be aware of her own personal values, and make sure not to impose personal values in the context of the therapeutic relationship. For instance, the therapist needs to understand her views on abortion and how these views may affect the manner in which she counsels Maria.
e. A.5.c. Nonprofessional Interactions or Relationships (Other than Sexual or Romantic Interactions or Relationships); A.5.d. Potentially Beneficial Interactions: The therapist and the client are neighbors. The therapist needs to be clear with both Maria and her father about appropriate interactions within the neighborhood. The therapist also needs to document the discussions about the nature of their living situation.
f. A.11.a Abandonment Prohibited; A.11.b. Inability to Assist Clients; A.11.c. Appropriate Termination; A.11.d. Appropriate Transfer of Services: If the therapist decides not to counsel Maria based on any circumstances, it is imperative that she make appropriate arrangements with Maria and her father for further treatment.
g. B.1.a. Multicultural/ Diversity Considerations; B.1.c Respect for Privacy; B.1.c. Respect for Confidentiality; B.1.d. Explanations of Limitations: The therapist needs to be aware of certain cultural differences that may be present between Maria's family and her own in terms of confidentiality. The therapist may be used to more of an assumed autonomy for minors in her previous urban setting as opposed to Maria's rural setting. On the most basic level, the therapist needs to be respectful of Maria's privacy and confidentiality. However, the therapist needs to be clear with Maria about the limitations of her confidentiality.
h.
B.2.a. Danger and Legal Requirements; B.2.b. Contagious, Life Threatening Diseases; B.2.d. Minimal Disclosure: The therapist needs to explain to Maria that any information given during a session that indicates serious harm or foreseeable danger for Maria or anyone else cannot be kept confidential. The therapist can explain that the reason for this is protection. Maria also needs to know that the therapist may need to consult with other professionals in order to provide the best treatment. In addition, the fact that Maria stated that she may have contracted an STD created an ethical dilemma for the therapist in that the therapist is ethically bound to inform any third party at risk for contracting the disease. It is important for the therapist to keep Maria as informed and involved as possible during any disclosure of private information. Lastly, the therapist should only disclose the necessary
information.
i. B.3.c. Information Shared with Others, Confidential Settings; B.8.a Consultation, Agreements; B.8.b. Respect for Privacy; B.8.c. Disclosure of Confidential Information: The therapist should make certain that any discussion with other professionals about Maria should take place in a confidential setting in order to ensure Maria's privacy, and that any individual involved in discussion is qualified and clear on the implications of their involvement.
j. B.4.b. Couples and Family Counseling; B.5.a. Responsibility to Clients; B.5.b. Responsibility to Parents and Legal Guardians; B.5.c. Release of Confidential Information: It is important that the therapist makes it clear to Maria and her father who the primary client is in therapy. The therapist must explain to the father the counselor's role and the confidential nature of therapy. It is important in this circumstance, that the therapist is sensitive to cultural differences within Maria's family over the inherent rights and responsibilities of the parents. The therapist must also be clear on the laws pertaining to Maria's situation. If the therapist finds that it is necessary to release information concerning Maria, and Maria is unable or unwilling to give consent, the therapist must seek permission from an appropriate third party.
k. H.1 Standards and the Law; H.1.a. Knowledge; H.1.b. Conflicts Between Ethics and Laws; H.2.d. Consultation: The therapist must have an understanding of the ACA Code of Ethics, and the laws that pertain to Maria's situation. Due to the nature of Maria's circumstances, the therapist should consult with another appropriate professional.
4. Obtain Consultation.
5. Consider Possible/ Probable Courses of Action and Consequences of each:
Course of Action #1: The therapist could refer Maria to another professional. It may be worth the drive to seek out a therapist that feels comfortable in treating Maria. Also, it may provide more anonymity for Maria.
Possible Consequences:
i.
Maria may not be as forth coming with her new therapist. ii. Referring Maria to someone else may damage the therapist's credibility within her new town as well any relationship she had with her neighbors. iii. Referring Maria to someone else may cause Maria's mental health to deteriorate. Maria's symptoms may become more severe and desperate.
Course of Action #2: The therapist could explain to the father that any discussion outside of the office is inappropriate, and ask the father to call and schedule an appointment sometime in the near future. Before meeting with the father, the therapist should consult another professional, and, if possible, have another session with Maria to explain the circumstances of the counseling relationship. The therapist could explain the guidelines of the informed consent and confidentiality at this time. The therapist could also meet with the father to explain the terms and guidelines of counseling, and the role that he would play in Maria's therapy. After the initial sessions, the therapist could spend a full session carefully assessing Maria's mental health, and decide if a break in confidentiality is in need. Once this decision is made, the therapist could develop a treatment plan for Maria and begun
recovery.
Possible Consequences: iv. Maria may not have been completely forthcoming about her situation, and may need immediate medical attention.
v. Maria may lose trust in the therapist once she understands that her sessions are not completely confidential all the time. vi. Maria may not want to talk after she learns the nature of the counseling relationship. vii. Maria may be in danger due to her interaction with the attacker at school. viii. The father- daughter relationship may be damaged as a result of the therapy, and the possible determination that the father should be informed about the rape, self mutilation, and so on.
6. Decide on Best Course of Action: Course of Action # 2