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Psychology, professional ethical legal problems

SCENARIO #2

A young woman seeks therapy due to a dog phobia that has significantly limited her functioning. During the informed consent procedure, the therapist explains that in accordance with his cognitive- behavioral orientation and treatment techniques, he will begin the treatment by teaching the client to identify and challenge the irrational thoughts underlying her fears. He explains that the treatment will also include exposure to stimuli associated with her fears (a slide show of different dogs) and watching others interact safely with dogs. Although the therapist hopes that the treatment will eventually involve exposing his client to an actual, live dog, he fears that telling her this too early on in the treatment might make her too anxious to even begin. Halfway through the treatment, when the therapist eventually brings up including a live dog in the treatment, the client balks at the suggestion. The therapist praises her progress and encourages her to participate in the exposure as a way of fully meeting her goals to eliminate her fear of dogs. The client feels as though she has been misled; she looks back at the informed consent process as being full of “half truths” and finds it difficult to trust or feel safe with her therapist again.

Note: Exposure therapy has demonstrated empirical support for both its effectiveness and clinical utility. Although there are variations on this therapy, the treatment protocol is well understood by practitioners who treat phobias.

Ethics and professional behavior

The psychotherapist in this scenario may have been well-intentioned. Perhaps he did not want his client to spend weeks worrying about her eventual contact with a live dog. If the practitioner thought that the prospect of live contact with a dog would be too anxiety producing during the initial informed consent process, he could have simply informed her that research has demonstrated it to be an effective technique in overcoming specific phobias, but that they could continue to discuss the possibility as treatment proceeded and some of her symptoms began to subside. This approach would reflect the evolving nature of consent to new stages of the treatment

Directions: This case study is a group assignment that each group will complete independently. Each step of the outline of the eight step model below needs to be addressed for full credit. The eight-step model format outlined below (i.e., Outline: Eight-Step Ethical Decision-Making Model) is a modification of the problem-solving model proposed on pages 24 to 26 of the course textbook. Answers to the ethics case study should be identified under the headings indicated in the bold italics; type face. The “bullet points’ must be full sentences that communicate your answer clearly and succinctly.

The group’s response to the ethics case study will generally follow APA format. The response should be 3 to 4 double spaced pages, in a Times New Roman, 12 point font. The paper should have one inch margins and page numbers with an abbreviated running head. Your submission will have a cover page that has the information specified by the APA Publication Manual, 6th edition.

Be sure to read the attached grading rubric to meet all graded criteria. When are ready to submit your project only one person needs to submit for the entire group

 

 

OUTLINE: EIGHT-STEP ETHICAL DECISION-MAKING MODEL

  1. Identify the problem or dilemma- Lora

What is the tension – dilemma – competing issue? The tension (dilemma/competing issues) could be a function of ethics vs. laws, ethics vs. institutional policies, ethics vs. a community norm, or any of those vs. professional behavior

  • Dilemma (2-3 sentence brief description)

  1. Identify ethical principles, personal values and/or moral conflicts- Lora

Identify the most important principle or principles (Autonomy, Nonmaleficence, Beneficence, Justice, Fidelity, or Veracity) associated with the dilemma and justify your selection. If there is more than one relevant principle are these in conflict or complimentary? Are there any personal values that this dilemma introduces?

  1. Relevant APA ethics code (site the specific professional ethics code)- Ola

Site specific guidance from the relevant professional ethical code (ACA, APA, ASMHC will be the codes that are available to you).

  1. Applicable laws and regulations- Ola

State any relevant IL state codes, statutes, case law, administrative policy, or federal guidelines?

  1. Seek consultation and consider what would successfully resolve this this dilemma- Alex

A consultant will give you a more objective view on the dilemma. Who would be most appropriate to consult with for this dilemma (e.g., a lawyer, a clinical peer, a specialist)? What would constitute successful resolution of the dilemma?

The best way to resolve this dilemma is consulting a specialist. I might refrain from consulting with a lawyer simply because they do not have expertise knowledge on exposure therapy. A specialist is the best option because the goal is to better inform the client on how my cognitive-behavioral approach and exposure therapy techniques can treat her phobia. Since the client currently has lost trust in me, bringing an expert in to discuss how he has helped others overcome their phobias might help her open up to the idea of coming in to contact with a real dog. Maybe then she will understand the benefits of using real fears over stimuli.

  1. Possible Course(s) of action- Alex

Identify and describe two or more different possible courses of action that are viable. Please note that a consultant is not a course of action

 

After consulting with an expert in the field the counselor needs to decide on the best course of action to take. One option is to introduce her to an expert in phobias to help explain how exposure therapy works and how it overall helps individuals overcome their fears. The purpose of bringing in an expert is so she has someone else to confide in other than the counselor. The goal of the counselor, of course, is toslowly gain trust back from the client so that they can move on and continue treatment.

Another option the counselor should consider is sitting down with the client and going over the informed consent in depth. The client noted that the counselor included “half truths” in the informed consent and no longer trusts the counselor. One way to potentially resolve this is to review the informed consent form with the client and overwrite or explain in greater detail in areas where the client feels the counselor is not being explicit. After reviewing the informed consent with the client the next step is to ensure that client completely understands by allowing for questions and keeping her involved through the discussion versus lecturing.

Once the informed consent is fully acknowledged by the client, the counselor should also review the treatment plan with her. It is not ethical for a client to proceed with a treatment plan that

  1. Enumerate the consequences of various decisions- Mia

The seventh step in the ethical decision-making model challenges the counselor to consider the consequences associated with different courses of action, both legal and ethical. Legal consequences that could arise might be seen in a lawsuit or a report to authorities by the client. If the client feels that her anxiety is worsening, and it is due to the ethical dilemma with the counselor, she might feel the need to contact a lawyer to solve this in a lawsuit. Lawsuits are costly, damaging to a reputation, and something that should be avoided at all costs as a counselor.

Although the counselor might have felt that withholding information from the client might help her from heightened anxiety, ultimately the counselor failed to keep an ethical principle of trust and honesty. Further consequences from an ethical standpoint lie with the client completely losing trust with the counselor, the client stopping treatment abruptly, or even worse, begin to feel alone in their battle with anxiety. Increasing feelings of loneliness, hopelessness, and worthlessness can begin a client down a path of severe depression that could have fatal consequences. Additionally, if the counselor decided to refer the client to another client, the client might feel reassured of their hopelessness in treatment. Having a counselor refer you elsewhere may feel insulting, and it is hard to assess how a client will react to be referred to a different counselor. If the client has lost all trust in the counselor, it may risk the client stopping treatment abruptly and losing faith in the effectiveness of mental health treatment. When someone stops treatment without notice, it can be detrimental to the progress already made in treatment and depending on what point in treatment they are stopping, the client may be vulnerable to severe relapse. It is the duty of the counselor to hold true to the ethical principles that govern treatment practices, but most importantly reducing the risk of harm is a main priority. By assessing the consequences, it is important to choose a course of action that reduces the risk of harm and carefully considers ethical principles.

  1. Recommended course of action- Mia

The final step in the ethical decision-making model is to determine the course of action to take in resolving the ethical dilemma. It is nearly impossible to make the perfect decision, and hindsight may be 20/20, but there are important questions a counselor can ask themselves to assure that their course of action is the best choice. Some of these questions may be, ‘how does my course of action fit ethical standards?’, ‘how would others evaluate my course of action?’, and ‘what have I learned from this ethical dilemma?’. In this ethical dilemma, the best course of action to take would be to start a new treatment method, like systematic desensitization or meditation therapy. Even though the client may have lost trust with the counselor, the counselor can use this new treatment method to reset and start fresh. In a way of re-establishing trust, the counselor will prepare a new hard copy informed consent form that clearly describes every step in the treatment process that is to be signed by the client. The client will also be provided a hard copy of this detailed treatment process, and together will review each step with the counselor verbally to address any confusion or questions that may arise. In addition to the presentation of this new treatment method, the counselor will provide data and empirical findings that support the effectiveness of the treatment to further provide evidence for the necessary change of treatment. Regarding ethical principles, this course of action addresses autonomy, veracity, beneficence, fidelity, nonmaleficence, and justice all equally. The client can choose whether to continue treatment, they will receive truthful information, continuing a new treatment method will promote the well-being of the client, the counselor is honoring the commitment made to the client for treatment, harm is being avoided, and the client is being treated equally and fairly. Rebuilding trust between the client and counselor will take time, but this course of action carefully considers ethical principles in a way to avoid further dilemmas and possible legal consequences.

 

Last Updated on February 11, 2019

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