Ethical Dilemma Scenarios

Example 1

Dilemma: A therapist discovers through a confession in confidence that a woman he is treating in couple's therapy is having an affair with therapist's cousin Solution: When presented with conflict of interest, therapist must terminate therapy. Obligated under ethical principles of the profession to make other arrangements for couple. Must facilitate this change without disclosing woman's affair, learned in confidence, to her husband. Possible solution to make arrangements for couple to continue with colleague that has similar style/methodology to minimize impact of change. Will have to offer explanation for couple that could be that as therapy has progressed he has determined the new therapist can better meet client needs

EX4

Dilemma: Female client confides to male therapist she is sexually attracted to him. Continues to make comments about this and has started calling his office excessively for trivial concerns. Solution: Initial response: a discussion that this reaction is common in therapy and explain about transference, focusing on emotions/feelings uncovered in therapy on therapist. Emphasize impossibility of any relationship due to professional integrity and communicate concern for client is genuine but professional/friendly. As problem continues/intensifies, take steps to ensure welfare/best treatment of client. Mention this obsession can interfere with effect treatment, protecting therapist from allegations or worse. Confer with another professional, use a co-therapist to reduce transference and create less intimate environment, or refer client for treatment with another therapist altogether

Ex3

Dilemma: In a session with therapist for depression, a gay man with confirmed HIV disclosed that he has been picking men up in bars and having unprotected sex to make himself feel better. Therapist addresses the potentially harmful aspect of this behavior but receives no assurances the behavior will stop. Solution: Involves moral/ethical/legal responsibilities. Primary concern is patient confidentiality. Health care professionals have a responsibility to report the case to appropriate state, country, federal agency but doesnt have to give a name. Since therapist did not actually perform test, this is not his responsibility. Bigger issue is client's unprotected sex with individuals who dont know. Likely therapist had client sign form that indicates potential harm to others could justify breach of confidentiality. If so, therapist should give consideration to reporting this admission. Some states have laws against specific behavior classifying it as felony assault, attempted manslaughter, or murder (indicates some view this behavior as an act that harms another). Involves an unidentified potential victim which some would argue that is not grounds for breaking confidentiality. Consider a consultation with colleague before proceeding.

EX5

Dilemma: In individual therapy, mother of family therapist is treating confides to therapist that last year she shoved her elementary son into a wall, breaking his arm. Was reported to hospital and the father as a fall. Child never contradicted the story. Mother's confession is driven by guilt, she assures the therapist there have been no violent incidents since. Mother has been attending group counseling for anger management for 6 months. Therapist has picked up no indicators of child abuse in family sessions. Solution: Conflicting concerns for protecting client's confidentiality and the welfare of the child. Professional ethics codes/state laws require therapist to break confidentiality if client might be danger to himself/others. Based on observations/experience, therapist may believe mother was not immediate danger to child. Most states require anyone with first hand knowledge or suspicion of child abuse report the info. In this case, therapist must inform authorities of the incident to be in compliance with legal authority. Therapist is not obligated to inform father of mother's confession.

EX6

Dilemma: Newly practicing therapist with 2 years of clinical experience receives referral to treat family with a child that has autistic disorder. Therapist conducts 2 introductory sessions with family to get intake date/begin hypothesis. Therapist observes many symptoms in child that she hasnt seen behavior and states family seems to be in crisis. Solution: Observations should be red flag that she is possibly under-qualified to treat family. Also indicate a lack of expertise/experience with autistic disorder. First obligation is see if she can find another therapist with expertise and refer family to that. If not possible, she can treat family on emergency basis. Has an ethical obligation to not abandon family AND has obligation not to conduct treatment outside of expertise. Has ethical/professional responsibility to educate herself/seek professional guidance if possible. Indicates a need for reviewing research on autism, reading books, consulting experts. Therapist should continue to treat family for as long as crisis seems present while continuing to help family seek expert help.

EX7

Dilemma: Therapist hired by defense attorny as expert witness in trial of man abusing son. Defendant claims that hes not responsible for actions because he was abused by his father. Therapist believes/studied research to support childhood abuse contribute to becoming future abuser. Therapist conducts session with defendant, takes detailed history, does additional research in area. Therapist comes to suspect that defendant may be making it up. Attorney who hired therapist says defendant made up the story for a good defense and offers a huge bonus to therapist if client isnt convicted. Solution: Therapist could take stand and honestly provide expert testimony on effects of childhood abuse. If he does this, the jury may gain impression that this applies to defendant. Therapist will be asked to answer specific questions about the defendant's mental status. Answering in a way that is incomplete is unethical. Therapist should indicate to attorney that he cannot testify in this case and withdraw his services. Therapist shouldnt accept payment for services past this point (fees directly related to testimony). Therapist should consider filing complaint against attorney with bar association for unethical practices (encouraging perjury).

Ex 2

Dilemma: Therapist is participating in research study and administering post treatment questionnaire about how the treatment affected patient's overall quality of life. Study consent form details medical risks but doesnt mention when confidentiality may be broken. Supervisor refuses to add this to release. Solution: Therapist has ethical responsibility to his patient to insure consent for treatment is fully informed. Leaving out potential legal/ethical requirements for breaking confidentiality means the patient doesnt have all needed info to make good decision. Confidentiality may be broken if therapist believes patient could harm self or others. Could be given to patient verbally, but therapist wouldnt be covered legally or with licensing boards in event of lawsuit or complaint. If supervisor wouldnt make change by informal requests/complaint, therapist could choose to back out of study on groups of ethical objects. Or can file formal ethical complaint with applicable state agencies/professional organizations or source of study funding.