Friend and Referring Attorney Asks for Legal Psychological Evaluation
As a close friend of the proposed client, I could see myself utilizing personal information and judgments that have no bearing on the evaluation to color the results of an assessment. During scoring, for example, I may unconsciously use biased information for my friend to create a more favorable evaluation. During a clinical interview our personal relationship may make it hard for me to stay objective and ask challenging questions of my friend, even when those questions are necessary to the validity and reliability of the interview.
I would not take on my friend as a client for a psychological evaluation and would cite my ethical principles, which I am required by the law of my state to follow (Wyoming State Statute, 2020). The main ethical code that applies to this decision would be 3.05 Multiple Relationships (American Psychological Association, 2017). This code discusses the harm that could come from having multiple relationships, for example providing therapy to a friend or a relative of a friend. It also discusses that those relationships that could cause harm are prohibited, but those that do not cause harm are not prohibited. Any relationship that hinders a psychologists’ competence, objectivity, or effectiveness are considered harmful by this code (American Psychological Association, 2017). In this case, because of the nature of the relationships—a close friend asking for legal psychological evaluation—there is cause to believe that engaging in this relationship could cause harm to the client by hindering my objectivity in administering assessments and clinical interviews (Fisher, 2017). This also falls under the code 3.04, Avoiding Harm (American Psychological Association, 2017).
Client Angry due to Session Cancellation
As a busy professional with a chronic illness, I totally understand where the client is coming from and may even have quite a lot of guilt around such a decision. I would also have some difficulty, due to the guilt, to not have a shame reaction to the client’s anger. These feelings of guilt and shame could be stemming from my own childhood trauma.
In this situation, I would first ask to discuss the anger my client is feeling and unpack how their knowing my reasoning would be helpful to them therapeutically. If, during this discussion, I deemed it helpful to my client to know about my family member’s funeral, then this would not be unethical self-disclosure (Fisher, 2017). In order for this to be an ethical self-disclosure I would need to establish that this is not just a way to alleviate the anger of the client or to help me feel more comfortable (Fisher, 2017). The self-disclosure of such personal information would need to somehow fit into the client’s treatment goals and plans and be helpful in exploring their feelings. The client’s anger could be in response to a perceived or real inequity in the therapeutic relationship. As a Chinese American, my client is a minority and deals with prejudice and racism in their daily life, which could be a huge trigger for this anger, in which case the self-disclosure may be helpful to show my client that the cancellation was not cavalier, but for a serious and valid reason (Iwamasa, 2012). However, I would also have to look to my informed consent and practice policies as outlined in 3.10 and 10.01 of the ethical codes to make sure I am following my established cancellation practices and that the client has been previously informed of these practices (American Psychological Association, 2017).
Partner of Client Sends Letter
As a concerned therapist, I would want to make sure my client is ok. Working with clients who have suicidal ideation can bring up extreme protectiveness in me and my first thought would be for the safety of my client. Having previous clients who have completed suicide heightens these feelings of anxiety and fear.
I would not open the letter and would have it returned to sender. The three main ethical codes that apply to this decision would be 3.05 Multiple Relationships and 4.01 Maintaining Confidentiality and 4.50 Disclosures (American Psychological Association, 2017). Legally and ethically I am required to maintain confidentiality with my client outside the legal limitations of confidentiality, including confirming our relationship (Fisher, 2017). Disclosure of confidential information is only allowed in very specific circumstances and must be laid out in an informed consent and communicated to the client before they divulge confidential information (American Psychological Association, 2017). Unless my client has been declared to be legally incapable of consent, I would be acting unethically and illegally to open the letter, which could be seen as confirmation of my work with my client (Fisher, 2017; Wyoming State Statute, 2020). On top of the issues of confidentiality, opening the letter would also open me up to a potentially harmful dual relationship. Any information contained in a letter from my client’s spouse creates a relationship between the spouse and I in addition to my relationship with my client. This relationship, especially because it is clandestine, could impair my objectivity in working with my client or could impair my effectiveness, making it an unethical dual relationship (American Psychological Association, 2017).
Client Wedding Invitation
It is my first instinct to always say no to any invitation to an outside event from a client. This can be explained by a fear of being unethical or causing unintended harm to my client. This fear probably due to previous ethics courses and various ethical horror stories I have been exposed to throughout the years. As an introvert, I am also uncomfortable at large gatherings of strangers, which definitely contributes to my hesitation in this area.
I would discuss the invitation and all the potential pitfalls or misperceptions with my client. If, after discussing the harm that could be done, he still is comfortable with me coming to the wedding, I would attend. Not all dual relationships are unethical. Relationships that would not reasonably be expected to cause harm, like a graduation or wedding, are not prohibited under code 3.05 Multiple Relationships (Fisher, 2017; American Psychological Association, 2017). In this case, the multiple relationship could potentially be beneficial to the client as his treatment goals centered around romantic relationships. While there is the chance that my presence at the wedding could cause harm or could change the therapeutic alliance, it is reasonable to believe that attending this client’s wedding would actually be potentially beneficial.
Code 4.01 Maintaining Confidentiality is another principal that needs to be addressed in this scenario. In public psychologists do not acknowledge clients in order to protect their confidentiality (American Psychological Association, 2017). If clients wish to engage, however, this is their choice and is not considered unethical. As long as I act in a professional manner (Fisher, 2017) and we discussed beforehand how we would handle the event, I see no reason to decline such an invitation (American Psychological Association, 2017).
Client with Terminal Disease
My thoughts on assisted suicide are complex. As a mental health professional, I do believe life is worth living and that suicide is not the answer. However, I can only imagine the anguish of waiting to die. This would be a huge struggle with my fear of a client dying versus my belief in client self-determination.
I would discuss with my client the limits of confidentiality again and make sure he understands what I would and would not be able to keep confidential based on the law and code 4.01 (American Psychological Association, 2017; Wyoming State Statute, 2020). After reiterating informed consent, I would assess his risk of suicidality. In this vignette, it appears he has not yet created a plan or is thinking of assisted suicide. Assuming this is the case, I would discuss the legalities of assisted suicide.
Principal E of the ethical code is very important in this scenario as the right to self-determination is paramount. When discussing things like end of life suicide or assisted suicide it is important to discuss the legal realities of the situation as well as to help increase current quality of life for a terminally ill client (Maytal & Stern, 2006). However, it would be unethical for me to breach confidentiality without reason to believe that my client is in imminent danger of hurting himself (American Psychological Association, 2017).
In this scenario I would also need to determine if I was competent to provide end of life counseling to this client based on code 2.01a of the code of ethics (American Psychological Association, 2017). Without the appropriate training in this area, ethically I would be required to refer to a professional with training or experience in end of life counseling (Fisher, 2017).
Comp’d Casino Expenses
I have an instinctual “no” to this scenario as it seems exploitative on my part. I have a hard time accepting gifts in relationships with any sort of power dynamic. These reactions could come from years of ethics training as well as issues stemming from my childhood trauma. There is a part of me that wants to celebrate with my former client, though without exchanging gifts or money.
In this scenario I would explain to the front desk that I could not accept this gift and then seek out my former client to discuss why I cannot accept his gift. If finding the former client is not possible, I would leave a note for him. While receiving gifts from clients (current or former) is not unethical, it can affect the therapeutic relationship in negative ways and lead to harm, like exploitation as outlined in code 3.08 Exploitative Relationships (American Psychological Association, 2017). However, relationships with former clients are also not unethical according to code 10.08a Sexual Intimacies with Former Therapy Clients/Patients (American Psychological Association, 2017). While this code is not discussing gift giving or platonic relationships with former clients, we can take it as a guide to whether these situations would be ethical. Based on this code, accepting the gift would be ethical.
However, if we look at 10.08b, it becomes clear that taking this substantial gift could cause harm and therefore is unethical (American Psychological Association, 2017). Should this client ever need to come back to therapy or need the psychologist to testify in a legal proceeding the psychologist’s objectivity may be called into question (Fisher, 2017). Taking this gift, while not currently creating harm, could lead to significant harm in the future and should be avoided.
Sexual Assault by Another Therapist
As a survivor of sexual abuse, this hits a lot of my buttons. I would feel outraged for and protective of this client. As this scenario doesn’t say this other therapist is her previous therapist or if it is a concurrent therapist, such as a family therapist or couples’ therapist. The fact that she is distressed enough to tell me but does not want to get the other therapist in trouble makes my heart sink for her.
I would make sure my client understands that if I file a complaint, it means violating her confidentiality as my name would be on the complaint form and the information needed to complete the form would be violating. In Wyoming, complaints cannot be anonymous, and a copy of the complaint form is then given to the person against whom the complaint is filed. The Wyoming Board of Psychology would then have an investigator talk with me and my client about the complaint (Wyoming State Statute, 2020). If, after knowing all of this, the client still would like me to file the complaint, I would do so.
I would file the complaint for both legal and ethical reasons. In Wyoming, a psychologist can be stripped of their license for sexual exploitation of a client in this manner (Wyoming State Statute, 2020). They can also face other disciplinary sanctions such as restitution and recouping of costs of the investigation.
Ethically, it is prohibited for psychologists to engage in sexual relationships with current clients as this can cause serious harm to the client. This is stated unequivocally in code 10.05 of the code of ethics (American Psychological Association, 2017).
Letter of Support to Graduate Schools
I attended my Masters in Community and Mental Health counseling with a few people with criminal records and/or mental health issues. I saw how hard their path to licensure was, regardless of their competence or fitness to be professionals. This appeals to my sense of justice and my belief in change.
In this scenario I would discuss what my letter might include—concerns as well as strengths—and my concerns about how this may negatively affect our relationship, especially if she is not accepted. If, after having this discussion, she still would like me to complete the letter, I would do so.
Ethically, this falls under the Multiple Relationship code 3.05 (American Psychological Association, 2017). The recommendation may cause harm or negatively affect the therapeutic relationship. I would also have to inform my client of the breach of confidentiality this will entail, pursuant to code 4.02 (Fisher, 2017). However, I believe that with informed consent—code 3.10—my client is able to take on that risk and make up her own mind in keeping with Principal E of the ethics code (American Psychological Association, 2017). The risk of harm, especially after engaging in informed consent, is minimal enough to be considered ethical.
Whether or not I believe my client is stable enough to become a psychologist is not within my scope of competency. Gatekeeping is, in my opinion, the responsibility of the educational institution and the licensing board of the state or country. My responsibility to my client is to provide mental health services, not to gatekeep the profession.
I am having a hard time coming up with countertransference issues on this scenario. I see no ethical issues, nothing here triggers past trauma or issues, and there are no legal issues I can find. It may be odd moving from a faculty relationship to a therapy relationship but working in rural Wyoming dual relationships like these happen quite frequently and are seen as a normal part of practice in the area.
As always, I would inform the student of the risks of switching from a student/teacher relationship to a therapist/client relationship in line with code 3.10 Informed Consent and 3.05 Multiple Relationships (American Psychological Association, 2017). I would make sure I am competent to treat the concerns of this client pursuant to code 2.01 and would be sure to only begin sessions after the students received their final grades and diplomas.
In the ethics code 7.05b Mandatory Individual or Group Therapy prohibits faculty who are responsible for assessing a student’s academic performance from providing therapy. This is to keep from impairing the therapists’ effectiveness because students are afraid that their personal revelations in therapy might be used against them in their academic evaluations (Fisher, 2017). It is also to keep the therapist objective by not allowing information about the student in class to interfere with the therapeutic process. However, if the student has graduated and is no longer being evaluated by the therapist, there is no prohibition, if the dual relationship is handled correctly (Fisher, 2017). While there is potential for harm in this multiple relationship, it is reasonable to assume the client would receive more benefit from therapy than harm in this case.
Former Client wants to be Friends
As a therapist who engages in personal therapy, this brings up feelings of embarrassment and empathy. While I have had therapists over the years that I really, really liked I would feel very weird asking to be friends with them after termination. Not only because they know intimate details about my life, but also because I know how uncomfortable it can be to have to hold ethical boundaries.
In this situation I would decline the invitation. If pressed, I would discuss the reasons why a friendship could be unethical.
According to code 3.05 Multiple Relationships a psychologist must not enter into a dual relationship if it can reasonably be expected to impair objectivity, effectiveness, or competence (American Psychological Association, 2017). Code 10.08a Sexual Intimacies with Former Therapy Clients/Patients prohibits a sexual relationship with former clients for at least two years (American Psychological Association, 2017). While this code does not explicitly encompass platonic relationships, it is a good guide for all post-termination relationships (Fisher, 2017).
In this situation, the dual relationship caused by a friendship so soon after termination could cause harm to the previous client. The client may begin to face new or continued difficulties in their life and need to resume therapy. In that case, it would be unethical according to 3.05to resume services with the client as the personal knowledge gained from the friendship would reasonably be assumed to impair objectivity in the therapeutic relationship. Beginning a friendship so soon after termination may also be a violation of 10.08a, if not in the letter of the code, then in the spirit of the code.
American Psychological Association. (2017). Ethical Principles of Psychologists and Code of Conduct.
Fisher, C. (2017). Decoding the ethics code: A practical guide for psychologists. SAGE.
Iwamasa, G. Y. (2012). Recommendations for the Treatment of Asian-American/Pacific Islander Populations. In Psychological Treatment of Ethnic Minority Populations (pp. 8-12). Council of National Psychological Associations for the Advancement of Ethnic Minority Issues.
Maytal, G., & Stern, T. A. (2006). The Desire for Death in the Setting ofTerminal Illness: A Case Discussion. Primary care companion to the Journal of clinical psychiatry, 8(5), 299–305.
Wyoming State Statute. (2020). Practice Act.