A popular American sitcom named A Different World (1987-1993) aired an episode involving a therapist and with a long standing client and a new family clientele. Whitley was a long term client of Dr. Langhorne; she sought counselling because herself and ex-finance were invited to thanksgiving dinner with their closest friends, the Bradfords’ Whitley hadn’t closure with her ex-finance who cheated on her the day before their engagement party. In the therapy session Dr. Langhorne constantly rushed the session and demonstrated impatience. Upon leaving the office as Whitley’s session had ended the Bradfords’ opened the door and entered with Whitley trying to conceal her identity as not being a patient of Dr. Langhorne. The Bradford’s session began with the therapist lying on a couch looking distressed as she counselled the family.
During the session Mr. Langhorne called to speak to his wife, as the therapist repeated her conversation about her frustrations with her mother –in- law whilst the Bradford’s remained in the office consoling each other after having an emotional moment. Upon ending the call Dr. Langhorne used abrasive language with the family to end the session hurriedly. The family invited her to dinner to show their gratitude however the doctor declined due to professionalism. Later on Dr. Langhorne showed up for dinner during which Dr. Langhorne disclosed details of Whitley’s session without her consent to her ex-finance to assist in mending their relationship.
The Bradford’s experienced a family crisis as Dr. Langhorne tried to resolve the crisis with everyone present. Dr. Langhorne then had an emotional breakdown sharing intimate details of her family situation whilst all other parties tried to console her stating she should discuss her issue with her husband and not the family, after which Dr. Langhorne left. ( Cosby, Friedman & Kerner, 1991). Principles Violated According to Singer (1994, p.4) ethical principles are “a set of rules and ways of arguing” (as cited in Cornforth, 2006, p. 35). According to the American Psychological Association (APA) Ethical Principles of Psychologist and Code of Conduct, ethical principles of psychologists and code of conducts is a framework built to guide professionals values in aid to better society through the protection and well-being of others (APA, 2017). The APA provides five general principles which guides and inspires psychologists toward the very highest ethical ideals of the profession (APA, 2017).
These five principles are beneficence and nonmaleficence, fidelity and responsibility, integrity, justice and respect for people’s right and dignity. This paper examines the ethical violations outlined in the above scenario using the principles and codes of the APA. A study conducted by Dibenedetto (2004) examined the differences between fantasized therapists in film and actual therapist in society. The study defined a therapist in film as a fantasy and most violations by film therapist were females as compared to real life therapist with nurturing, maternal and parental characteristics. According to Mascari (2004, p. 11) “ethical violations are behaviors which do not adhere to professional codes of ethics established by such organizations as the American Counseling Association (ACA) and the National Board for Certified Counselors (NBCC)” . Smith (2013) reports the most common ethical violations documented by the APA being multiple relationships, confidentiality, informed consent , trainees , roles, expertise, billing and end of therapy. The above ethical dilemma presents a number of ethical violations based on the APA’s ethical principles, these are; respect for people’s right and dignity, nonmaleficence and fidelity. Kant (1785, 1964) eludes that respect for autonomy should encapsulate freedom to make one’s own choices, dignity, privacy and confidentiality (as cited in Welfel, 2016).
Dr. Langhorne used abrasive language with her clients which are a potential threat to their dignity. Cornforth (2006) writes autonomy to include a safe space for clients while being non-judgmental. “A person should have the power to decide what information about self to share, rights to control what other know about his or her private life” ( Welfel, 2016, p. 42). This power was stripped from Whitley after information was released about her emotional distress with her ex-finance in confidence, without giving consent to do so. Disclosure of information has special cases for breaching confidentiality such as court orders ,clients breaking the law, harm to one’s self or others and underage clients in abusive situations Welfel (2016) .
This dilemma didn’t present any reason to breach confidentiality. As mental health professionals we are obligated to protect those we serve by trying to avoid harm to clients, such acts are based on the principle of nonmaleficence. Welfel (2016) linked non- maleficence to virtues of prudence, trustworthiness and compassion, all of which Dr. Langhorne failed to deliver; though she genuinely wanted to help her clients she rushed both sessions and used harsh words with both clients, which caused both clients to react. Trust was violated at the dinner table through disclosure of private details. Did Dr. Langhorne place her needs ahead of her clients during in her moment of emotional distress? The principle of fidelity is relates on professionals to placing their clients need and interest ahead of their own (Welfel, 2016).
Confidentiality is based on the principle of fidelity since mental health professionals are required not to disclose information shared in the client-counsellor space (Welfel, 2016) which was breached in this dilemma. Dr. Langhorne needs came in front of her clients firstly, by crossing her boundaries attending the dinner. She had her personal issues and transferred it to her clients in an unprofessional manner. Koocher and Keith-Spiegel (2017) noted a number of cognitive errors of crossing boundaries by therapists. Cognitive error one stipulates that what happens outside the psychiatrist sessions has nothing to do with the therapy, this relates to events outside the therapy sessions that can become problematic for the client and therapist, as seen in the dilemma. Cognitive error seven lends itself to self-disclosure of the therapist that is inconsistent with therapy goals and intervention techniques, Koocher and Keith-Spiegel (2017). Ethical standard code of conduct violated Competence entails knowledge, skill and diligence (Welfel, 2016).
Pope and Brown (1996) defined two types of competence; personal competence which is needed for “high quality professional practice” (as cited in Koocher & Keith- Spiegel, 1998, p. 55) and intellectual and emotional competence , entails acquisition of knowledge and abilities for effective practice . (as cited in Koocher & Keith-Spiegel, 1998). Reviewing the year this episode was aired (1991) principles were guided by American Psychological Association’s Council of Representatives which adopted The Ethical Principles of Psychologists (1981 Revision). Competence as principle number two stated that professionals should refrain from any personal problems and conflicts which may interfere with professional effectiveness and potentially result in in poor performance, thus examination of termination of session, suspension or limit of scope should be taken into consideration by recognition of an ethical issue (APA, 1981). Compared to the 2010 amendment of the code the same principle applies to the standards of conduct. Code 2.06 personal problems and conflicts (a) and (b) were violated. Code 2.06 (a) states that psychologist should refrain from an activity they know their personal problems will prevent them from work – related activities (APA, 2017). Dr. Langhorne referenced her issues with her mother-in- law and husband in both sessions that caused her to be anxious thus this clearly raises the issue of personal competence. Code 2.06 (b) (APA, 2017) relates to termination of services or seeking consultation if the therapist is knowledgeable that they personal problems can interfere with their work, in this circumstance Dr. Langhorne attended the dinner event as an emotional outlet to avoid her personal issues at home which turned into a emotional outburst and countertransferenced to her clients.
Human relations 3.06 (1) conflict of interest states psychologist should refrain from taking on a professional role when professional relationships could be expected to impair objectivity, competence or effectiveness in performing their functions as psychologist (APA, 2017). Dr. Langhorne showing up to the dinner for reasons of an emotional outlet posed a conflict of interest and impairment of competence, thereafter exposing her clients to emotional harm such breach of confidence which can cause the other parties to lose faith in the profession as well as an unnecessary conflict between Whitley and her ex- finance. The Bradford’s may also be reluctant to share their issues in a next therapy session with the doctor due to the conflict of interest and her emotional outburst. Code 3.10 multiple relationships states a psychologist should refrain from entering a multiple relationship if it may impair objectivity, however multiple relationships may not be unethical if the professional can foresee potential harm and take necessary precautions to resolve it (APA, 2017).
Dr. Langhorne initially declined the dinner offer but she decided to accept after her domestic issue. Maybe attending the dinner with the Bradford’s only could’ve been beneficial or less harmful to the client boundaries were crossed with knowledge of another client attending the event along with another party (reason for therapy). Standard four relates to privacy and confidentiality, in this scenario code 4.05 (a) and (b) was violated. Standard 4.05 (a) states that’s psychologist may disclose confidential information with appropriate consent of the organizational client (APA, 2017) thus Dr. Langhorne breaching confidentiality without because consent of her clients. Code 4.05 (b) states that disclosure of information without consent is only mandated by law, consultation, professional services or protecting clients from harm (APA, 2017), there was no evidence to suggest any of the above stipulations to the clients or dilemma. A study conducted by Lewis (2015) reported 11.4% breach of confidentiality reported by clients documented by the Psychotherapy and Counselling Field of Australia (as cited in Lamont – Mills, Christensen & Moses, 2018). Discussion I think this dilemma could’ve been handled differently.
Professionals face personal issues just as their clients do in their everyday lives. I believe the therapist had the interest of her clients at heart but allowed her personal issues to cloud her judgment at certain points in the counselling section. I believe she counter transferred her frustrations upon the family clients because of her own issues. In my opinion the therapist could’ve taken the day off but instead she wanted to get the Christmas rush for more billing hours thus failure to put the needs of her clients first in space of greed. In addition extra measures of privacy could’ve been accounted for since Whitley tried to conceal her identity as the Bradford’s enter without a buzzer or knock, at the end of a session there should be a time gap before another client enters the room for privacy of a client. The acts of the therapist both in session and out session shows some form of emotional disturbance and personal counselling should’ve been taken into account to minimize her distress. The offer to dinner was a kind gesture by the clients, in the real world avoiding social interactions with a client whether intentionally or intentionally may be inevitable thus some form of strategy should be considered as a boundary between the client and therapist especially in a small country or community.
The necessary steps I would utilize to resolve this dilemma is adoption of the ethical decision making model proposed by Welfel (2016). This model proposed ten steps to resolving an ethical dilemma; in this scenario I would use steps one, three, four, five, six, seven and ten. Step one states becoming sensitive to the moral dimensions of practice. In this step professionals are expected to have ethical sensitivity that is being knowledgeable of professional and personal ethics and principles (Welfel, 2016). Being ethical sensitive is the ability to recognize ethical dilemmas, in this scenario the Dr. Langhore recognized the ethical dilemma of mixing the professional with personal after being offered an invitation to dinner with her clients, however in the end she succumbed to her own value dilemma which posed a threat to her clients. this step is necessary in this case because of the potential conflict that was foreseeable , the client were new and their issues weren’t completely resolved in collection of the therapist emotional state. Step three involves defining the central issues in the dilemma and the available options. tis step eludes to analyzing the ethical issues posed in the dilemma and analyzing the case with potential alternatives taking into consideration both intuitive and professional values ( Welfel, 2016).
The alternatives I would consider are ; seeking personal therapy as the therapist, taking the day off or suspending therapy session after seeing Whitley (first client), not attending the dinner , maintaining client – patient confidentiality at the dinner party ( if so desired), not to self- disclose about personal issues and retract from bringing the therapeutic role into the dinner. Step four refers to professional ethics standards, guidelines and relevant laws and regulations. As stated in the above violations, referring to the same principles and codes to this dilemma as a professional guide. This step may assist the professional to remain objective in ethical dilemmas even though the principles and codes won’t have every solution to a problem but acts as a template. Step five involves searching out the relevant ethics literature. According to Welfel (2016) this step allows professionals to research the work of other professionals in practice as it relates to similar ethical issues.
For instance the decision of not attending the dinner would be in support of literature posed by Gutheil & Gabbard, 1993; Simon, 1991; Strasburger, Jorgenson & Sutherland ( 1992) refers to the slippery slope dilemma pertaining to meeting with clients outside the office for treatment or non- treatment ( as cited in Zur, n. d. ) . Zur ( n. d.) contends that meetings outside of the office is beneficial to a client only for purposes of a treatment plan. In a study conducted by Tallam (1981) relocated attending special events for clients should be in the interest and benefit of the client ( as cited in Koocher & Keith – Spiegel, 1998). For purposes of the qualitative data I wouldn’t have advised the therapist to attend the dinner. Step six involves applying fundamental principles and virtues to the situation. I would apply the principles of autonomy, fidelity, non-maleficence and justice to this dilemma because they are all based on concept of confidentiality and non- maleficence of avoiding harm ( Welfel, 2016).
The Bradford’s were first time clients I would’ve resolved this dilemma by showing virtues of compassion and trustworthiness so the client can feel a sense of safety and trust in the profession and try to alleviate common myths of the counselling process such as limits of confidentiality (Welfel, 2016). Step seven involves consulting with colleagues about the dilemma. Consulting with colleagues enables the professional to evaluate an ethical problem with relevant expertise and experience that may not be explicitly stated in the professional codes. Consultation not only relates to the dilemma of a client’s case but also entails sharing personal issues one may face as it relates to emotional distress. A study conducted by Bhola, Sinha, Sonkar and Ragurum (2015) seek to examine the types of ethical dilemma by trainee clinical psychologist and their choices of resolving ethical dilemmas.
The study found that 35 out of 67 respondents reported ethical dilemmas involving 37. 1% therapist- patient boundaries, 34.3% confidentiality, 8.5% competence, 8.5% beneficence and non – maleficence, 5.7% client autonomy and 5.7% other. It was also reported that the most common methods of resolving the dilemmas accounted 45.7% consultation and supervision, 34.3% professional ethical guidelines, 8.6% discussion with clients and 2.9% observation of professional clients. Thus evidence supports the decision to consult with colleagues of professional conflicts such emotional distress. Step ten entails reflecting on the actions taken. After consideration of the previous steps utilized I would carefully examine the benefits and risks the overall dilemma and best course of action.
