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Ethical Dilemmas in Counseling

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What's the ethical dilemma in this case?
What did the counselor do wrong?
What could the counselor do differently?

Case study: Ward and June

Brett is a ten year old son of June and Ward. They visited Brett's school psychologist who tested and assessed Brett on their request. The results showed that Brett has ADD and a learning disorder related to math. They are upset by these news and they opt to seek a second opinion. This is despite the fact that they know that their kid has been struggling lately, and they feel that his difficulties are as result of something else but not what the school psychologist concluded. Brett is presented to me for a second opinion. Even though I don't have experience working with children I decide to re-test him after disagreeing with the school psychologist. I even go further to tell the family that it's not uncommon for school psychologists to misdiagnose children. I also request for the school psychologist to fax me raw data from his tests as the family counselor.

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Ethical dilemma

? What's the ethical dilemma in this case?

There are several ethical concerns in this case study including: competency, ethical guidelines for colleagues, and testing. The primary ethical dilemma is ethical violation of competence. For example, the psychologist is working out of her area of expertise as she acknowledges that she has no experience in working with children. This decision to provide services without the professional knowledge and experience is a clear violation of Standard 2.01 of the APA's ethic code outlined in the "Boundaries of competence" (APA, 1992, 2002). Wise (2008) explains this standard as focused on the practitioners' ability to practice competently, as emotional well-being is entwined with professional functioning. Along with the lack of experience, the psychologist/therapist without supporting information on the need for assessment has decided to re-test the child.

? What did the counselor do wrong?
The counselor in this case committed several errors. In addition to working outside of his or her area of expertise, by suggesting that "counselors often misdiagnose children, the counselor made an unethical decision to provide information that could be harmful, and that violates ethical guidelines. Based on Standard 4.06 & 4.07, psychologists are encouraged to disclose only information that is useful for treatment ...

Solution Summary

This solution examines a case study focusing on the ethical dilemmas in professional counseling.

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Counseling referral with an ethical dilemma

Irina, a 13-year-old girl of Arabic cultural heritage living in Boston, Massachusetts, was brought by her parents to a hospital emergency room after an assault by a stranger. Based on her injuries, the hospital staff suspected that the attacker had also sexually assaulted the girl, but she and her parents refused medical evaluations for rape. The family received a referral to see Janet Matthews, a clinical psychologist specializing in adolescent trauma. During their initial meeting with Dr. Matthews, the parents asked the psychologist not to discuss any sexual aspects of the assault with their daughter but to treat the psychological trauma from the assault in general. They told the psychologist that admitting a rape had taken place would cast a stigma on their daughter and make her ineligible to be married to men in their closely knit ethnic community. When asked in private, the girl also requested that sexual issues not be discussed for the same reason.

Ethical Dilemma
Dr. Matthews does not know if she should agree to the parents' and child's request
How might Irina's age and parents' involvement in the referral affect how Dr. Matthews can resolve the dilemma? How might the state law on treatment of minors and HIPAA rule on access of guardians to a minor's health care record influence Dr. Matthews' decision?
What are Dr. Matthews' ethical alternatives for resolving this dilemma? Which alternative best reflects the Ethics Code's aspirational principle and enforceable standard, as well as legal standards and Dr. Matthews' obligations to stakeholders?
What steps should Dr. Matthews take to ethically implement her decision and monitor its effects?

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