PSY4405 – Ethical Case Study (Chantelle) – Hannah Godwin



hi and welcome to this presentation on an ethical dilemma case study my name is Hannah Goodwin and I will be discussing the client case of Chantal the dilemma begins when chantels mother asked for an update on chantels progress I am an early career psychologists with little experience in working therapeutically with LGBTI youth my initial reaction to chantels mother's request was that I should not provide her with the confidential information however it did raise a number of questions for me such as what is my dual Duty between Chantal and her mother what are the confidentiality obligations here am i competent to treat sent home though chantels 25 year old partner pose a risk to my client what is the best cost of action that is in the best interest of Chantal and results in the least amount of harm to her there are ethical issues and a dilemma in this case study that must be worked through specifically around chantels right to confidentiality an ethical dilemma arises when there are ethical pros and cons on either side of the decision a good ethical decision can be based on the APS code of ethics and can be defended by a well-thought-out decision-making process this is why I will apply the 8 step ethical decision-making model by Kouta and Spiegel throughout the presentation step one of the model considers whether dilemma is an ethical one the ethical dilemma in this case is whether I should or must disclose confidential information arising from my sessions with Shinto this is an ethical dilemma as it has pros and cons on either side of the decision in addition I have identified three intertwined issues client well-being and rights nature of clients relationship and parental rights the overarching primary concern here is that of confidentiality and who has a fundamental right to chantels information step 2 of the model consults relevant code guidelines and laws looking at the issue of client well-being and rights it must first be considered whether Chantell is of sufficient maturity and developmental capacity to provide informed consent referring to standard 0.3 informed consent i should assess her capacity to provide consent with regards to the Victorian law a minor is considered as being under 18 years of age however referring to stand a 2.2 capacity to give informed consent of the guidelines for young people gentle would need to be considered capable of giving informed consent when she can fully understand what I proposed with regards to consent confidentiality and benefits and miss of the psychological services previous research also has found that 14 to 15 year olds were determined cognitively mature enough to make adult decisions thus able to provide informed consent referring to standard 0.5 confidentiality when considering whether to disclose chantels information I must consider in balance her well-being wishes and the relevant laws I would therefore team Chantelle is capable of providing informed consent my confidence to therapeutically work was gentle must also be considered referring to standard 3.1 competence I should consider wedding treating Chantelle is within the boundaries of my experience and competence I next need to consider the nature of the client's relationship and whether it is healthy legal and not abusive referring to standard 0.5 confidentiality if the relationship is abusive then I should disclose confidential information given there is an immediate and specified risk of harm to an identifiable person Chantell is potentially engaging in sexual conduct with a partner 9 years her senior so they look at it the legality of the relationship must be determined in Victoria at the age of consent in Victoria is 16 years of age therefore is Chantal and her partner are sexually involved they are engaging in consensual relations and not breaking the law as Chantal is at the age of consent referring to standard viewpoint 3 professional responsibilities I should also consider the implications of revealing Chantal sexual orientation and lesbian relationship to her mother in a u.s. case where a police officer threatened to disclose a sexual orientation of an 18 year old to his family the court decided that the adolescent sexual orientation should not be disclosed however sadly the boy killed himself in order to avoid the disclosure of his sexuality to his family amongst Australian use 41 percent thought about harm and/or suicide and the highest risk of suicide is when a young person has come out to themselves but not to anyone else I therefore need to recognize the potential risk of Chantal situation be mindful of this and take steps to minimize any harm to her particularly given that Chantal has come out to herself but not others as yet my next need to consider chantels parents rights to information about their daughter referring to general principle a respect I need to respect the relationship between Chantal and her mother be aware of conflicting views between the mother and Chantal and remember chantels right to autonomy referring to standard eight-point-five confidentiality I should discuss with Chantal and her mother under what circumstances information may be disclosed this should be made clear at the beginning of the therapeutic relationship given Chantal is deemed a major minor I am not ethically or legally bound to disclose confidential information when parents request information on their child's therapy sessions the child's best interest is the most important issue when considering breaching confidentiality I need to consider whether disclosure would help or harm my client and the cost of the benefit must be carefully weighed step 3 of the model identifies factors and traps which could influence the decision process prior to commencing this ethical decision-making process I believe that a common-sense objective solution to this dilemma without reference to ethical codes was easy since I'm somewhat an ethical person of good character I also have personal views that may affect my decision I do not believe in conservative religion and politics which may contrast with chantels parents I am conscious of my preference for solving problems from a teleological perspective under this perspective whether an action is ethical or not depends on the nature of the consequences it is underpinned by the utilitarian approach where the greatest good for the greatest number of people is valued it is important to consider how the family might respond if told about chantels homosexuality and the consequence of breaching confidentiality would likely cause harm to more people than benefits in contrast from a deontological perspective if the intention was good then the action is ethical regardless of the consequences from this perspective it is my duty as a psychologist to uphold the code code of ethics and confidentiality as this is the right thing to do given Chantal ISM a Jimena interestingly when I applied both of these lenses it led me to the same outcome not to breach confidentiality step 4 of the model involves consulting with experienced colleagues I will consult with senior psychologists who have asked in sensitivity to ethical matters experience in LGBTI identity development and who hold a different political and religious perspective from my own step 5 of the model involves evaluating the rights vulnerabilities and responsibles of responsibilities of all parties involved in this case I must consider Chantal her parents her partner and myself Cheers displaying sorry Chantal has the rights to respect informed consent and autonomy Cheers displaying potential signs of underlying mental health issues and this could place her in a more vulnerable position if there is rejection from her parents she may face identity foreclosure if forced to early to come out protective factors include a supportive gay Network to help her through this process and her history of positive mental health Jen tells parents have a right to be treated with respect and should be considered in the decision-making process Gentiles coming out may cause severe distress and upset to her mother considering her conservative religious and political views it could also affect her political career given they are engaging in a legal relationship chantels partner also has the right to privacy and confidentiality I myself have a responsibility to understand the unique difficult si Chantal is facing as she navigates problems specific to her identity step 6 and seven of the model involves generating alternative decisions and probable consequences the first option is to disclose confidential information tutions tells parents the consequences of this option could be does not preserve client welfare Chantal may experience identity foreclosure she may face rejection from family or potential eviction from home it may disrupt the therapeutic relationship he does not respect her autonomy then Chantelle could take legal action against me the second option is that Chantelle discloses the information I could act as a mediator in a joint session between Chantelle and her parents and the consequences are of the same first three in the scenario above the third option is to respect chantels right to confidentiality and autonomy remind parents that I'm not le or legally required to disclose such information support Chantelle to develop coping skills and develop herself acceptance of coming on clearly set the boundary that the decision to tell her parents has ultimately hers the consequences of this decision could be therapeutic relationship remains a safe environment for chantels exploration assist in developing longer-term plan of action reserves her right to autonomy chantels mother's wishes are not honored and chantels parents could take legal action against me step 8 of the model involves taking action my decision is based on chantels best interests in this critical development stage and the potential to do harm if I breach confidentiality I should give Chantelle the time to develop her acceptance of her sexuality as I have established that no apparent danger exists I will let Chantell know her parents are seeking information and that when or if she is ready I can assist her with the disclosure process I therefore choose not to disclose to chantels parents however I will discuss with them the benefits of confidentiality and reassure them that should Chantelle be in any harm I would let them know this keeps the parents involved as partners in chantels mental health and so she enters right to confidentiality and autonomy and clearly sets the boundary that this is asian is ultimately hers I started this process with quite black-and-white thinking which shifted to gray the questions I raised in the beginning helped me to realize the importance of using an ethical decision-making model particularly given I'm in the early stage of my career as a psychologist using the model as a framework for making this decision has answered the questions I had and more it has led to a justified decision considering rights of all parties and consequences of actions I became aware of personal biases I was not aware I had and how this can impact their decision-making process a limitation of this model must be acknowledged however in some steps information was related or interdependent and hence difficult to separate out as an individual factor however with this in mind I am humbled and I look forward to using such a decision-making model in my future practice I also take forward the vital ethical consideration of being clear on informed consent and rights to confidentiality with adolescent clients and their parents prior to therapeutic treatment commencing thank you for listening

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