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Who are the parties that will be impacted by whatever course of action is chosen?
Parties impacted include Janet (therapist), Larry (client), supervisor, potentially AA group members, Larry’s family (if any), employees at agency dealing with his random appearances.
What are the ethical issues involved in this clinical scenario, including conflicting and competing values of the parties involved?
In my opinion, ethical issues include client’s breech of therapist’s boundaries with harassing/stalking behaviors of her; agency duty to provide client with mental health/substance use treatment; therapist duty not to abandon client; if relevant, potential need to alert probation officer; therapist’s disclosure of AA attendance/recovery to supervisor and/or agency employees in dealing with this issue. Primary conflicting values seem to be around boundary violation/harassment and duty for provision of services to client.
Questions 3 & 4
What are all the viable courses of action and what the possible benefits and risks for each?
Please include the pros and cons of each course of action based on relevant codes of ethics, laws, agency policies, licensing board regulations, reasonable and customary clinical theory and practice, and personal values including religious, cultural, ethical and political ideology.
One viable course of action is to terminate Larry from Janet’s caseload and transfer him to another therapist. According to the ACA Code of Ethics, ethical issues should be resolved with all parties involved, but it is unclear if involving Larry in a conjoint meeting with Janet would be safe to her and if it would exacerbate his boundary infractions. Risks are that he will feel abandoned, increase his harassing/stalking behaviors of her, possibly drop out of treatment with new provider and relapse. If Janet also files for a protection from harassment order, cons are that it could escalate Larry, may be hard to enforce, may require more police interference at an agency where other clients will be triggered; pros are that it may provide more safety to Janet and reduce her fears. Cons of not filing an order to protect Janet could trigger her recovery and put her own recovery in jeopardy.
Another course of action would be to meet with all parties, Janet, Larry and supervisor to create a plan of action going forward that would involve Larry ceasing the harassing behaviors and remaining in counseling with Janet, and only terminating or transferring if he defaults on the agreement. Risks would include that it may still put Janet on edge and keeps her at risk without legal backup. Pros are that Larry may not experience abandonment by Janet and be able to work through this issue by exploring other ways to seek emotional support without resorting to harassment/boundary violations.
In either scenario, if Janet is unable to return to her regular AA meeting due to Larry’s attendance there or fear of it, she may lose her support group and the other AA attendees may also lose their fellowship with her. Similar cons may happen for Larry as well.
Who will you, as a supervisor, consult regarding this clinical scenario and why?
I would consult with my supervisor and/or agency director, my liability insurance provider and attorney, possibly a police mental health liaison, as they can all contribute to the ethical decision-making process and it is critical to document consultation as well.
What is the best possible course of action to take in this clinical situation?
I believe protection of Janet, the therapist, and the agency employees with do-no-harm actions to the client: file protection from harassment, transfer client to another counselor at the agency for continuity of care, allow Janet to return to her regular AA meeting comfortably with the legal order in place. It would be important for the facilitator at the AA meeting to know the potential threat of Larry appearing on premises if Janet were there to mitigate crisis.
How will you implement the decision, document the decision making process, and monitor and evaluate the effects of the decision?
The decision would be documented in progress notes, crisis notes, supervision logs, discharge summary, new therapist re-opening documentation. Monitoring with all agency staff involved and any legal interaction as needed.