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Who are the parties that will be impacted by whatever course of action is chosen?
The client, Janet, Janet’s supervisor, the agency, and possibly Janet’s family and the AA group.
What are the ethical issues involved in this clinical scenario, including conflicting and competing values of the parties involved?
The client has already stated his fear of abandonment so terminating treatment might have a negative impact regarding 1) relapsing and 2) validating his abandonment issues. However, if Janet doesn’t do anything, it could compromise her recovery as well.
If the client actually conducts physical harm to Janet, then the agency could be liable as well.
Filing legal charges is another ethical quandry as this will violate the client’s confidentiality being in a treatment program.
We would hope that the agency has a protocol and procedures around this type of issue.
Questions 3 & 4
What are all the viable courses of action and what the possible benefits and risks for each?
1. Do nothing and let the behavior to continue. Benefits might include not having to make the decision and risks are that the client assumes this behavior is appropriate and gets into trouble when doing this with another provider. Also risks are that janet or her family are harmed or janet relapses or quits her job. Agency runs a risk allowing this behavior to continue as more clients might do it, janet sues them, community learns of it and reputation is damaged.
2. Meet with the client and explain his behavior is inappropriate and cannot continue. Outline a plan to help the client find another meeting and Janet continues to work with him. Benefits – client is supported and learns new behavior. Janet feels that she handled the decision appropriately and can help others when they run into similar issue. Risks – client relapses, client feels validated and continues his behavior. Client leaves agency.
3. Meet with the client and explain that his case is being transferred to another clinician and why. Benefits, Janet feels listened to and supported by agency. Janet feels relief. Client learns about inappropriate behavior and uses this in therapy going forward. Risks – client relapses, client feels abandoned, client ups the ante. Janet feels like she failed the client.
4. Call law enforcement and serve client papers. Benefits – client cannot harass Janet any longer. Janet feels relieved and safe. Risks – confidentiality is broken, client feels abandoned and attacked, client relapses, client ups the ante, client sues agency, client files complaints with regulatory body, client bad mouths agency.
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.
Who will you, as a supervisor, consult regarding this clinical scenario and why?
I would consult with the Clinical Director and Medical Director of the agency. These directors are responsible for the policies and procedures of the agency. Additionally, the more consultation sought, the better the outcome/decision process
What is the best possible course of action to take in this clinical situation?
I feel that the best possible course of action to take in this situation is to sit with the client and address each issue; 1) attending Janet’s meeting 2) obtaining my number and address 3) the phone calls. The meeting should include a discussion of boundaries and confidentiality. Validating the clients rapport with Janet is important also as is a discussion that Janet is trying to abandon Larry but that boundaries are important and implemented to protect the client. The meeting should also include consequences if the behavior doesn’t stop.
How will you implement the decision, document the decision making process, and monitor and evaluate the effects of the decision?
I would implement the decision by advising the CD and MD of my decision and then calling the client for a meeting. I would carefully document the facts and why I feel I need to seek supervision around this, then document each step taken, i.e., meeting with the CD/MD, my decision making process, and the plan and then finally the outcome. I would also document if these issues arise again. If not, then the intervention was successful, if they did, then its back to the decision making process.