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1. Who are the parties that will be impacted by whatever course of action is chosen?
2. What are the ethical issues involved in this clinical scenario, including conflicting and competing values of the parties involved?
a. Dual Relationship
b. Abandonment of client
c. Client dependency
d. Clinician’s competence
e. Clinical consultation to guide decision making
3. What are all the viable courses of action and what are the benefits and risks of each?
a. Address behaviors directly with client/review boundaries and set firmly with client/address gift giving policy/in consultation address countertransference/seek continued consultation to address possible abandonment of client and personal safety within the therapeutic relationship.
A. Dual Relationships/: Pro: build therapeutic relationship with client/set firm boundaries in the therapeutic relationship to include following agency policy on gift giving and spending time with clients outside of the therapy sessions/address keeping clients confidentiality when at public meetings (AA). Cons: Addressing boundaries in a negative or aggressive voice or manner/being disrespectful to the client when addressing sensitive matter such as gift giving or following clinical outside the office/not remembering it is the clinician’s responsibility to maintain boundaries and confidentiality.
B. Clinician’s competence and use of Consultation/ Countertransference: Pro’s: clinicians awareness of issues that create the countertransference/addressing countertransference in consultation/addressing fear of personal safety/seeking consultation on whether there is enough evidence of stalking behavior to require legal action or a transfer to another clinician due to countertransference issues/addressing clinicians AA meetings and how to manage own recovery in current situation. Cons: clinician may not be aware of how countertransference is connected to fears/ may not be able to make a clear, informed decision about how to proceed with the case/clinician may receive guidance in consultation and not have the emotional strength to follow through or inform the consultant due to various reasons/possible liability if a decision is made to transfer or close the case without proper rational for decision and/or appropriate documentation. Referring to code of ethics and agency policy where appropriate to support decision making.
5. Who will you, as a supervisor, consult regarding this clinical scenario and why?
I would first consult with my own clinical consultant to review the primary issues such as clinician’s countertransference/clinicians ability to manage boundary setting with this client due to not feeling safe/ abandonment issues for the client. Discuss if there is a legal and safety component that needs to be acted upon. Second, I would consult with the CEO of my agency regarding agency policy and identified issues that are a dilemma with possible legal issues and clinician’s safety. Possibly contact NASW’s Legal Assistance with questions of all precautions not to abandon the client and keep the clinician safe while complying with agency and code of ethics.
6. What is the best possible course of action to take in this clinical situation? Addressing boundary setting, preventing abandonment of client, and properly addressing clinician safety.
7. How will you implement the decision, document the decision making process, and monitor and evaluate the effects of decision? Clinical consultation notes will be detailed and complete on each meeting with the clinician to include identified issues, decision making process with pro’s and con’s and what action was taken and outcomes. Follow-up in consultation on case until all concerns are resolved. Keep my consultant and CEO updated on case throughout the decision making and action process. When case is resolved consult on resolution and if there were actions that might have been taken that would have made a positive difference in the case. Use this case as a learning tool to address future ethical dilemmas and as appropriate update agency policy as a result of this outcome.