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Who are the parties that will be impacted by whatever course of action is chosen?
Larry (the client), Janet (the counselor), clinical supervisor, other agency staff, and potentially other clients
What are the ethical issues involved in this clinical scenario, including conflicting and competing values of the parties involved?
Dual relationship- Larry has begun to participate in AA meetings that Janet attends
Non maleficence- Larry could potentially be harmed by possible options to address the issue
Boundary violations- Larry’s boundary violations caused an ethical conflict for Janet
Counselor’s competence- since Janet is an LADC, it is outside her scope of practice to directly treat personality disorders
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.
Option 1- Transfer Larry to another agency
Pros- Janet feels safe and supported
Larry might get treatment better tailored to his diagnosis
Larry might understand there was a boundary crossing
Cons- Larry would likely feel abandoned
Larry might not understand his own role in the decision
Option 2- have Janet sit with Larry alone and explain her own discomfort with his pushing of boundaries and set firm limits
Pros- The situation might take on less intensity if dealt with by the initial two parties
Cons- Janet might be operating outside her scope of practice by handling it on her own
Larry might not understand and continue to escalate
Janet might feel unsupported
Option 3- Clinical supervisor and Janet could meet with Larry to share concerns about what had occurred, set boundaries going forward, and attempt to repair working relationship
Pros- Larry can have limits set without feeling abandoned
Janet might feel supported by having her supervisor help in vivo
Cons- Janet might not be able to continue to address the issue on her own after the initial session
Larry might see supervisor’s presence as a threat
Option 4- Larry could be transferred to a clinician within the agency who treats mental health disorders
Pros- Larry gets tailored treatment
Janet feels safe and supported
Cons- Larry feels abandoned
Larry might not understand his role in the matter
Option 5- agency gets a PFA on Larry
Pros- Janet feels safe
Cons- Violation of HIPAA when it is unclear if he broke the law
Would escalate situation
Who will you, as a supervisor, consult regarding this clinical scenario and why?
I would consult with my own clinical supervisor and my peer group
What is the best possible course of action to take in this clinical situation?
I would choose option 3, placing non maleficence as highest priority while also ensuring Janet felt safe and supported. I would attempt to use the situation as a learning experience for Larry and our firm boundaries into place to ensure safety was maintained. I would explore adding mental health counseling to his team
How will you implement the decision, document the decision making process, and monitor and evaluate the effects of the decision?
I would document my supervisions with Janet leading to the decision, all of my own supervision meetings and peer supervision meetings, and the written plan for implementation
After we met with Larry, I would create an ongoing safety plan to review weekly with Janet to ensure that the decision had been successful and no further action was needed