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Who are the parties that will be impacted by whatever course of action is chosen?
John, the agency that John and Steve work for, Steve, John’s direct clients, John and Steve’s families, other clients in the agency when John is working, other co-workers
What are the ethical issues involved in this scenario, including conflicting and competing values of the parties involved?
Practicing counseling while intoxicated is at the heart of the conflict. There is also a need to help John get the support he needs from his supervisor. There may be possible burn out, and/or secondary/vicarious trauma going on for John based on his heavy caseload. John’s clients are also being impacted by his change in demeanor. It is unclear why the change has occurred, and the only clue is smelling alcohol on John’s breath.
Questions 3 & 4
What are all the viable courses of action and the possible benefits and risks for each?
Steve does not follow up with John and hopes that it doesn’t happen again. This is risky for John, the agency, and the clients. This would possibly preserve John and Steve’s friendship, however. This will but the agency at great risk if something happens to John at work due to his drinking or with one of his clients and it came out that Steve knew about the problem but did not address it. This would put Steve’s license at risk.
Steve follows up with John and asks to talk about how John is doing overall. They could discuss self-care strategies, and make a plan for what John needs to return to work. This strategy may preserve the friendship if Steve is able to approach John in a non-threatening and compassionate way. Based on their friendship, this may work if they have a solid relationship. A con is if John is unwilling to acknowledge what is going on for him, it puts John in a position where he may need to make a difficult decision that is in the best interest of the clients and the agency. The ethical standard of do no harm to clients I feel is the primary driver of this decision.
Steve could fire John for showing up at work intoxicated. This will damage the friendship and impact client/counselor relationship because the relationship would end abruptly. The agency would be protected.
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 supervision theory and practice, and personal values including religious, cultural, ethical and political ideology.
Who should the clinical supervisor (Steve), consult regarding this scenario and why?
I would get peer consultation as Steve did in this situation. I would also consult with Legal to make sure we are acting in a way that is in accordance with the law. I would also consult the board if I felt I was stuck and unsure of where to go.
What is the best possible course of action for a clinical supervisor (Steve) to take in this situation?
I would send John home for the day and ask to meet with him the following day when he was not intoxicated. I would discuss my worry for him, the value he brings to the agency and talk about what he might need in the way of self-care and work modifications in order to feel healthy again. If John was unwilling to discuss this with me, I would consult with legal and I am guessing would be given guidance to move towards a disciplinary process with documentation of expectations for work for John.
How should the clinical supervisor (Steve) implement the decision, document the decision making process, and monitor and evaluate the effects of the decision?
I would keep a written log of who I talked to, what the direction was and a timeline for implementation. When I met with John I would also document our conversation and have him sign the notes at the end so we are both in agreement of the plan moving forward. I would have frequent, regular, and documented check-ins with JOhn for a specific amount of time. If John decides to take time off, we would discuss his cases and appropriate coverage while he is out. We would also discuss messaging he is comfortable sharing with his co-workers and clients. This plan would be documented in writing.