Ethical Dilemma
Below is an ethical dilemma scenario. YOU ARE TO COMPREHENSIVELY AND RATIONALLY DEBATE ALL SIDES OF THE DILEMMA AND OFFER A SOLUTION TO THE PROBLEMATIC SCENARIO IN THE FORM OF AN ESSAY. HINT: In some ethical dilemmas (such as this one), not just one party has made an error in judgment. Sometimes, thoughtless mistakes are made by many parties involved and so it is not a matter of who is to blame but rather, what might be a good/ best path towards ethical reconciliation. You can use your main text (Welfel) 10 Steps of Ethical Decision Making as well as the 17 steps to address an ethical dilemma (from Pope/Vasquez in E360 Resources) as references during this exam.
Marsha is an AGSC student in counseling who hopes to complete an internship in a womens shelter (a NYS licensed agency) for survivors of domestic violence. Among this agencys staff, there are only two NYS licensed professional staff, the director Ms. Ingram, LCSW and the assistant director, both who do not have the time to regularly supervise an intern. Other MH professional and support staff at the agency do not have the proper credentials to supervise her. Nevertheless, Marsha has decided that this is the clinical population and site where she wants to do her internship. There is several highly competent mental health professionals affiliated with the shelter and the director has recommended a NYS licensed Psychologist Dr. Scott, in particular as a good candidate to be her clinical supervisor. Because she is committed to this population and site for Marshas own personal reasons, Marsha devises an arrangement that she believes will allow her to complete her internship at this agency and still meet all AGSC training/internship and NYS licensing requirements.
Marsha first meets with Dr. AGSC, the Internship Director at AGSC NYC and discusses her plans. Though Dr. AGSC strongly recommends seeking a different internship site where her supervisor would be readily available on site during her internship hours, Marsha is adamant to make this site work out for her internship. Together Dr. AGSC and Marsha negotiate and revise Marshas plan into an acceptable plan for AGSC NYC and the NYS Licensing Board.
The final plan that all agree to, is a compromise and it is as follows. The agency agrees to pay Marsha a minimum hourly wages for her 700 hour, ten-month internship starting in June 2014 and Marshas direct supervisor is Psychologist Dr. Scott. Next, Marsha meets with Dr. Scott. He is currently a full time private practitioner in Manhattan and he is the former director of the shelter from 2000 through 2012. Dr Scott continued as a consultant to the shelter and spends one day (the first Monday of every month) at the shelter. During that consultation Monday, Dr. Scott agreed to supervise Marsha for at least one face to face hour during that day. During the other weeks of each month, Marsha agreed to travel to Dr. Scotts practice office on Madison Avenue for one face to face hour of supervision each week. However, Dr. Scott consults for the Ohio State agency overseeing shelters in that state and during the third week of every month, he is usually traveling in Ohio. Supervision during that third week is agreed to be conducted via internet video-audio or email communications. Dr. Scott indicated clearly to Marsha that he viewed clinical supervision as a mentorship and teaching relationship but that he is also not blind to his role as a mental health field gatekeeper and his increased practice liability incurred with her as a new supervisee. Dr. Scott agrees to write a letter to Albanys Department of Education and AGSC verifying his credentials and experience and the supervision plan for Marshas internship. He is pleased to know that Marsha earned thus far a cumulative GPA of 3.75. As is customary in a private setting, Dr. Scott is to be paid for his professional work as a clinical supervisor. Marsha agrees to pay $40 per hour for supervision and the agency agreed to pay Dr. Scott the balance of his hourly supervision fee. Finally, the current director of the shelter Ms. Ingram agreed to offer sporadic and informal clinical supervision and support to Marsha as Ms. Ingrams time would permit. Both Dr. Scott and Ms. Ingram agree that Marsha has the potential to be a good intern and they provide Marsha with reading lists of books, articles and journals pertinent to the clinical work and population at this site and that she is expected to review by specific dates and to apply this information in her internship.
It is now early August and Marsha has just finished eight weeks of practicum at the shelter, putting in about 15 hours per week. She completed her course in Ethics and Professional Issues in June. Marsha currently co-runs two group therapies per week and has seven women in her individual psychotherapy caseload and it is growing, about one new case per week. Supervision with Dr. Scott is weekly except with one missed week of expected face to face supervision last month due to a crisis patient that took up Dr. Scotts time that week.
Near the end of her second supervision session, Marsha casually mentioned to Dr. Scott that her main motivation for her interest in the treatment of domestic violence is that during her childhood, she regularly witnessed her 40ish year old mother victimized by her multiple boyfriends. Marsha also mentioned in those brief minutes, with increasing intensity and animated emotional distress, that her mother and she has spent one night at that very same shelter many years ago and that she was determined to help victims of domestic violence. Nothing more was said or queried by either Marsha or her supervisor regarding her statement as the supervision hour had lapsed. However, Dr. Scott was concerned about Marshas off the cuff self admissions, he casually mentioned Marshas comments to Ms. Ingram over a business luncheon they had, he made a request to the facility medical records director to see if there was any documentation of her mother and Marshas reported treatment at the facility though he received no reply from the medical records department yet and Dr. Scott intended to follow up with Marshas comments once he had more background information. Supervision hours through June and July were mostly used to help Marsha identify clusters of signs and symptoms within her clients and arrive at accurate differential diagnoses using the DSM-5 and instruction on writing comprehensive treatment plans and progress notes for the agency clients.
Marshas newest individual client was a 40ish year old woman who was a long-term victim of domestic violence and multiple assaults and she was seen for two sessions before the case came up in supervision. Dr. Scott was on site 6 days ago and reviewed Marshas new clients chart however he did not get a chance to personally interview the client himself though he did speak to other professionals on staff about the client in question. In last weeks face to face supervision session, Marsha and Dr. Scott had a substantial disagreement about the new clients diagnosis and treatment plan. They discussed their differences in clinical thinking and observations extensively but Marsha would not be persuaded by Dr. Scott of his diagnoses for the client. Regarding the clients diagnosis in question, both at least agreed that the diagnosis was likely some form of Anxiety Disorder, however, they could not agree on whether or not the client met criteria for a personality disorder diagnosis, while Dr. Scott strongly suspected a personality disorder based upon his reading of the chart and his conversation with staff. Marsha saw no evidence that would warrant a PD diagnosis. Dr. Scott referred Marsha to re-read the DSM-5 chapter on Personality Disorders and he lends her a book on PDs and several published articles on the BPD diagnosis. It is Dr. Scotts believe that psychotherapeutic treatments specific to the clients personality disorder would be incorporated into her treatment plan such as DBT however the PD diagnosis needed to be established first.
It is now the next week. This is the week that Dr. Scott is in Ohio and emails are exchanged regarding this client in question as part of the distance supervision. A passionate exchange of differing opinions regarding this client is send back and forth. Then, Marsha received this email from Dr. Scott that evening:
Ive been concerned about the difficulties you seem to have in conceptualizing these cases and in formulating a differential diagnosis and effective treatment plan. I believe that there are some personal factors interfering with your judgment. Ive discussed these issues with Ms. Ingram who has been observing you at the shelter and we both agree that you need to enter individual psychotherapy to address these problems. Marsha looked up at the cc line and noticed that the email was also sent to Dr. AGSC, Director of Internships at AGSC.
Discussion Questions: These are questions to help you formulate your essay to this ethical dilemma. DO NOT simply answer each question as your response. These rhetorical questions are intended to help you think through these ethical and professional issues. Utilize your text (Welfel) and the handout (Pope/Vasquez) to assist you in formulating a response and write your essay, being careful to attend to the questions below and any other important issues that you feel need to be addressed within this ethical dilemma scenario.
- If you were Marsha, how would you feel after reading this email?
- If you were Marsha, what would be the best possible way you could respond to this email? If you are Marsha, what are your ethical concerns?
- If you were Dr. Scott, what would be your concerns for Marsha as her supervisor?
- If you were Ms. Ingram, what would be your concerns for your agency?
- If you were Dr. AGSC, what would be your concerns for AGSC?
- What ethical guidelines and rules have been breached by this email from Dr. Scott?
- If you were Dr. Scott, how might you have better handled his conclusion that Marsha had some counter-transference issues to work through?
- In setting up the original internship and supervision plan, what improvements could have been implemented from the start (such as written contractual agreements or informed consents) that might have avoided this complex ethical dilemma?
- How can this breach in supervisor-supervisee relationship be reconciled? Offer a concrete and practical suggestion or recommendation.
- In this scenario, were there any ethical issues or violations (and by whom) of competence, confidentiality, freedom of choice, personal and professional boundaries, unfair procedures, inappropriate multiple relationships, professional misconduct or impairment, use of poor professional judgment, a lack of integrity and irresponsibility exhibited?
Collepals.com Plagiarism Free Papers
Are you looking for custom essay writing service or even dissertation writing services? Just request for our write my paper service, and we'll match you with the best essay writer in your subject! With an exceptional team of professional academic experts in a wide range of subjects, we can guarantee you an unrivaled quality of custom-written papers.
Get ZERO PLAGIARISM, HUMAN WRITTEN ESSAYS
Why Hire Collepals.com writers to do your paper?
Quality- We are experienced and have access to ample research materials.
We write plagiarism Free Content
Confidential- We never share or sell your personal information to third parties.
Support-Chat with us today! We are always waiting to answer all your questions.
