Friday Challenge: Open or Shut?

Wahoo! It’s Friday! Happy day. Before you get all down with your Thanksgiving leftovers, consider the following ethical scenario, borrowed with gratitude from Consider your answers and then send them in to us. We may include your answers in a later blog article.
Dr. Betty Frances has been treating Peggy Olson for anxiety and depression related to job stress and intermittent spousal bullying.  During their course of treatment, Mr. Olson physically abused Mrs. Olson to the point where the police arrested him on charges of domestic violence and terroristic threats.  Because of the seriousness of his threats and prior criminal behavior, Mr. Olson’s family could not bail him out of prison.
After this event, Mrs. Olson became more forthcoming with Dr. Frances.  His behavioral history includes stalking, assault, battery, public disturbance, public intoxication, and other out of control behaviors.  Dr. Frances continues to treat Mrs. Olson for anxiety and depression on a weekly basis.
Dr. Frances arrived at her office one day and found a letter with the return address of Mr. Olson at the local detention facility.  Dr. Frances feels an anxiety reaction in her body.  Trying to calm down, Dr. Frances writes out a list of questions.
1.      Should I open the letter now (as it is addressed to me)?
2.      Should I tell the patient about the letter before I open it?
3.      What are the benefits of telling the patient about the letter?
4.      What are the drawbacks of telling the patient about the letter?
5.      If the letter contains threatening information toward Mrs. Olson, or me, am I able to turn the letter over to the District Attorney?
6.      Am I required to turn the letter over to the DA if there is threatening information in it?
7.      How much control does the patient have over the letter and its contents?
8.      Is the letter automatically part of the treatment record or does it depend on the contents of the letter?
9.      Do I need a self-care plan as I am stressed out about this situation?
Having calmed down and written out these questions, Dr. Frances calls you for an ethics consultation about the letter.


Bring the Warmth

Howdy readers 🙂

Here is an article published last fall in Counselor Connection about taking care of yourself during the holiday season. This year’s holiday season is nearly upon us, so this is a good time for some personal and professional inventory to see if there are any areas you can strengthen before those holidays work their magic. Click on the link below to read the article.

Bring the Warmth


Do you get Counselor Connection in your inbox? If you don’t you really should! It comes twice a month filled with articles about important topics from leaders in our profession. It fills the gap between issues of Counselor Magazine. Go to their website to subscribe: Subscribe here!

Friday Challenge: What’s in a Name?


Happy Friday! The following was borrowed, with thanks, from ethical for this week’s ethical puzzle. As ever, send in your comments and we may publish them in a later article.
Dr. Thomas is a psychologist who is a part owner of a private practice in which they offer Employee Assistance Program (EAP) services.  The EAP service provides a solution-focused, three-session benefit for companies within Pennsylvania.  Dr. Thomas normally does not handle EAP services. Several staff members were either ill or overbooked, so Dr. Thomas responds to EAP requests during the day.

When dealing with the EAP program, she thinks her title of “doctor” might put people off, so she announces herself as “Sue” when dealing with EAP clients.  When returning a call from Chuck who works for a company with the EAP benefit, the psychologist indicates that she is “Sue” from the EAP program.  Chuck is a 20-year old man who immediately expresses a great deal of agitation and anger. He complains loudly about his parents and his girlfriend. In the process of conversation, Dr. Thomas realizes that Chuck is the son of her next-door neighbors.  While Chuck now lives in an apartment in town, she remembers him well.  She actually attended his graduation party briefly and hired him to cut her lawn for two years.

Also during the course of the phone contact, Chuck expresses some homicidal rage toward his parents, particularly around financial issues and early childhood sexual abuse from his father. Dr. Thomas wants him to come in immediately for a more in-depth evaluation. Chuck hesitated to have a face-to-face interview at the practice, but agreed only if he can talk with Sue.  Sue schedules the appointment for early in the evening.

What are the ethical concerns in this scenario? How would you advise Dr. Thomas to handle them?

Friday Challenge: To much information?

Happy Friday, ethical gods and goddesses. This week’s challenge is borrowed from ethical with a few alterations. As always, please send in your answers to add to our discussion next week of this challenge. Get your thinking caps on!
Dr. Smith is a psychologist who has worked with a young woman for about 9 months. The patient presents with a history of rejection and abandonment as well as persons of power misusing her. She recently received an offer to become a sales representative for a pharmaceutical company. The psychologist and patient discussed the type of job she was entering because she may experience rejection from doctors, nurses, and other office personnel.
After her 6 weeks of training, the company assigns her to a regional director that the psychologist knows personally. She reports an increase of her anxiety related symptoms. Dr. Smith knows her new boss, Mr. Biggy (they dine together with their wives several times a year), and seeks to reassure the patient that “he is a really a good guy” that seems bright, friendly, and fair. He indicates that Mr. Biggy is a good “family man”. The patient is reassured, and reported less anxiety. 
Several weeks later, your patient reports that Mr. Biggy has been spending more time with her, complimenting her on the way she looks and her ability to make the sale. She begins to feel uncomfortable as she feels like they are spending too much time together and Mr. Biggy is asking questions that are more personal, forwards her “funny” emails, and texts some inappropriate remarks to her, mainly about her alluring power that helps make sales. Two days later, Mr. Biggy and Dr. Smith meet in an unplanned social venue. Mr. Biggy pulls Dr. Smith aside and explains how he has become very attracted to a new sales representative. He thinks that she is young and impressionable. He confides that he would like to have an affair with her.
Dr. Smith politely explains that he feels uncomfortable with them discussing his more personal marital issues. Mr. Biggy indicates that he wants to talk more about his feelings. Dr. Smith suggests a referral to a psychologist, but Mr. Biggy states that he feels more comfortable talking with Dr. Smith. After some other small talk, Dr. Smith leaves to mingle with other friends. Dr. Smith is now worried about the entire situation.

Friday Challenge: Thinking outside the scope?

Dr. Plenty lives and practices psychology in a rural area.  She began to provide psychotherapy to Mr. DiMencha, a 52-year-old, who suffered with depression.  After six sessions, Mr. DiMencha suffered a significant concussion while at work.  His impairment is noticeable by Dr. Plenty without any type of testing.  He struggles with understanding concepts and becomes tangential during the next two sessions.
Mr. DiMencha demonstrates a variety of cognitive deficits, and will likely need to go into an assisted living facility. His family lives at a distance and provides minimal help. Workers Compensation refuses to pay for the case management services of an independent social worker. Attempts to find social service agencies able to help him have not been successful. Mr. DiMencha doesn’t appear to understand his legal rights or the settlement process.
Mr. DiMencha’s co-worker, Janet, helped him find an attorney so that his rights are protected.  Dr. Plenty had Mr. DiMencha sign a release to talk with the attorney as well as Janet.  From a phone call with the attorney, Workers Compensation wants to work out a settlement. However, the attorney has little awareness about how impaired Mr. DiMencha is.  The patient has never met the attorney face-to-face, just by email and phone contacts.
Because there is no one else to provide the case management services, Dr. Plenty has been doing most of the case management work. Prior to providing this extra-therapy support, Dr. Plenty had Mr. DiMencha sign a document explaining her fees for the additional services.  She is not sure that he completely understands what is happening or her version of informed consent for the additional services.
Consider: what are the potential ethical issues with this case? What are the competing ethical principles? What problems may occur as a function of Dr. Plenty engaging in a multiple relationship role in Mr. DiMencha’s care? What suggestions would you make to Dr. Plenty?

Caught in a Loop, Stuck in a Rut

Hello there readers,

Here is an article published in The Counselor Connection last winter. Have you ever felt stuck in your profession, doing the same thing every day, wondering how to get back to that passion that once filled your work? Check out the link below to discuss this very thing.

Caught in a Loop, Stuck in a Rut

Do you get Counselor Connection in your inbox? If you don’t you really should! It comes twice a month filled with articles about important topics from leaders in our profession. It fills the gap between issues of Counselor Magazine. Go to their website to subscribe: Subscribe here!

Friday Challenge: A Familiar Face

Hola challengers! Here is this week’s challenge. Consider what you would do and send in your answers. We’ve got lots of articles coming you way this fall discussing previous challenges, and we will include this one, so your answers may be featured!
You have a new client assigned to your caseload, who is interested in individual therapy with you. You assess her needs by gathering information over the next several sessions. She tells you she is currently in a semi-stable relationship with a man named Jack. She is also close with her parents, and it is to her parents that she releases all information. She doesn’t see the need to sign a release for her boyfriend, stating that her parents and boyfriend are close so they can keep him updated with information, and that her parents have known her longer and are better at providing any needed information you may need. Treatment goes along over the next month, and you work at helping her in several areas, including her relationship with Jack. You view Jack as supportive at times, and hurtful at other times, and question whether he is going to be the kind of support your client needs, which is a frequent topic in your sessions.
About a month and a half into your treatment, your client reveals that Jack knows you. You ask for his last name and are alarmed to realize Jack is a previous client of yours, who you treated on and off for three years. Jack did not tell his girlfriend that he was your client, just that he knew you. Now you are in an awkward position. If you tell your current client that Jack was a previous client, you will breech your confidentiality with him. If you do not reveal this information, you are worried you will have a conflict of interest in treating her, and that she will one day realize your previous relationship with Jack and be angry that you did not admit to it. Should you tell her how you know Jack or keep silent and continue treating her?