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[SOLVED] Robert Haines was discharged from the hospital

5.1. Understanding Treatment Challenges

Professional values and biases significantly influence group and family therapy. When engaged in treatment, professionals must be careful to act competently. Counsellors and therapists in the community and private practice settings must wrestle with conflict-of-interest dilemmas. The ethical and legal issues significantly with those who are facing community counsellors. Acting ethically means being an as competent professional, recognizing the well-being of the client as dominant, responsible for exercising power and acting to raise the reputation of the profession.

Review what the codes of ethics have to say about this topic and incorporate this into your discussions:

Robert Haines was discharged from the hospital following treatment for chronic schizophrenia under multidisciplinary team care that included Dr. Bellissimo, a psychologist. A short time later, Mrs. Haines discovered the shotgun in their garage and telephoned Dr. Bellissimo, who then asked Mr. Haines to return to the hospital, which he did. Dr. Bellissimo assessed M. Haines’s risk of suicide as not imminent, and they arranged to accompany him home to take possession of the gun. However, when they arrived, it took more than three hours for Dr. Bellissimo to persuade Mr. Haines to surrender the gun. Later that night, Dr. Bellissimo telephoned Mr. Haines to check on his mental status and deemed him to be “all right.” The next day, Mr. Haines purchased another gun and fatally shot himself. Mrs. Haines sued Dr. Bellissimo for malpractice.

  • What ethical obligations do you think Dr. Bellissimo owed Mr. Haines’s wife in relation to her husband’s suicide?
  • Do you think Mr. Bellissimo should have done anything different to prevent Mr. Haines’s suicide? Explain.

5.2. Counselling Ethics for the 21st Century

The course introduced you to the information and fundamental skills required in your journey and development towards becoming professional helpers. With online counselling, there is a range of ethical issues which must be considered in order to develop the best practices. The formation of your professional identity and practice will be a lifelong process, with new concepts and constructs constantly challenging your values and beliefs.

  • What do you think about online counselling? What specific ethical issues do you think should be raised? How convenient would it be for you to use this form of technology in your counselling practice?
  • Search for articles in the media relating to unethical practices by mental health professionals. Choose one article (cannot be older than 12 months) on a present-day ethical dilemma and discuss how the issue could affect you personally and your future profession as a counsellor.

Final Paper

Description:

When analyzing ethical dilemma(s) in the ethical course, you do not focus on any specific clinical treatment and intervention options (i.e., evaluate the effectiveness of treatment interventions), but only on the ethical justification behind the hypothetical counsellor’s actions/decisions.

The following is a fictitious case that illustrates the ethical issue(s) in counsellingYou (as a counsellor) will use an ethical decision-making model to help in reasoning out your response to the ethical dilemma contained in the scenario.

Be sure to make reference to relevant ethical codes and standards and fundamental moral principles in your response.

Instructions

Consider the following scenario:

Andy Johnson, age 30, is in counselling therapy with you for problems related to lack of productivity at work. Johnson also has a history of voyeurism but initially claims to have not engaged in the practice in about five years. During the treatment, Johnson hesitantly reveals to you that he has been reexperiencing urges to engage in voyeurism and has purchased high power binoculars so that he can gaze into his neighbour’s windows. In fact, he relates that he has also taken pictures of his neighbour undressing and is now contemplating taking videos of her. Since you are not a specialist in treating paraphilia, you inform Johnson that you will need to refer him to another therapist. Johnson tells you that he will never reveal to another therapist what he revealed to you and pleads with you to continue to counsel him regardless of your lack of expertise in this area.

Define ethical dilemma(s), where you, as a counsellor, have to resolve based on the presented ethical decision-making model.

Final Paper Outline:

This model is a principle-based decision-making model that incorporates the use of emotional decision-making. For your information, this model below is outlined in the Code of Ethics (pg. 3) and on pages 16 to 18 of the casebook. (with the description in Appendix A, on page 539).

Step One: 

—    What are the key ethical issues in this situation?

Counsellors determine the type of problem or ethical dilemma. They then collect information about the problem, identify primary concerns/conflicts, and consider potential responsibilities.

In the casebook, authors have suggested that the students describe parameters, define potential issues, or determine the type of ethical dilemma.

Step Two: 

—    What ethical articles from the CCPA Code of Ethics are relevant to this situation?

—    Are there policies, case law, statutes, regulations, bylaws or other related articles that are relevant to this situation?

Provide related articles from CCPA (Code of Ethics) in relation to the presented case scenario.

Review the CCPA Code of Ethics to see if ethical articles (e.g., confidentiality or record keeping) are appropriate for your particular situation. For this step, focus on using the Standards of Practice.

Step Three: 

—    Which of the six ethical principles are of major importance in this situation?

This step also involves securing additional information and examining the probable outcomes of various courses of action. Examine moral and ethical principles that are relevant and important to the situation. These principles are:

a) autonomy – allowing clients the freedom to make informed decisions and to plan their own action

b) nonmaleficence – doing no harm

c) beneficence – doing good

d) justice – acting fairly

e) fidelity – upholding the clients trust

Step Four: 

—    How can the relevant ethical articles be applied in this circumstance?

—    How might any conflict between ethical principles be resolved?

—    What are the potential risks and benefits of this application and resolution?

Choose the most important principles and relevant ethical articles and start implementing some possible actions by:

a) Generating alternatives and examining the risks and benefits of each,

b) Securing additional information, and

c) Examining probable results of various courses of action.

Step Five:

—    What do my feelings and intuitions tell me to do in this situation? (See also Virtue-Based Ethical Decision-Making.)

Up to this point, decision making was mainly cognitive and rational. In this step, the task is to use emotional decision-making techniques. At this stage, counsellors can add some elements of virtue ethics, especially considering all the options below that can best help and show respect for the client. Consider the emotional response to the dilemma and answer these questions:

1. What emotions and intuition am I aware of as I consider this ethical dilemma, and what are they telling me to do?

2. How can my values best show caring for the client in this situation?

3. How will my decision affect other relevant individuals in this ethical dilemma?

4. What decision would I feel best about publicizing?

5. What decision would best define who I am as a person?

Step Six: 

—    What plan of action will be most helpful in this situation?

—    Follow up to evaluate the appropriateness, adequacy, and effectiveness of the course of action taken. Identify any adjustments necessary to optimize the outcome.

Counsellors should consider the breadth and depth of possibilities. What are all the different ways that the situation might be handled? How feasible is each possibility?

Identify and follow the specific action plan, evaluate it, and provide the rational how to adjust any negative or neutral consequences that may occur as a result of your actions.

Alberta residents may apply the values and principles that are required by the College of Alberta Psychologists (Canadian Code of Ethics for Psychologists), while international students may follow the guidelines that are in place in their respective country of residence.

Important: Use the six steps as headings in the assignment

Specific Requirements

Maximum Length: 5-7 pages, double-spaced (excluding the cover page, appendix, and the reference list), written in a word document and in essay format.

All written assignments should have a cover page (including the title of the assignment, your name, the name of the course, and the date of submission) and be double-spaced throughout (without leaving an extra-space between paragraphs or reference).

This program uses 7th edition APA style. This is a guide for all professional communication. At the same time, please know that we have program expectations for assignments. These expectations include: 12pt text size, Times New Roman font and no running head. The reference list should only include sources that were used for in-text citations in the paper itself.

No abstract, introduction or conclusion sections will be needed for the assignment.  Do not type the case scenario into your assignment.

Reminder: As a graduate-level course, student work should be based on critical thinking, not merely on summarizing or paraphrasing material. Follow APA guidelines (current edition) for general writing styles. The project will be evaluated concerning organization, clarity, and thoroughness of presentation, and justification of evaluation criteria.

Important Notes

· Please review the  instructions for uploading assignment files through Turnitin .

· The system will not allow you to resubmit after the due date. In the event of an emergency situation preventing you from submitting within this time frame, special permission must be obtained from your professor. Documentation substantiating emergency is required. In such a circumstance, if the extension is granted, the professor will reopen the submission function for you on an individual basis.  Please do not email your submissions to your professor, either before or after the due date.

· Please review the  instructions for reviewing your feedback in a Turnitin assignment .

Evaluation

The following rubric indicates those areas you should be focusing on in preparing your assignment, and how the professor will weigh these components relative to one another.


     Assessment Criteria
% of Assignment Grade
1. Presentation, Originality, Relevance, Insight (10%)

Originality, the relevance of references; insightful; clear and accurate citations and/or references; logical profession of ideas.

/10
2. Mastery of Material/ Comprehensiveness (70%)

(10) Theory: Student demonstrates knowledge of different ethical theories and codes

(15) Recognition: Student can recognize decisions requiring ethical judgments

(25) Logic: Student demonstrates knowledge of the logic of ethical reasoning

(20) Judgment: Student can make and support plausible ethical decisions

/70
3. Writing Quality (20%)

Written in a clear, intelligent, and professional manner; avoid colloquialisms and texting-style shorthand – professional grammar, spelling, and style is expected; succinct; APA style

Required Readings

Textbooks

Martin, L., Shepard, B., & Lehr, R. (Eds.). (2015). Canadian counselling and psychotherapyexperience: Ethics-basedissues and cases. Ottawa, ON: Canadian Counselling and Psychotherapy Association.

    • Chapter 11
    • Chapter 12
    • Chapter 14
    • Chapter 15
    • Appendix B
    • Appendix D

Canadian Counselling and Psychotherapy Association. (2020). Code of ethics. Retrieved from https://www.ccpa-accp.ca/wp-content/uploads/2020/05/CCPA-2020-Code-of-Ethics-E-Book-EN.pdf

    • H. Use of Electronic and Other Technologies

Canadian Counselling and Psychotherapy Association. (2015). Standards of practice (5th ed.). Retrieved from http://www.ccpa-accp.ca/wp-content/uploads/2015/07/StandardsOfPractice_en_June2015.pdf

    • G. Guidelines for Dealing with Subpoenas and Court Orders
    • H. Guidelines for the Conduct of Custody Evaluations

Canadian Psychological Association. (2017). Code of ethics. Retrieved from https://www.cpa.ca/docs/File/Ethics/CPA_Code_2017_4thEd.pdf

    • Principle IV: Responsibility to Society

For residents of the province of Alberta:

College of Alberta Psychologists. (2019). Standards of practice. Retrieved from: https://www.cap.ab.ca/Portals/0/pdfs/StandardsOfPractice.pdf

Articles & Online Content: use this link to access a list of readings

Ethical Considerations for Tele-Mental Health: https://spark.adobe.com/page/DCyKEy19UBlN0/

Ethical Considerations for Psychologists in the Time of COVID-19: https://content.apa.org/fulltext/2020-35285-001.html

Unit Notes:

Olszewski, J. (2020). Ethical Standards for Mental Health Service Providers [Lecture notes]. Retrieved from: from https://courses.yorkvilleu.ca/

ANSWERS

5.1 Understanding Treatment Challenges

Dr. Bellissimo owed Mrs. Haines two ethical obligations. The first obligation is beneficence (Canadian Counselling and Psychotherapy Association, 2020). The Dr. committed to promote the wellbeing of Mr. Haines. However, he failed to protect his patient from harming himself, which caused the client’s death. After being told that a short-gun was in the client’s garage, the doctor should have noted that the patient has high chances of harming himself. Therefore, he should have ordered the client to be taken to a mental health facility to be monitored and prevented from harming himself. Dr. Bellissimo made his call to let the patient say at home and thus is obligated to be accountable for his decisions and treatment outcomes.

Correll & Schooler (2020) argue that chronic schizophrenia can prompt a patient to harm themselves due to the hallucinations and delusions symptoms. Hence, when one is diagnosed with the condition, the individual should be monitored closely to prevent them from harming themselves or others. After taking a long time to surrender the gun he owned, Dr. Bellissimo should have ordered that Mr. Haines be taken to a mental facility for proper monitoring and treatment. While in the mental facility, Mr. Haines would have been monitored and prevented from killing himself.

References

Canadian Counselling and Psychotherapy Association. (2020). Code of ethics. Retrieved from https://www.ccpa-accp.ca/wp-content/uploads/2020/05/CCPA-2020-Code-of-Ethics-E-Book-EN.pdf

Correll, C. U., & Schooler, N. R. (2020). Negative Symptoms in Schizophrenia: A Review and Clinical Guide for Recognition, Assessment, and Treatment. Neuropsychiatric disease and treatment, 16, 519–534. https://doi.org/10.2147/NDT.S225643

5.2 Counselling Ethics for the 21st Century

I think that online counseling is significant and has improved general counseling practice. One of the reasons why I think that online counseling is important is because it is easily accessible. Online counseling can be done through a smartphone, computers by logging into a secure app, such as zoom. Online counseling can also reduce geographical distance and improve therapy scheduling flexibility (Chen et al., 2019). Though it is a good type of counseling, some of the ethical issues regarding the practice that should be raised include privacy and confidentiality, communication issues specific to the method, and the therapists’ competence and professionality engaging in the practice. Online counseling is convenient for me because I have the tool necessary to implement the therapy. The article being analyzed in this part is “Patient alleges therapist crossed ethical line by accepting legal power over her health and money” by Bethany Lindsay. The therapist, Susannah-Joy Schulenberg, is a subject of a complaint that her doctorate and two master’s degrees might not be “credible and possibly fraudulent (Lindsay, 2021).” This issue with is therapist could tarnish my reputation and prevent clients from trusting me, a situation that will prevent me from executing my professional duties as a counselor.

References

Chen, J., Lan, Y. C., Chang, Y. W., & Chang, P. Y. (2019). Exploring Doctors’ Willingness to Provide Online Counseling Services: The Roles of Motivations and Costs. International journal of environmental research and public health, 17(1), 110. https://doi.org/10.3390/ijerph17010110

Lindsay, B., 2021. Patient alleges therapist crossed ethical line by accepting legal power over her health and money | CBC News. [online] CBC. Available at: <https://www.cbc.ca/news/canada/british-columbia/patient-alleges-therapist-crossed-ethical-line-by-accepting-legal-power-over-her-health-and-money-1.5674320> [Accessed 1 February 2021].

Final Paper: Expert Answer and Explanation

Solving Ethical Dilemma

Step One

Here, the counselor identifies the issues in the situation. The case of Andy Jonson presents a significant ethical dilemma. In this case, the key issue is that Johnson wants me to handle his problem even if I am not qualified to treat patients with paraphilia. The ethical dilemma is that the patient vows not to tell any other counselor what he has told me if I refer him to another psychologist. If I attend to him, I will be breaking the law, and I do not, I will be preventing the patient from receiving quality care.

Step Two

The code relevant to this situation is the CCPA’s ethical code A (professional responsibilities) sub-code A3 (boundaries of competence). The subcode notes that therapists and counselors should limit their professional practices and services to those that they are educationally competent, have professional experience in, and are allowed by their provincial/territorial and national credentials to handle. The code reports that they can refer the clients to other professionals or seek supervision when the therapy needs surpass their professional competence. Other codes in the CCPA handbook that have explained the ethical code include D1, C3, E4, C4, F1, G2, H4, G14, E6, and F2 (CCPA, 2020). All these codes stress that counselors of psychologists should only handle cases within their professional competency in terms of experience and educational level.

Step Three

This ethical dilemma relates to the ethical principle of autonomy. According to the CCPA (2020), counselors should respect clients’ ability to make decisions concerning their health, how they want to be treated, and by who. The client has warned that he does not want the services of other psychologists except me. It is my responsibility as a counselor to respect the client’s wishes (Fiske et al., 2019). Another ethical principle that is consistent with this case scenario is nonmaleficence. This ethical principle requires counselors or psychologists to not harm their clients knowingly or unknowingly. Therefore, when deciding this ethical dilemma, I should ensure that the patient is not harmed in any way. The last ethical principle beneficence. According to O’Donohue (2020), psychologists should always put their clients’ interests in their mind while conducting their functions and ensure that they do good to them. As a result, in this case, I will ensure that the decision I make will be in the client’s best interest.

Step Four

The following are the possible ethical articles that can be applied in this situation. The first article is ethical code A (professional responsibilities) sub-code A3 (boundaries of competence). This code says that when a counselor is faced with a situation beyond their professional competence, the psychologist can refer the clients to seek supervision. This ethical article conflicts with the principle of autonomy, which needs counselors to respect patients’ decisions regarding their treatment. Therefore, supervision is the only option in the situation. The benefit of this application is that the patient will have the opportunity to work with me but under the supervision of a senior professional with competency in paraphilia. Personally, I will also have an opportunity to experience new knowledge and add it to my professional qualifications. The risk of this application is that the client’s information will be shared with a third party, creating a confidentiality problem.

Confidentiality is an ethical article found in code B (Therapy Responsibilities) subcode B2 (Confidentiality). The conflict between subcode A3 and B2 can be solved using ethical code B subcode B4 (Client’s Rights and Informed Consent) (CCPA, 2020). The client has the right to know the goals, purposes, procedures, techniques, potential risks, limitations, and advantages of the services performed so that they can make a better decision when signing an informed consent form (Sivanadarajah et al., 2017). As a result, before including a supervisor when treating Johnson, I have a professional responsibility to tell him and explain to him the benefits and disadvantages of including a senior professional in the therapy. I am also required to respect the client’s decision because it is his right to decide about the course of action. The benefit is this course of action is that the patient’s privacy and confidentiality can be secured because the supervisor will sign a confidentiality form prohibiting them from sharing the client. The disadvantage of this application is that the client might decline to give his consent. Overall, the ethical codes that should be used o solve the situation include boundaries of competence, client’s rights and informed consent, and confidentiality.

Step Five

The client fears being judged by other people considering that he has voyeurism behavior. The client only trusts me with this information and does not believe that other psychologists can avoid prejudging him. As a counselor, I should protect the client from such ideologies and help him improve his self-esteem. Therefore, I am aware that the client does not like sharing his secret data with many people. To help him, I should share his feeling and emotions. My emotions tell me that I should not refer this client because doing so will prevent him from receiving the help he deserves. Frederiksen et al. (2021) note that counselors should always make decisions basing their judgment on stipulated laws and laws. As a counselor, my values include protecting clients from harm, respecting their dignity and rights, providing just and objective care, and ensuring that my relationships with my clients are based on integrity.

These values will help me in this scenario because they will guide me in making the objective, informed, and integrity-based decision. Hence, the client will get just care regardless of his values and beliefs. My decision may affect the client in that a third party will be involved in the therapy to ensure that I remain professional. Therefore, the client will receive quality and safe care. The decision that I feel is the best is seeking supervision while handling the patient. According to Watkins Jr (2017), supervision can help counselors maintain ethical and professional boundaries, the focus of self-care to avoid “burnout,” develop their knowledge, both practically and professionally, and stay grounded. Supervision can also help counselors gain a fair and objective insight into their skills and performance (Benuto et al., 2019). The decision will reflect me as a professional counselor who knows their boundaries and keen on gaining new knowledge. The decision also reflects me as a counselor of integrity who respects the right of their clients.

Step Six

The plan of action that will help the situation is seeking the services of a competent supervisor in this area and asking them to monitor me and guide me when I am wrong. However, to bring in the supervisor in the therapy, I will have to inform the client and ask for his informed consent. Responsible counselors do not make decisions for their clients; they should respect the patients and allow them to make their choices about their health and wellbeing (Martin et al., 2015). To help the client make an informed decision, I will provide all data pertinent to informed consent. This plan will ensure that the client receives the best care even if his problem is beyond my professional competency. Another course of action is terminating the relationship because the client does not want to be referred to other psychologists (College of Alberta Psychologists, 2019). However, this action is not in the client’s interest, and hence will not be implemented.

The first course of action is the most appropriate because it will allow the client to receive the best care and, at the same time, be assured that his information will remain private and confidential. The plan can be effective because the patient will be included in decision-making. According to Kinnaer et al. (2020), one way to make therapies effective and efficient is by including patients in the decision-making process. When presenting the client will inform consent, I will provide him with the necessary data to improve his decision-making. The plan might fail if the client does not trust the third party. In that regard, I will improve the relationship between the client and the supervisor by scheduling a meeting between them so that they can get to know each other and for the patient to trust the supervisor the same way he trusts me.

References

Benuto, L. T., Singer, J., Newlands, R. T., & Casas, J. B. (2019). Training culturally competent psychologists: Where are we and where do we need to go?. Training and Education in Professional Psychology, 13(1), 56. https://psycnet.apa.org/buy/2018-49543-001

Canadian Counselling and Psychotherapy Association. (2020). Code of ethics. Retrieved from https://www.ccpa-accp.ca/wp-content/uploads/2020/05/CCPA-2020-Code-of-Ethics-E-Book-EN.pdf

College of Alberta Psychologists. (2019). Standards of practice. Retrieved from: https://www.cap.ab.ca/Portals/0/pdfs/StandardsOfPractice.pdf

Fiske, A., Henningsen, P., & Buyx, A. (2019). Your Robot Therapist Will See You Now: Ethical Implications of Embodied Artificial Intelligence in Psychiatry, Psychology, and Psychotherapy. Journal of medical Internet research, 21(5), e13216. https://doi.org/10.2196/13216

Frederiksen, K. S., Nielsen, T. R., Appollonio, I., Andersen, B. B., Riverol, M., Boada, M., … & Waldemar, G. (2021). Biomarker counseling, disclosure of diagnosis and follow‐up in patients with mild cognitive impairment: A European Alzheimer’s disease consortium survey. International Journal of Geriatric Psychiatry, 36(2), 324-333. https://doi.org/10.1002/gps.5427

Kinnaer, L. M., Nelis, M., Van Hecke, A., & Foulon, V. (2020). Patient-centered care coordination, education and counseling of patients treated with oral anticancer drugs: An importance-performance analysis. European Journal of Oncology Nursing, 47, 101765. https://doi.org/10.1016/j.ejon.2020.101765

Martin, L., Shepard, B., & Lehr, R. (Eds.). (2015). Canadian counselling and psychotherapy experience: Ethics-based issues and cases. Ottawa, ON: Canadian Counselling and Psychotherapy Association.

O’Donohue, W. (2020). Criticisms of the Ethical principles for psychologists and code of conduct. Ethics & Behavior, 30(4), 275-293. https://doi.org/10.1080/10508422.2019.1679632

Sivanadarajah, N., El-Daly, I., Mamarelis, G., Sohail, M. Z., & Bates, P. (2017). Informed consent and the readability of the written consent form. Annals of the Royal College of Surgeons of England, 99(8), 645–649. https://doi.org/10.1308/rcsann.2017.0188

Watkins Jr, C. E. (2017). Convergence in psychotherapy supervision: A common factors, common processes, common practices perspective. Journal of Psychotherapy Integration, 27(2), 140. https://psycnet.apa.org/doi/10.1037/int0000040

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