Ethical Dilemma

Based on the Decision Making Model:

1. Identify the Problem:

See Ethical Dilemma Handout

2. Potential Issues Involved:

* Maria is a minor

* No signed Informed Consent

* Dual Relationship/ Neighbor

* Rape

* Underage Drinking

* Possible Pregnancy and/or STD

* Self mutilation

* Rural community, cultural differences

* Maria (client) asks not to inform parent/ legal guardian for fear of his reaction.

* Father approaches therapist in an unprofessional setting and wants to information regarding his daughter.

* Maria goes to school with the rapist.

3. Review Basic Ethical Guidelines/ Laws

a. A.2.a. Informed Consent; A.2.b. Types of Information Needed; A.2.d. Inability of Give Consent: First and foremost, the therapist needs to explain the purpose of counseling and the counseling relationship to Maria in a way that ensures that she understands purposes, goals, techniques, procedures, limitations, potential risks, and benefits of services. Also, Maria needs to understand the role her father will play in the counseling procedure as her legal guardian.

b. A.2.c. Developmental and Cultural Sensitivity: The therapist needs to communicate with Maria in a developmentally appropriate way. The therapist also needs to make sure that she is sensitive to the cultural differences that may present themselves such as the differences between rural and urban communities.

c. A.4.d Avoiding Harm: The therapist needs to sure that her actions are not inflicting any kind of harm on Maria or any individual involved.

d. A.4.b. Personal Values: The therapist needs to be aware of her own personal values, and make sure not to impose personal values in the context of the therapeutic relationship. For instance, the therapist needs to understand her views on abortion and how these views may affect the manner in which she counsels Maria.

e. A.5.c. Nonprofessional Interactions or Relationships (Other than Sexual or Romantic Interactions or Relationships); A.5.d. Potentially Beneficial Interactions: The therapist and the client are neighbors. The therapist needs to be clear with both Maria and her father about appropriate interactions within the neighborhood. The therapist also needs to document the discussions about the nature of their living situation.

f. A.11.a Abandonment Prohibited; A.11.b. Inability to Assist Clients; A.11.c. Appropriate Termination; A.11.d. Appropriate Transfer of Services: If the therapist decides not to counsel Maria based on any circumstances, it is imperative that she make appropriate arrangements with Maria and her father for further treatment.

g. B.1.a. Multicultural/ Diversity Considerations; B.1.c Respect for Privacy; B.1.c. Respect for Confidentiality; B.1.d. Explanations of Limitations: The therapist needs to be aware of certain cultural differences that may be present between Maria's family and her own in terms of confidentiality. The therapist may be used to more of an assumed autonomy for minors in her previous urban setting as opposed to Maria's rural setting. On the most basic level, the therapist needs to be respectful of Maria's privacy and confidentiality. However, the therapist needs to be clear with Maria about the limitations of her confidentiality.

h. B.2.a. Danger and Legal Requirements; B.2.b. Contagious, Life Threatening Diseases; B.2.d. Minimal Disclosure: The therapist needs to explain to Maria that any information given during a session that indicates serious harm or foreseeable danger for Maria or anyone else cannot be kept confidential. The therapist can explain that the reason for this is protection. Maria also needs to know that the therapist may need to consult with other professionals in order to provide the best treatment. In addition, the fact that Maria stated that she may have contracted an STD created an ethical dilemma for the therapist in that the therapist is ethically bound to inform any third party at risk for contracting the disease. It is important for the therapist to keep Maria as informed and involved as possible during any disclosure of private information. Lastly, the therapist should only disclose the necessary information.

i. B.3.c. Information Shared with Others, Confidential Settings; B.8.a Consultation, Agreements; B.8.b. Respect for Privacy; B.8.c. Disclosure of Confidential Information: The therapist should make certain that any discussion with other professionals about Maria should take place in a confidential setting in order to ensure Maria's privacy, and that any individual involved in discussion is qualified and clear on the implications of their involvement.

j. B.4.b. Couples and Family Counseling; B.5.a. Responsibility to Clients; B.5.b. Responsibility to Parents and Legal Guardians; B.5.c. Release of Confidential Information: It is important that the therapist makes it clear to Maria and her father who the primary