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Brunner 1 Rachel Brunner March 3, 2024 Communication Ethics COM 3513 Dr. Thomas Parham

Brunner 2 Case Study Paper When choosing a career, one must consider potential ethical dilemmas that may arise within any particular career field of pursuit. Careers that work closely with others in intimate areas of their lives, such as psychologists working with clients, may be more prone to ethical dilemmas that need thorough and thoughtful consideration, discussion, and understanding to work properly and professionally with clients seeking guidance. I am pursuing a career in psychology with an emphasis on marital and family counseling. Within the practice of psychology, ethical dilemmas may arise in numerous forms, such as confidentiality and duty to warn, and dual relationships; however, there are proper and professional ways to deal with these ethical dilemmas when working with clients. One potential ethical dilemma that may arise within the practice of psychology is a psychologist maintaining the confidentiality of the client and a duty to warn. When a psychologist receives information about a client, whether from the client directly or from another source, that the client has intentions of harming others or themselves, an ethical dilemma arises, calling for the psychologist to properly and professionally balance duty to warn and keep the confidentiality of the client. A real-world example of the ethical dilemma of confidentiality and duty to warn in the practice of psychology appears in the case of Tarasoff v. Regents of the University of California. In the Tarasoff case, a student discloses his intentions of killing another person to his psychologist, who happened to work for the university. The psychologist correctly warned the police, enacting his professional duty to warn, and breached the confidentiality of the client since the threat of danger to another person outweighed keeping the client’s intentions of killing another confidential. Despite the psychologist’s request to have the student arrested, the student was released after he appeared rational during his encounter with the

Brunner 3 police. Not more than two months later, the psychologist’s client, a student at the university, carried out the act of violence. Author Laves’ Journal of Forensic Psychology , states, “THE COURT RULES THAT PSYCHOTHERAPISTS ARE LIABLE FOR DAMAGES IF THEY FAIL TO WARN A THIRD PARTY OF A THREAT BY THEIR PATIENT, AND THE PATIENT CARRIES OUT THE THREAT” (Laves). To address the Tarasoff v. Regents of the University of California case differently and reach an ethical, defensible solution, several additional steps within the duty to warn could have been taken. For example, rather than relying solely on the concept of “duty to warn,” which was fundamental to the Tarasoff case, the importance to protect should have been discussed to a deeper level to help keep the victim safe. As a result, the potential harm caused to others could be assessed far more broadly than just a simple warning would allow. Also, by simply using risk assessment protocols could better help to identify a patient’s risk of harming others, leading to better assess the patients risks as seen in Ewing v. Goldstein case. In the Ewing v. Goldstein case, the patient confided in his father, and discussed with him his intent to harm himself and his former girlfriend’s new boyfriend. However, the father rightfully discussed with the therapist the conversation between him and his son. The psychologist suggested for the patient to become hospitalized in order to receive help. Even though the right steps were taken the psychiatrist discharged the patient due to the fact, they felt like the boy was legally sane. Once the patient was discharged, the patient killed the boyfriend and committed suicide. The therapist had never talked with the patient regarding his intent to harm other people, but rather acted on the information he received from the father of his son’s intentions to commit harm. The father later sued the therapist for not following the law of duty to warn. The therapist argued, “ he could not be liable for failing to alert the police and the

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Brunner 4 intended victim to danger posed by his patient because the patient had never directly disclosed to him a threat” (Ewing v. Goldstein). The Ewing v. Goldstein case was dismissed from court since the patient had never communicated with the therapist and therefore the psychologist was not held accountable. Later, on appeal, the court changed their mind and reversed the trial court’s decision stating, “that the trial court too narrowly construed the duty to warn statute and further stating that a communication from a family member to a therapist made for the purpose of advancing a patient’s therapy, is a “patient communication” within the meaning of the statute” (Ewing v. Goldstein). During the appeal, the court discussed that they did not see a difference between the threats expressed by the patient versus immediate family members of the patient. However, it was questioned how the psychologist did not even notice the mental health issues going on with the patient. There are several cases where psychologists learn of their client’s threats to harm others simply from the client’s family. An article written by Jackson states, “Although these providers may not witness or hear the threat directly, they often have the authority and responsibility to act upon these types of threats. Notably, these situations are also ripe for violations of client privacy if not handled properly” (Jackson) . There is no doubt that keeping the ethical dilemma of duty to warn and confidentiality in check is the right choice, as it will help avoid future victims from harm, and help clients to thrive, but as Aristotle discusses further steps may need to be taken when making ethical decisions which requires cultivating virtues to make good decisions. From Aristotle’s perspective, ethical decision making involves cultivating virtues. In the dilemma of duty to warn versus confidentiality facing mental health professionals, Aristotle might argue the issue by considering how to develop practical wisdom regarding this dilemma ( Kraut ). In the Tarasoff v. Regents of the University of California case, Aristotle might argue

Brunner 5 that the psychologist needs to determine if breaking the clients trust and confidentiality is the best decision if they are potentially not respecting the privacy of the client, while also highlighting the importance of protecting the client from doing harm to themselves or others. Making this discission to break a client’s trust could potentially lead to several consequences. Author Kraut states, “The principal idea with which Aristotle begins is that there are differences of opinion about what is best for human beings, and that to profit from ethical inquiry we must resolve this disagreement. He insists that ethics is not a theoretical discipline: we are asking what the good for human beings is not simply because we want to have knowledge, but because we will be better able to achieve our good if we develop a fuller understanding of what it is to flourish” (Kraut). Aristotle would try to find a resolution on the balance duty to warn and keeping the confidentiality of the client by using the Golden Mean. The “Golden mean, in philosophy, an approach to ethics that emphasizes finding the appropriate medium, or middle ground, between extremes” (Eldridge) . Aristotle would argue psychologist should try to find a healthy balance between exposing the client and trying to respect their privacy, while also being careful to watch for potential signs of harm and waiting for the need to warn. When comparing Aristotle’s thoughts on this ethical dilemma to Hegel , a German philosopher, there are several new insights to consider regarding the duty to warn. A lthough Hegel does not explicitly discussed duty to warn, there are several concepts that can be applied, such as emphasizing the importance for individuals to act ethically and have mutual respect for one another. Hegel suggests that psychologists are obligated to protect their client and their well-being, even if that means breaking confidentiality. Hegel would suggest for psychologists to weigh the potential consequences if they disclose information of the client rather than maintaining confidentiality. Author M. Blake Wilson states, “Respect is the first

Brunner 6 “commandment” of Hegelian property” ( Wilson ). This applies to the ethical dilemma of duty to warn because some psychologists consider to protect their client’s confidentiality and respect them, they should not tell anyone. In the article Confidentiality and Duty to Warn it states, “In this case, how long the therapist has been working with the patient and how well she knows him legitimately may affect her judgement of whether there is a serious threat” (Confidentiality and Duty to Warn). The problem with this ethical dilemma is when trying to maintain confidentiality of your client while also looking for indications of any potential threat of violence to the client or others. “Informed consent is built from the biomedical ethical principle of autonomy, which emphasizes the importance of respect for persons” (Darby ) . As a result of this, it is possible for us to protect others from being adversely affected by the situation. A psychologist might handle this ethical dilemma simply by asking themself these questions, “will lack of this specific patient information put another person or group you can identify at high risk of serious harm?” (Confidentiality and Duty to Warn). Psychologists are credible to report any threats due to the state law in fulfilling the duty to warn. It is vital for psychologist to warn the victim that they could potentially be at risk of harm. Another necessity is to warn the relatives and report immediately to law enforcement what is going on with your client if they are signs of potential threat that would enact a duty to warn. Also, there are several ways to protect potential victims, such as hospitalizing the client (Jackson). A psychologist could and should continue to counsel the client and encourage the client to understand the consequences of causing harm and direct them away from that harm, suggest hospitalization, while also warning others, such as family members, potential victims, and law enforcement, all while weighing the client’s confidentiality.

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Brunner 7 By warning others of a client’s potential violent behavior, a psychologist is upholding ethical standards and ensuring public safety, while also properly and professionally navigating the difficulties of human behavior effectively. When a psychologist realizes someone may be a threat and harmful to others, the duty to warn, is not only the right thing to do, but is also required by law . For each dilemma there are several ways to address and reach an ethical, defensible solutions. There should be a clear understanding between the client and the psychologists regarding confidentiality limits and when information may have to be shared. Another example would be, is vital for psychologists to conduct thorough assessments and evaluations of their clients so that they can identify any potential risks or harmful behaviors that might exist within them. Psychologists are legally liable for breaking this law, and not protecting potential victims from their patients. The American Psychological Association in their code of conduct states, “ Psychologists have a primary obligation and take reasonable precautions to protect confidential information obtained through or stored in any medium, recognizing that the extent and limits of confidentiality may be regulated by law or established by institutional rules or professional or scientific relationship” (Behnke ). There is a great deal of potential for psychological services to provide victims with better protection if psychologists understand the risks of failing to adhere to the ethical principles of duty to warn when working with them. In many cases, the law stipulates that these procedures must be followed in order to protect third parties from harm when a patient has publicly expressed a threat or confidentially disclosed information regarding violence. Along with the ethical dilemma of confidentiality and duty to warn, psychologists also have the potential ethical dilemma of dual relationships. Dual relationships are another example of a potential ethical dilemma a psychologist may face during their career. Dual relationships are when there are multiple roles between a therapist

Brunner 8 and their client (Sutherland). A real-world example of dual relationships is discussed in Steph Auteri’s article, “Should Dual Relationships Always Be Off-Limits?” stating, “Based on what Dr. Zur had been taught from the very beginning of his days as a mental health professional, he informed the couple he was not the right man for the job because of his preexisting personal relationship with them” (Auteri). Dr. Zur is a licensed psychologist who moved to a small community in California. Dr Zur, “preaches a more open-minded, less restrictive view of dual relationships, claiming that “the context within which multiple relationships take place is, without a doubt, one of the most important factors in determining their appropriateness. In fact, he believes that in certain instances a purposeful dual relationship can prove helpful to a client's progress” (Auteri). He opened a private practice and established himself among his community while being placed in a difficult situation since he often socialized with the couple, he was counseling. The couple was struggling with their marriage and came to him as a mental health professional to help their relationship. This created a big dilemma for him since he did not want to break any laws regarding dual relationships with his clients. Doctors often struggled with the fact that they wanted to help benefit their client, but also did not want to break ethical guidelines. The couple came to Dr. Zur because they had a pre-existing bond with him and trusted his opinion. Dr. Zur questioned, “ But how is one to find the line between an unethical and ethical dual relationship?” (Auteri). The issue of the relationships are almost unavoidable in small communities. Due to the fact that psychologists and their clients will cross paths at multiple different times. Dr. Zur made several arguments in order to defend his perspective such as, “ He also feels it’s possible for the avoidance of all dual relationships to only exacerbate the power dynamic within the therapist/client relationship, which can easily lead to exploitation” (Auteri). Ultimately, the professional decision of the psychologist, based on the ethical dilemma of a dual

Brunner 9 relationship, left a couple upset because he did not want to interfere with the already existing relationship. Even though Zur was trying to respect his clients by following the ethical code for psychologists, he asked himself, “Were there instances in which entering into a dual relationship might benefit a client?” (Auteri). In order to take a deeper look at different approaches that could have been taken during this difficult ethical dilemma we can look at another study done at a small college counseling center in Michigan. A study was done of dual relationships in a small college counseling center at Western Michigan University in 1991. The purpose of the study was to discuss dual relationships and find out whether they should be considered acceptable. Darling Terry states, “psychologists consider dual relationships to be among the most difficult ethical issues that they face” (Darling). Also, how frequently do counselors engage dual relationships with clients simply based on being in a small college setting. Author Darling Terry discusses how clients sometimes feel intimidating giving information to there, psychologists if they feel as though they are speaking to a teacher or supervisor. They want to be able to approach them as if they are their friend and can talk to them about anything. This becomes a problem because it is difficult to develop that bond without breaking the code for dual relationships. Another question that arises is whether this sort of guideline to avoid dual relationships placed on psychologists should become outdated? (Auteri). Dual relationships have the potential to cause an ethical dilemma due to the fact they are typically frowned upon in this line of work and can interfere with proper successful treatment of clients. By warning others of this behavior, you are upholding ethical standards and ensuring public safety, and navigating the difficulties of human behavior effectively. However, Aristotle's view on these ethical principles are very different.

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Brunner 10 Aristotle’s perspective stresses the importance of justice in all relationships. Within the context of dual relationships, Aristotle might argue that for a psychologist to prioritize their own interests instead of the well-being of their clients and connecting with them on a deeper level. Aristotle ‘s concept of the golden mean also suggests finding a middle ground between the two extremes like discussed previously, when comparing it to the concept of dual relationships, Aristotle would suggest psychologist should enter these relationships with moderation and avoid being overly involved, but still being able to connect with them on a balanced level. It is sometimes difficult to find the correct balance to maintain appropriate boundaries between psychologist and client. Dual relationships are a widely talked about problem due to the fact that it is difficult to find a happy medium. The article from Aristotle’s Psychology discusses, “ Aristotle assumes something which may strike some of his modern readers as odd. He takes psychology to be the branch of science which investigates the soul and its properties, but he thinks of the soul as a general principle of life, with the result that Aristotle’s psychology studies all living beings, and not merely those he regards as having minds, human beings” ( Shields). Applying Aristotle findings to help navigate finding resolutions can be approached in several different ways. For example, Aristotle discusses how important honesty is when navigating behavior such as dual relationships. This creates the ability to recognize if a person is being biased or simply considering what is actually going on. Another resolution to better help diminishes the possibility of breaking the ethics code for dual relationships would be to set boundaries. When a psychologist sets up clear boundaries from the beginning of the relationship with the client, this will ultimately help the client to understand their rules and expectations by maintaining professionalism. Also, psychologist must consider what the consequences would be if they become involved with their client. There are several laws in place to protect a client from

Brunner 11 becoming involved with psychologist on a deeper level. In order to ensure client safety and confidentiality, these laws and ethical guidelines are intended to protect clients against harm and breaking confidentiality as a result of dual relationships with psychologists that are not appropriate. For psychologists to maintain the confidentiality of the relationship with their client and to ensure that their clients' well-being, it is crucial that they follow and listen to these laws and ethical standards as part of their carrier. There are numerous ethical dilemmas associated with the practice of psychology that can arise in a variety of forms, such as confidentiality and duty to warn, as well as dual relationships, however there are proper and professional ways to deal with these dilemmas. Navigating these dilemmas will require a deep understanding of the client and their needs, while also maintaining the integrity and professionalism of the psychologist. In order to effectively handle ethical dilemmas, it is advisable to challenge them with a positive attitude and to anticipate potential ethical dilemmas beforehand. This will better help the ability to connect with your clients and create a positive environment for those seeking help.

Brunner 12 Works Cited American Psychological Association. (2017). Ethical principles of psychologists and code of conduct (2002, amended effective June 1, 2010, and January 1, 2017). Auteri, Steph. “Should Dual Relationships Always Be Off-Limits?” AASECT , Feb. 2014. Behnke S. “Ethics Rounds--Multiple Relationships and APA’s New Ethics Code: Values and Applications.” Monitor on Psychology , American Psychological Association, Jan. 2004. “Confidentiality and Duty to Warn.” University of Santa Clara. Markkula Center for Applied Ethics , 20 May 2022. Darby, William Connor, and Robert Weinstock. “The Limits of Confidentiality: Informed Consent and Psychotherapy.” Focus (American Psychiatric Publishing) vol. 16,4 (2018): 395-401. doi:10.1176/appi.focus.20180020 Darling, Terry W. A Study of Dual Relationships in Small College Counseling , Apr. 1991, scholarworks.wmich.edu/cgi/viewcontent.cgi?article=3015&context=dissertations. Eldridge, Stephen. "Golden mean". Encyclopedia Britannica , 7 Jul. 2023, Accessed 27 February 2024. “Ewing v. Goldstein.” American Psychological Association , American Psychological Association, 1994. Jackson, Erin. “Duty to Warn and Reporting Threats of Harm: What You Need to Know.” Jackson LLP Healthcare Lawyers , 18 July 2022. Kraut, Richard. “Aristotle’s Ethics.” Stanford Encyclopedia of Philosophy , Stanford University, 2 July 2022. Laves R and International Acad of Forensic Psychology Suite 1020 2355 Stemmons Freeway Dallas TX 75207. “Tarasoff vs the Regents of the University of California Et Al - the Mental Health Worker As Expert in the Prediction of Violent Behavior.” Journal of Forensic Psychology 1979 pp. 39–54. Personhood and Property in Hegel’s , philarchive.org/archive/WILPAP-29. Accessed 29 Feb. 2024. Shields, Christopher. “Aristotle’s Psychology.” Stanford Encyclopedia of Philosophy , Stanford University, 12 Oct. 2020,

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Brunner 13 Sutherland, Megan. “The Dilemma of Dual: Dual Relationships in Counselling.” Willow Tree Counselling , 31 July 2018.

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