HermosilloC5102-3

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Ethical Decision Making Clarisa Hermosillo Northcentral University MFT 5102- Legal, Ethical, and Professional Development in Marriage and Family Therapy Dr. Moncrief August 28, 2023

2 Ethical Decision Making Under the order of Child Protective Services, the single mother of four children has been mandated to see clinical services. The family was not pleased with getting treatment. Over the course of seven months the family has been more vulnerable, and open towards the therapist. The family has brought gifts to show their gratitude. The therapist talks to the family’s medicine man. The family has decided to invite the therapist to the son’s ceremony. In the case study provided there’s a single mother that is gifting items to the therapist and wants the therapist to attend her son’s ceremony. This is a violation of the AAMFT code of ethics. Ethical code 3.9 reflects the importance of making the decision to accept the gift (American Association for Marriage and Family Therapy, 2015). Ultimately it is up to the therapist to make the decision. Based on cultural norms, and the potential effects receiving or giving a gift can cause. The second violation is ethical code 1.3 which mentions the therapist must avoid having multiple relationships with clients which could impair professional judgement or increase the risk of abusing power (American Association for Marriage and Family Therapy, 2015). Attending the ceremony could conflict with standard code 3.4 which states therapist create a conflict of interest and will impair clinical judgement (American Association for Marriage and Family Therapy, 2015). A referral can be made if the therapist feels the need to terminate treatment. Additional information can be made to ensure the appropriate procedure to make an ethical decision. Evaluating details such as the purpose of the ceremony, who will attend, and the outcome whether the therapist decide to attend or decline the invitation. Lastly, the third dilemma is the therapist is talking to the medicine man, and this can cause conflict of interest. Explain the process of this model and how you will utilize it.

3 Based on the Kitchener’s model there are ethical principles when evaluating ethical decisions (Urofsky, Engels, Engebretson, 2009). There are seven principles that are used for counselors, agencies, private practice, and other mental health settings. The first step is identifying the problem. The problem can cause emotional distress to the client. The problem can also cause financial, or physical harm. Writing down facts, and any suspicions you may have. If the dilemma contains legal action, make sure to seek professional advice (Counseling Education, 2015-2021). The second step is applying the code of ethics. Refer to the marriage and family therapy ethical guidelines which are located on the AAMFT website. The third principle is to determine the different aspects of the dilemma. Analyzing all parts of the dilemma will help conclude the best choice. This may include multicultural perspective, and other additional stimuli that can affect the dilemma. Looking at the dilemma based on the ethical decision model. Using the five foundational principles autonomy, beneficence, nonmaleficence, justice, and fidelity. Determining which foundational principles apply to the dilemma can help determine the decision. The first one is autonomy which refers to the freedom, and action. There are two things to consider when encouraging clients to be autonomous. They can help the client see how their actions have outcomes, and how it affects people around them. The next approach is to help the client make rational decisions. Clients who are young of age or do not have the mental stability to make choices will not have the opportunity to make decisions that can harm themselves. The case explains a single mother being obligated to seek mental health services. The second principle is justice which relates to treating people fairly, and equal. The next one is beneficence, and it relates to promoting well-being, and prevent any harm from happening. This can be seen in many ways, but the goal is to be proactive, and have early

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4 intervention (Corey, Corey, Corey, 2019, p. 21). The family would benefit from outside resources. Getting appropriate healthcare, and basic needs such as food, and shelter. The fourth principle is nonmaleficence which is the idea of not causing harm to others. The principle is based on the idea the client cannot cause intentional harm and not act on harming others. The members in the family have not shown signs of causing harm to themselves, or others. Based on observations, and analyzing the family dynamic it is safe to conclude the family is not at risk. Lastly fidelity, which involves loyalty faithfulness, and keeping promises. The therapeutic relationship is important, and one of the foundational skills to build in session. Violating trust in therapeutic relationship will be difficult to restore. This family has struggled to build trust and be open to therapeutic alliance. Declining the invitation to the ceremony will be upsetting for them and might cause resentment. The fourth step in the decision-making model is creating potential series of action. This will help create some options, and a visual of what each option might have. The fifth step is to consider the consequences of each option. Some consequences might be more severe and cause significant damage. The sixth step allows for an evaluation of the outcome. Looking at all aspects such as justice, publicity, and universality. These topics look at other ideas and can affect the outcome of the dilemma. Explain the process and how you will utilize it Identify the problem The Mother demonstrates her gratitude by giving gifts.. As part of her culture, she shares her gratitude by gift giving (Martin, Yurkovich, 2013). Over the course of the seven sessions the mother has open significantly. She feels comfortable enough to invite the therapist to a

5 ceremony. The therapist is also talking to the medicine man, and talks to them outside of treatment. Apply the code of ethics Ethical cod 3.9 marriage and family therapist will have to meet cultural norms when thinking about receiving a gift (American Association for Marriage and Family Therapy, 2015). The therapist must also consider the effects of receiving a gift will cause. This can ultimately affect the therapeutic relationship. Based on this ethical code I would no longer receive gifts. By accepting the gift this has open a relationship and has been misunderstood. Being invited to a ceremony as an outside activity can be a violation of privacy, and boundaries. Ethical 1.3 therapist avoid forming multiple relationships with clients that can impair professional judgment and can increase the risk of inequality (American Association for Marriage and Family Therapy, 2015). This can reflect the outside relationships, and how they can affect the therapeutic alliance. Talking to the medicine man can be seen as insignificant and does not correlate to the session. Unfortunately developing relationships that can be interconnected can have negative affects during treatment. Ethical guideline 3.4 mentions therapist does not have to provide treatment which can form a conflict of interest and can also decrease work performance or clinical judgment (American Association for Marriage and Family Therapy, 2015). The relationship between the therapist and the medicine man can cause impairment. The medicine has a friendship with the family, and this can cause problem. Having relationships within a community you are putting at risk the integrity of treatment and compromising boundaries.

6 Determine all aspects of the dilemma Beneficence plays a role in this case study. The mother has demonstrated having challenges with finances and having access to everyday items. Our responsibility is to ensure the well-being of our clients. The dilemma with gift giving has caused concern with the other areas of her life. The family has not demonstrated any signs of disrespect. There has been a boundary crossed when gifting, and the therapist accepting the gift. This has changed the dynamic of the therapeutic relationship. Opening the door to a relationship outside of treatment can be challenging and cause future problems. Fidelity also contributes to this case study. The family has shown signs of growth and trust. It has taken them a long time to trust the therapist and will continue to find things to hold back. Based on observations it’s important to maintain the relationship, and for the family to feel they can count on the therapist. The mother has given gifts and has been more open about coming to therapy. Although this is a nice gesture it’s against ethical code 3.9 which states that a therapist must decide to accept or decline a gift (American Association for Marriage and Family Therapy, 2015). In this case study the therapist accepted the gift. A few sessions have been completed and the therapist got invited to a ceremony. It is unclear whether the ceremony will be held in public or private, and how important this ceremony will be. Based on cultural knowledge Native Americans have ceremonies for the rite of passage (Martin, Yurkovich, 2013). In certain cultures, this can mean they are entering adulthood. It can also be seen as a new chapter in their life. Potential courses of action

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7 Attending the ceremony will make the family feel supported and continue to grow trust. By declining the invitation, the family will be upset, and hold resentment. Talking to people withing the community can cause conflict, and mixed feelings. Since there are friendships with people the family knows it makes it seem that I’m being biased or intentionally hurting their feelings. Consequences Attending the ceremony will cause the therapeutic relationship to grow, and the family will feel inclined to trust, and be open with me. With being trustworthy of the therapeutic relationship the family will be vulnerable to share their personal thoughts, and feelings. In addition, the family will gain a since of friendship, and continue to invite me to ceremonies. This will develop a relationship outside of treatment and cause a conflict of interest. If this continues the family will have to be referred to a different mental health specialist. Declining the ceremony will cause resentment, and a lack of commitment to the therapeutic relationship. The family will believe the therapist lacks integrity and decrease in commitment. By not attending the ceremony the family might terminate session and feel they can’t trust the treatment process. Evaluate course of action The best option for the family is to decline the ceremony. Treating the family with respect and explaining my intentions behind my decision. Discussing the potential effects of treatment, and how this can be a conflict of interest for future sessions. Attending the ceremony and opening a possibility to a friendship will result in a clinical referral. I would probably say something along these lines, “Thank you for inviting me to your son’s ceremony. I would like to attend the ceremony, but unfortunately under the ethical boundaries and procedures I cannot

8 meet outside of the session. It will be a conflict of interest, and I might have to refer you to a different therapist.” I do believe this decision is fair and will cause minimal to no public attraction. Talking about this course of action and recommending it to colleagues is a possibility. The decision follows ethical guidelines, and overall has the well-being of the client in mind. Final thoughts Attending the ceremony will cause increase the trust, and responsibility on the therapist. It will benefit the client and increase the trust in treatment. Although it will benefit the client it will also affect the relationship. Native Americans prioritize connection and loyalty since they live in a collectivistic culture (Martin, Yurkovich, 2013). Overall attending the ceremony would have resulted in a personal relationship and required further boundaries to be broken. This will cause distress in the therapeutic relationship, and cause challenges in treatment. Setting boundaries is essential when it comes to ethical guidelines. It develops structure, and consistency. Sharing personal information, and providing feedback is part of the therapeutic process. Doing this with caution, and being able to identify personal information, and professional knowledge. When boundaries diverge there’s a violation in the treatment process. As mentioned by Kitchener forming small decisions will result into bigger problems (Urofsky, Engels, Engebretson, 2009). Promoting self-care and establishing these boundaries early in the therapeutic process will prevent from roles diverging (Russell, Peterson, 1998). Boundaries are formed to protect the integrity of treatment. Some of these boundaries include not forming relationships outside of treatment. Not participating in activities that can cause a conflict of interest. The information being shared cannot conflict with personal life. The decision made for this case study was keeping the client relationship in mind. I do believe there are other options, but will disrupt the relationship, and the progress that has been

9 made. For further clients declining gifts and keeping boundaries secure will decrease the chances of being invited to an activity outside of treatment.

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10 References American Association for Marriage and Family Therapy. (2015). AAMFT code of ethics. Retrieved from http://www.aamft.org/resources/lrm_plan/ethics/ethicscode2001.asp. Corey, G., Corey, M. S., & Corey, C. (2019). Issues and ethics in the helping professions. Cengage Learning Inc. Counseling Education. (2015-2021). Ethical decision making models American Counseling Association. Martin, D., & Yurkovich, E. (2013). “close-knit” defines a healthy Native American Indian family. Journal of Family Nursing, 20(1), 51–72. Russell, C. S., & Peterson, C. M. (1998). The Management of Personal and Professional Boundaries in Marriage and Family Therapy Training Programs . Contemporary Family Therapy, 20(4), 457–470. https://doi.org/10.1023/a:1021676015676 Urofsky, R. I., Engels, D. W., & Engebretson, K. (2009). Kitchener’s principle ethics: Implications for counseling practice and research. Counseling and Values, 53(1), 67–78. https://doi.org/10.1002/j.2161-007x.2009.tb00114.x

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