MFT 5222_Week 3_Ethical Dilemma

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SLEEPP Decision-Making for Ethical Dilemmas Capella University MFT5222 Name May 2023

SLEEPP Decision-Making for Ethical Dilemmas Therapists bring their values, goals, morals, and biases to therapy (Miller & Seedall, 2020). It is nearly impossible for anyone to be neutral, even with all the training and experience (Miller & Seedall, 2020). A therapist must consider the ethical principles and the American Association for Marriage and Family Therapy (AAMFT) Code of Ethics that guide our therapeutic practices (Miller & Seedall, 2020). The six ethical principles are autonomy, beneficence, nonmaleficence, veracity, justice, and fidelity (Miller & Seedall, 2020). The ethical principles are preserved in the code of ethics, which is vital to ethical decisions worldwide (Miller & Seedall, 2020). This paper reviews a therapy scenario and analyzes the possible ethical dilemmas using the SLEEPP decision-making model. The Couple in Therapy John and Sally recently started attending marriage and family therapy. John is a divorced, 35-year-old, straight male in a relationship with Sally, who is 23 and bi-sexual. John and Sally are in a dominant-submissive relationship. John is into sexual bondage. Sally, the dominant one in the relationship, says she is not a sadomasochist. John is the submissive one. The couple has signed all the necessary consent forms to begin therapy with Jim. The therapist met with each partner for 10 minutes to ask about BDSM safety. They both felt safe and agreed to physical intimacy actions about BDSM. John also attended an Al-Anon meeting where his therapist was. After the meeting, John asked Jim to meet with him privately. The Therapist Jim has been a marriage and family therapist for ten years. He has worked with hundreds of couples with different issues over the years. Jim has siblings with alcohol addiction issues. He attends Al-Anon meetings, which he has been going to for years.

Jim recently started seeing new clients, John and Sally. Jim discovers this new couple is into BDSM. Although Jim has treated couples with sexual intimacy issues, he is not familiar with BDSM or agrees with this lifestyle. Jim made sure to review the necessary consent forms the couple had filled out prior to starting therapy. During one of the therapy sessions, Jim noticed that John had bruises on his neck. He asked if he could talk to John and Sally separately for 10 minutes to inquire about their safety. Both John and Sally assured Jim that they have consented to physical intimacy actions, and both feel safe. Jim considers John and Sally’s autonomy separately and decides they are both consenting adults. Different sociocultural factors could give a therapist clue about the relationship dynamic. John is about 12 years older than Sally. The age difference could be informative, considering that people are in different stages of their lives during their 20s and 30s. Being in her early 20s, Sara might still be exploring her identity and life in general. John, being divorced, has more life experience and is more established. A therapist would be curious as to why John’s previous marriage ended. Other ideas that a therapist would be curious to know more about are: Why does John have a submissive role in his relationship? Is this vulnerability after divorce? Was there prior abuse? Does he have a low self-image? Is this what he wants, or is it a phase? The Ethical Dilemma There are some ethical concerns for Jim, the therapist, that he should consider before therapy with John and Sally. The first concern is Jim’s knowledge and experience of a BDSM lifestyle. Due to a therapist’s ability to influence their clients and the Commitment to Serve according to the AAMFT (2023) code of ethics, Jim must acknowledge the ethical principles of beneficence, veracity, justice, and fidelity to contemplate what is in the best interest of his clients

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and if he is the right therapist that would be the most beneficial the couple (Miller & Seedall, 2020). Another ethical dilemma is whether John and Jim attended the same Al-anon meeting is ethical or unethical. These meetings could be therapeutic for Jim to attend. The idea of Al-anon meetings is to have a space to share feelings of negative or traumatic experiences with others who can understand and have been through the same things (Timko et al., 2013). Al-anon meetings are private and personal meetings to promote a comfortable, open, safe space free from judgment. Jim has been attending the same Al-anon meeting for years. John, his client with whom he should have a professional relationship, also attends the same Al-anon meeting. This is a personal space where past experiences are shared. John would become privy to personal information about his therapist, which could create a personal relationship. If John has attended the meeting because he is seeking a safe space to talk about his family members or friends struggling with alcoholism, Jim must decide how to handle this long-term. He could decide to find another group, or he could decide to stay. An ethical dilemma is whether John came to the Al-anon meeting to talk to Jim outside therapy sessions. It is scary to think that John found Jim during his time. This could raise questions on whether there will be harassment from the couple in the future. If it was a coincidence, John making the first move to come up to Jim in a public and personal setting is also concerning because John has no regard for boundaries. Jim needs to decide if this would be ethical or unethical to agree to speak to him outside of therapy. Jim needs to consider how these potential ethical dilemmas will affect the lives of his clients and himself. It is vital to consider the outcomes before acting to avoid future conflict. Jim

should review the SLEEPP decision-making model to analyze the best possible outcome for ethical dilemmas. SLEEPP decision-making model Sociocultural, sexual identity, professional problem, or issue conflict Awareness of a possible ethical concern is that the therapist, Jim, has no experience with and disagrees with the BDSM lifestyle. This could create bias due to Jim’s disagreement and hinder an adequate treatment plan a therapist with experience or knowledge would give in therapy. Jim should reflect on his definition of personal values of marriage and gender roles (Aponte, 1985). Jim should decide which of his values should be shared and how he would utilize his influence in discussing his values and those of the clients (Aponte). Without prior knowledge or experience in this area, he may not be able to fully understand the different dynamics of BDSM and the gender roles in submissive-dominant relationships in sexual gratification. According to an article by Aponte (1985), a therapist needs to be aware of the social context of psychological distress they confront” (p. 3). Codes 1.9 Relationship Beneficial to Client, 3.1 Maintenance of Competency, and 3.6 Development of New Skills relate to this scenario according to the AAMFT Code of Ethics (2023). Therapist is responsible for their influence of values on their clients. They should consider their values as well as the values of their clients (Aponte, 1985). Being completely neutral in thoughts, feelings, values, and morals is impossible (Miller & Seedall, 2020). However, being honest and transparent will give clients the autonomy to decide what is best for them (Miller & Seedall, 2020). Jim should reflect on the ethical principle of veracity to be truthful to his clients regarding his experience with BDSM relationships. According to the AAMFT Code of Ethics (2023), Standard 1.2, Informed Consent, Jim should respect the client's

autonomy while going over all the risks and benefits with the clients, including any deficiencies he may have in this type of relationship (Caldwell & Stone, 2016). Other codes of ethics that apply are coded 1.1 Non-Discrimination, 3.10 Scope of Competence, and 8.4 Truthful Representation of Services pertain to Jim's lack of knowledge of BDSM (AAMFT, 2023). The safety of both clients must be considered. Although John stated he felt safe, his degree of autonomy is questioned due to his submissive personality (Caldwell & Stone, 2016). The bruises are likely due to bondage and submission, even if Sara did not intend to hurt John. However, Code 1.8 Client Autonomy in Decision Making pertains to this dilemma because Jim does not have the experience or complete knowledge of what could be considered ethical or unethical in this type of relationship (AAMFT, 2023). Coping with family addiction can leave a family member feeling anxious, worried, and helpless to help others with addiction. Al-anon meetings help family members take their power back. John’s submissive role could be challenging for Jim to understand. Possible discrimination or bias against Jim violates code 1.1, Non-Discrimination, according to the AAMFT Code of Ethics (2023). John attended the same al-anon meeting that Jim attended. The question arises of whether John is also coping with alcoholic family members or if he just went there to find Jim to talk to him. If John genuinely attended the al-anon meeting to cope with alcoholism in his family, this could form a connection between Jim and John outside of therapy. This could also create an alliance between them and upset Sara, affecting the therapeutic relationship between the therapist, client, and partners. Code 1.3 Multiple Relationships relates to this scenario according to the AAMFT Code of Ethics (2023).

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Attending the same meetings outside of therapy can feel like a breach of confidentiality and invading John and Jim’s personal lives. Sharing personal stories on both sides changes the dynamic of a professional relationship to a friendly relationship. According to the AAMFT ethics code, 3.4 conflicts of interest can affect a therapist’s professional judgment when a relationship is formed in personal situations outside therapy (AAMFT, 2023). Legal implications of the ethical issue John could reveal some damaging information, such as being a victim of domestic violence. It would leave Jim to wonder if John lied in therapy about his safety and if he fears Sara. Jim is put in a duty to report, the duty to warn, or a secret-keeping position, depending on the immediate danger John says he is in. Since there is no written consent for anything disclosed outside of a therapy session, Sara and John could file a complaint with the AAMFT Board of Ethics or take Jim to court for breach of confidentiality. Jim's license could get taken away. It is also possible that John and Sara could try to exploit Jim’s personal life for money or some other reason. Code 3.8 Exploitation, 1.6 Reports of Unethical Conduct relates to this scenario according to the AAMFT Code of Ethics (2023). Ethical imperatives John could be coping with mental or physical abuse by a family member, his ex-wife, or Sara. This could explain why John is interested in being in a submissive relationship. If John reveals this outside of therapy, Jim will have to decide to disclose the information and whether it was told to him as John's friend or his therapist. Code 8.4 Truthful Representation of Services relates to this scenario according to the AAMFT Code of Ethics (2023).

Economic impact John could get embarrassed or upset that Jim turned him down to have a conversation. John might feel uncomfortable coming to Jim for help and may stop coming to therapy. They could want their money back from any sessions that they previously attended. Code 8.4 Truthful Representation of Services relates to this scenario according to the AAMFT Code of Ethics (2023). Political ramifications Currently, LGBTQ is politically polarized. Meeting John outside of sessions could promote negative feelings for Sara. She is the dominant one in the relationship and finding out that John went to talk to Jim behind her back could create feelings of anger for Sara. She could feel offended by the two men talking behind her and meeting outside therapy sessions. This could cause paranoia in session for the therapist and the clients, especially if Jim has a different political view. Sara could become offended by anything Jim says or does and claim she was discriminated against for her sexual preference. If any complaints were filed and things escalated, the situation could be used as political propaganda, leading to outbursts or riots from the LGBTQ community. Code 3.7 Harassment and 1.6 Reports of Unethical Conduct relate to this scenario according to the AAMFT Code of Ethics (2023). Power If Jim agrees to talk to John at the Al-anon meeting, a personal connection could form because of their newly discovered similarity in family dynamics or because of new information that John discovered about Jim. Relatable conversations could form a friendship between them. This could then carry over to the sessions, where John might wonder if Jim is authentic with him or if it is because they had a friendly bond. The therapist should be seen as a helper to the couple

(Wiley, 2020). Code 3.12 Professional Misconduct relates to this scenario according to the AAMFT Code of Ethics (2023). Power is established in a potential connection between John and Jim and creates privileged identities between John and Jim concerning both clients and therapists. Therapists can influence their client’s decisions, significantly impacting their lives (Miller & Seedall, 2020). Code 1.7 Abuse of the Therapeutic Relationship relates to this type of scenario according to the AAMFT Code of Ethics (2023) because with power comes the duty to be just and fair to each client while allowing them to use autonomy to decide what is best for them in therapy (Miller & Seedall, 2020). Seeking Consultation and Resources Jim should consider ensuring he incorporates a “no secrets” policy with specific outlines before he meets with anyone outside of a therapy session where all clients are present. This would help reduce the chance of being put into a secret-keeping dilemma in the future. According to the AAMFT code of ethics (2023), if further assistance is needed for the therapist to decide on how to proceed in ethical situations or dilemmas, they should seek assistance by contacting c onsultants, attorneys, supervisors, colleagues, or other appropriate authorities. A therapist can also review the ‘enhance knowledge’ and ‘frequently asked questions’ pages on the AAMFT code of ethics website (AAMFT, 2023). S caling can be beneficial because it allows the therapist to compare and evaluate different strategies and outcomes to decide how to proceed (Caldwell & Stone, 2016 ). Jim can call or email AAMFT directly if a decision still cannot be decided on.

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Ethical Decision Conclusion Using the SLEEPP decision-making model, Jim is involved in multiple ethical dilemmas. While reflecting on different scenarios, I do not think Jim should talk to John outside of therapy meetings because the risk is too high for Jim to violate ethical principles and codes and put himself in a potentially dangerous spot. John is a consenting adult who seems to possess the autonomy to make decisions (Caldwell & Stone, 2016). Witnessing bruises on John's neck does not call for immediate alarm since John admits he is willing to explore bondage sexually and prefers to take a submissive role in a submissive-dominant relationship. The bruises could be caused by tools used during sexual exploration. Sara states she is not a sadomasochist and does not gain any sexual pleasure by inflicting pain on herself or others. I think Jim should find another therapist that is better suited for BDSM relationships. Getting involved more than therapy seems unhealthy and dangerous since this is a different realm of social behaviors outside the scope of Jim's prior experience and knowledge (Caldwell & Stone, 2016). Continuing therapy would be a disservice to all parties involved. BDSM is an unusual sexual preference that needs a specific type of understanding in that societal niche in order to treat in therapy properly. According to the AAMFT ethics code, 3.3 Seek Assistance, 1.11 Non-Abandonment, and 1.10 Referrals, Jim should not end therapy with the client until he finds and formally recommends another appropriate therapist that will best suit John and Sally’s needs (AAMFT, 2023).

References American Association for Marriage and Family Therapy. (2023). Code of Ethics . https://www.aamft.org/Legal_Ethics/Code_of_Ethics.aspx Aponte, H. J. (1985). The Negotiation of Values in Therapy. Family Process , 24 (3), 323–338. https://doi.org/10.1111/j.1545-5300.1985.00323.x Caldwell, B. W., & Stone, D. J. (2016). Using Scaling to Facilitate Ethical Decision-Making in Family Therapy. American Journal of Family Therapy , 44 (4), 198–210. https://doi.org/10.1080/01926187.2016.1150797 Hecker, L. L. (2012). Ethics and Professional Issues in Couple and Family Therapy . https://doi.org/10.4324/9780203866245 Miller, R. B., & Seedall, R. B. (2020). The Handbook of Systemic Family Therapy, The Profession of Systemic Family Therapy . John Wiley & Sons. Timko, C., Cronkite, R. C., Kaskutas, L. A., Laudet, A. B., Roth, J., & Moos, R. H. (2013). Al- Anon Family Groups: Newcomers and Members. Journal of Studies on Alcohol and Drugs , 74 (6), 965–976. https://doi.org/10.15288/jsad.2013.74.965

MFT 5222_Week 3_Ethical Dilemma

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