PSYC4900_Assessment2

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Herzing University *

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4900

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Psychology

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Dec 6, 2023

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1 Hannah and Adara: Ethical Issue and Action Plan This case study revolves around the ethical dilemma faced by Hannah, a school counselor, as she grapples with the balance between maintaining confidentiality and ensuring the safety of her student, Adara. Adara confided in Hannah about her feelings of depression and a desire to harm herself. Hannah determined that Adara's safety was at risk and promptly informed her parents about the potential harm their daughter posed to herself. Adara's parents hold reservations about therapy due to cultural and religious beliefs. Adara viewed Hannah’s actions as a breach of trust, causing her to feel betrayed and hesitant to confide in Hannah. The ethical issue at hand pertains to the duty of care, raising questions about when it is appropriate to breach confidentiality for the well-being of a client. The Ethical Principles of Psychologists and Code of Conduct underscores the importance of prioritizing a client’s safety in situations involving potential harm (American Psychological Association, 2023). This ethical issue mirrors larger societal challenges, including the mental health struggles of adolescents of diverse ethnic backgrounds, how culture impacts perceptions of mental health, and the importance of trust in the therapeutic alliance. This paper will delve into the ethical considerations that underlie this case, aiming to arrive at a responsible course of action that is supported by research. Applied Ethical Principles and Standards The primary ethical concern in this case, confidentiality, aligns with Standard 4.02 of the Ethical Principles of Psychologists and Code of Conduct, “Discussing the Limits of Confidentiality.” This standard emphasizes the necessity for psychologists to discuss confidentiality limits with clients, providing them with a clear understanding of potential breaches for their safety (APA, 2023). It would have been vital for Hannah to clarify with Adara under what circumstances she might need to involve her parents. This discussion could have

2 provided Adara with a clear understanding of the potential situations where confidentiality may need to be breached. Additionally, Standard 4.05(b), “Disclosures,” is relevant, stating that psychologists may disclose confidential information without consent if mandated by law or to protect the client or others from harm (APA, 2023). In this case, Hannah's ethical duty is to prioritize her safety, disclosing only the minimum necessary information. Furthermore, General Principle A, "Beneficence and Nonmaleficence," is applicable. It underscores psychologists' responsibility to benefit and avoid harm to those they work with (APA, 2023). It urges them to navigate conflicts responsibly, minimizing harm while prioritizing the welfare of the client. In this case, Hannah had to carefully weigh the potential benefits and risks of breaching confidentiality, considering both Adara's immediate safety and their therapeutic relationship. General Principle E, “Respect for People's Rights and Dignity,” is also relevant, as it emphasizes the need for psychologists to be sensitive to and respectful of cultural, individual, and role differences, in order to avoid discrimination and bias (APA, 2023). Alternative Solutions Option 1: Utilizing a Cultural Mediator One approach to address the ethical dilemma involves engaging a cultural mediator with expertise in Adara's background. This step can foster trust and understanding between Adara, her parents, and Hannah (World Health Organization, 2019). Obtaining Adara's informed consent before involving the mediator is crucial (APA, 2023). The mediator can convey Adara's concerns about the breach while ensuring her parents grasp the gravity of the situation. They would also work sensitively with Adara's family to address any mental health misconceptions and collaborate with Hannah for culturally sensitive approaches (WHO, 2019). However, finding a cultural mediator may be challenging. Adara may also be hesitant to introduce another person, as

3 she is already distrustful. While this approach improves understanding, it may not entirely resolve the issue if Adara's parents remain opposed to therapy. Option 2: Providing Education on Legal and Ethical Obligations Providing education on legal and ethical obligations is another approach to address the breach of confidentiality. This involves Hannah providing Adara and her parents with comprehensive information about the responsibilities that mental health professionals are bound by (APA, 2023). By doing so, Adara can gain an understanding of the obligations that guided Hannah's decision to involve her parents (APA, 2023). This open and honest communication can help rebuild trust within the therapeutic alliance (Avasthi et al., 2022). This approach also empowers Adara's parents with knowledge about therapy, potentially shifting their perspectives and fostering a more collaborative environment. However, while education on legal and ethical obligations can empower Adara and her parents with an understanding of the professional responsibilities guiding Hannah's decision, it is essential to address Adara's feelings and concerns. Adara may still have reservations about the breach of confidentiality, particularly if she feels that information about her mental health may be shared with her parents in the future (Avasthi et al., 2022). This could potentially lead to a further erosion of trust. Option 3: Consulting with Professionals (APA or ASCA) Another potential solution is for Hannah to consult with the American Psychological Association (APA) or the American School Counselor Association (ASCA). The APA Ethics Office may be a particularly useful resource for Hannah, as they specialize in providing ethics consultations for mental health professionals navigating ethical dilemmas (APA, 2023). This office is staffed with experts who are well-versed in ethical guidelines, and they can offer valuable insights and guidance tailored to specific situations (APA, 2023). These experts can

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4 analyze the situation, taking into account factors such as Adara's well-being, her parents' perspectives, and the cultural dynamics at play. They can offer specific recommendations on how to balance confidentiality with the need to ensure Adara's safety, providing Hannah with insights into best practices for communicating with her parents about the breach while respecting Adara's autonomy and cultural background (APA, 2023). This can also help Hannah understand any legal implications or requirements related to confidentiality in her specific jurisdiction (APA, 2023; ASCA, 2022). However, ethics consultations with the APA Ethics Office are only available for members of the APA (APA, 2023). Therefore, if Hannah is not already a member, she may need to become one or rely on the published resources provided by them, supplemented with seeking advice from supervisors or colleagues who are well-versed in ethical matters. Option 4: Implementing a Clear Action Plan One potential solution is to implement a collaborative action plan involving Adara. This empowers her to play an active role in her safety (Maukasch & Safford, 2013) and addresses her immediate concerns while respecting confidentiality. The plan, developed with input from Adara, her parents, Hannah, outlines clear protocols for responding to situations endangering Adara's well-being (Moscardini et al., 2020). It specifies how Hannah would communicate and take steps for Adara's safety, including emergency services if needed (Moscardini et al., 2020). Regular reviews and updates are essential to meet Adara's evolving needs. This procedure reassures all parties that Adara's safety is paramount, while still respecting her autonomy. However, Adara may feel uneasy about potential privacy loss, as she is already upset about Hannah involving her parents. This may lead to hesitancy in sharing with Hannah. Additionally, implementing a plan involves coordinating multiple parties (Hannah, Adara, her parents, and potentially emergency services), which can be a complex process (Moscardini et al., 2020).

5 Option 5: Cultural Sensitivity Training Cultural sensitivity training emerges as a powerful tool in addressing the breach of confidentiality in Adara's case. This entails providing comprehensive training for Hannah in understanding and respecting the unique cultural background and experiences of individuals like Adara (Govere & Govere, 2016; Sue et al., 2009). By investing in cultural sensitivity training, Hannah can develop the knowledge and skills necessary to navigate the complexities of Adara's cultural identity, including the challenges associated with being a Muslim-American in a predominantly non-Muslim environment. Cultural sensitivity training encourages open dialogue about cultural differences and equips Hannah with the ability to address cultural barriers that may arise (Sue et al., 2019). However, cultural sensitivity training is an ongoing process that requires dedication and a commitment to continuous learning. It may also necessitate allocating time and resources for training sessions or workshops (Govere & Govere, 2016; Sue et al., 2009). While this approach is beneficial, it should be complemented by other best practices. Course of Action Upon brainstorming several potential solutions in this case, the best course of action would be a combination of approaches. Firstly, Hannah should educate Adara on the limits of confidentiality. In the case study, Adara expressed, “Doesn't she have to keep what I say to herself?" This suggests that the limits of confidentiality were not discussed with Adara at the onset of their sessions. According to the Ethical Principles of Psychologists and Code of Conduct, this step should have been taken at the beginning of therapy (APA, 2023). Therefore, educating Adara on the ethical obligations that mental health professionals are bound by is paramount in this case. Failing to educate Adara on these limits of confidentiality may negatively impact her trust in the therapeutic process and affect her willingness to engage in therapy

6 (Avasthi et al., 2022). If Adara is still uncomfortable continuing speaking with Hannah after being educated on the limits of confidentiality, Hannah should refer Adara to another professional (APA, 2023). Should Adara wish to continue with Hannah, collaboratively developing a clear action plan together could be beneficial. This aligns with Standard 3.10, “Informed Consent” (APA, 2023). The action plan would establish a framework for communication going forward, outlining the specific circumstances under which Adara's parents would be informed in order to prioritize her safety (Moscardini et al., 2020). This collaborative approach aligns with ethical guidelines and promotes a transparent therapeutic environment. Furthermore, in accordance with Standard 2.01(b), titled “Boundaries of Competence,” Hannah should prioritize cultural sensitivity training (APA, 2023). This training will equip her with the knowledge and skills needed to grasp the nuances of Adara's experiences, including the challenges associated with being a Muslim-American in a predominantly non-Muslim school (Govere & Govere, 2016). With this heightened awareness, Hannah can offer more tailored and effective support to Adara. Lastly, if Hannah has any doubts regarding her decision to breach confidentiality, consulting with the APA Ethics Office may provide valuable input (APA, 2023). Research Various studies highlight the importance of trust in the therapeutic relationship (Avasthi et al., 2022). Research has found that when a client is not properly informed about the exceptions to confidentiality, the therapeutic alliance is significantly damaged (Avasthi et al., 2022). Darby and Weinstock (2018) conducted an analytic review which involved a thorough examination of existing literature on informed consent and the discussion of confidentiality limits. They conducted a comprehensive search of peer-reviewed articles, drawing from reputable databases. An analytic review was appropriate in this case, as it allowed the authors to ensure that their

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7 findings were well-informed and evidence-based. This methodology strengthens the credibility and reliability of their findings. In their review, the authors underscore that discussing limits of confidentiality improves communication between practitioners and clients, leads to better patient outcomes, and lowers rates of malpractice claims (Darby & Weinstock, 2018). This emphasizes the necessity of ensuring that Adara is well-informed about the limits of confidentiality. Furthermore, research shows that implementing an action plan with the input of the client fosters a sense of empowerment in the therapeutic process (Maukasch & Safford, 2013). In doing so, Hannah can help rebuild trust with Adara. Creating a collaborative action plan is linked to improved outcomes for mental health conditions such as depression (Maukasch & Safford, 2013). Research indicates that effective care planning should focus on the individual's goals and values for the best outcomes (Maukasch & Safford, 2013). By including Adara in this planning process and outlining the specific situations in which confidentiality may necessitate a breach, Adara becomes an active participant in her own treatment (APA, 2023). This transparency empowers Adara with the knowledge needed to make informed decisions about her care. In addition, research supports the efficacy of cultural sensitivity training for mental health professionals. Govere and Govere (2016) conducted a literature review related to cultural competency and patient satisfaction. The review included literature published within a 12-year period from various reputable databases. The quality of the studies was assessed based on criteria including experimental design, sample size, sampling methods, and the diversity of participants. Studies utilizing quasi-experimental designs were excluded. Govere and Govere (2016) found that seven large studies met the inclusion criteria. Among these, six studies indicated a significant increase in the cultural competence level of healthcare providers following cultural competence training (Govere & Govere, 2016). Five studies found a notable

8 association between cultural competence training and higher levels of patient satisfaction. This suggests that if Hannah were to undergo training, it could lead improved outcomes for Adara. Training time ranged from 5 to 36 hours. Longer training time was positively associated with higher levels of cultural competence and higher levels of patient satisfaction (Govere & Govere, 2016). The impact of cultural sensitivity training is particularly relevant to Adara's case, where her Muslim-American identity requires a therapist who understands and respects her unique cultural background. The range of training duration (5 to 36 hours) offers practical insights, indicating that while longer-duration training is more effective, even shorter-duration training is impactful (Govere & Govere, 2016). This is crucial to consider in the context of busy school counseling settings. Conclusion In conclusion, the breach of confidentiality in Adara's case is of paramount importance as it directly impacts her trust and autonomy in the therapeutic process (Avasthi et al., 2022). This ethical dilemma highlights the need for a culturally sensitive and respectful approach that acknowledges Adara's unique background. By educating Adara on the limits of confidentiality, Hannah empowers her with knowledge and rebuilds trust (Darby & Weinstock, 2018). Additionally, the implementation of a clear action plan safeguards Adara’s autonomy and demonstrates a commitment to her safety and well-being (Maukasch & Safford, 2013). However, to truly bridge the gap and provide the highest quality care, it is crucial for Hannah to undergo cultural sensitivity training. This speaks to a broader commitment to understanding and valuing the unique experiences of every individual. In embracing this comprehensive approach, Hannah can rebuild trust in the therapeutic relationship, grow professionally, and provide more culturally competent care.

9 References American Psychiatric Association. (2019). Family Involvement in Treatment Can Improve Outcomes . https://www.psychiatry.org/news-room/apa-blogs/family-involvement-in- treatment-improve-outcomes . American Psychological Association. (2023). APA Ethics Office. https://www.apa.org/ethics . American Psychological Association. (2023). Ethical Principles of Psychologists and Code of Conduct. https://www.apa.org/ethics/code?item=6#310 . American School Counselor Association. (2022). ASCA Ethical Standards for School Counselors . https://www.schoolcounselor.org/getmedia/44f30280-ffe8-4b41-9ad8- f15909c3d164/EthicalStandards.pdf . Avasthi, A., Grover, S., & Nischal, A. (2022). Ethical and Legal Issues in Psychotherapy. Indian Journal of Psychiatry, 64, 47–61. https://doi.org/10.4103/indianjpsychiatry.indianjpsychiatry_50_21 . Darby, W. C., & Weinstock, R. (2018). The Limits of Confidentiality: Informed Consent and Psychotherapy. Focus, 16 (4), 395–401. https://doi.org/10.1176/appi.focus.20180020 . Govere, L., & Govere, E. M. (2016). How Effective is Cultural Competence Training of Healthcare Providers on Improving Patient Satisfaction of Minority Groups? A Systematic Review of Literature. Worldviews on Evidence-Based Nursing, 13 (6), 402- 410. https://doi.org/10.1111/wvn.12176 . Maukasch, L., & Safford, B. (2013). Engaging Patients in Collaborative Care Plans. Family Practice Management, 20 (3), 35-39. https://www.aafp.org/pubs/fpm/issues/2013/0500/p35.html .

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10 Moscardini, E. H., Hill, R. M., Dodd, C. G., Do, C., Kaplow, J. B., & Tucker, R. P. (2020). Suicide Safety Planning: Clinician Training, Comfort, and Safety Plan Utilization. International Journal of Environmental Research and Public Health, 17( 18), 6444. https://doi.org/10.3390/ijerph17186444 . Sue, S., Zane, N., Nagayama Hall, G. C., & Berger, L. K. (2009). The case for cultural competency in psychotherapeutic interventions. Annual Review of Psychology, 60 , 525- 548. https://doi.org/10.1146/annurev.psych.60.110707.163651 . World Health Organization. (2019). What are the roles of intercultural mediators in health care and what is the evidence on their contributions and effectiveness in improving accessibility and quality of care for refugees and migrants in the WHO European Region? National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK550148/ .

PSYC4900_Assessment2

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