The dilemma of dual relationships, particularly in rural communities, can present significant ethical challenges. Review the articles by Gonyea, Wright, and Earl-Kulkosky (2014) and by Witt and McNichols (2014) in the studies for this unit.
In your initial post, discuss some of the methods used to manage potential dual relationships from the perspective of a provider and from the perspective of a supervisor. Describe at least one similarity and one difference in the ways a provider and a supervisor address dual relationship situations.
In the following scenarios, you will play the role of a counselor and educator in rural and small communities.
After you read each scenario, you will select one of the three options to best manage the ethical issue. Media items are not graded, but consider your understanding of laws and ethical codes when responding to each question.
SCENARIO 1: COUNSELING IN RURAL AND SMALL COMMUNITIES
Maria lives in a rural farming community of about 1,200 residents. She holds several positions in the community, including child psychologist and youth pastor at a local church. Maria enjoys being involved with her clients on a personal level. She finds value in the therapeutic process being a partnership, rather than the clinician as all-knowing. However, lately, Maria has been uncomfortable with her level of enmeshment in client lives; particularly due to her extended role in the community.
Maria was recently asked to develop a youth mentoring program at her church. The program involved matching adolescent mentors with children that had one or no siblings. Maria was thrilled when two current adolescent clients asked to participate in the program. She understood that increased commitments would ensure program funding and assist her clients in personal growth.
Maria has also found that one challenge in professional practice is the client’s ability to pay for treatment. Several parents are uninsured or are unable to pay sliding scale fees. Maria has offered extensions in these cases, but was recently asked to barter mentoring participation with payment for clinical services.
Maria is uncomfortable with bartering, and wonders if this will be in the best interest of her clients and the children in the mentoring program.
How would you advise Maria to proceed in this case?
Proceed with using bartering as payment
Maria lives in small farming community. Bartering services may offer the greatest amount of assistance for rural and indigent areas. Still, it’s important to consider how this might impact the delivery of human services. What are cultural and ethical considerations? Is the clinician comfortable with bartering services? Would this be an equitable form of payment for all clients?
Resign her role as a youth pastor
Given that ethical conflicts may arise from Maria’s position within the church, it’s important to consider how this might impact professional practice. Maria will need to weigh the impact of dual relationships in clinical work. Maria may also consider a different role within the church that decreases the likelihood of working with current clients.
Terminate participation in the mentoring program
Maria is engaged in a multiple relationship as the mentor program advisor and clinical therapist. If she agrees to barter clinical services, clients may remain active in the mentoring program to continue treatment. As such, it’s important to consider how the client’s therapeutic progress will be evaluated and affected.
Since referrals may not be an option in rural areas, terminating program participation may be an option. Be sure to process how this can be best managed with the least amount of impact to each client and program participant.
SCENARIO 2: LAKE PARSONS TECHNICAL COLLEGE
Mr. Nelson is a Psychology instructor at Lake Parsons Technical College. He was recently asked to develop a mental health counseling center within the student services department. Lake Parsons is a career-focused college offering associate and baccalaureate degrees in Graphic Arts, Criminal Justice, and Health Information Management. A significant percentage of enrolled students are adult learners seeking re-training or transitional careers.
Mr. Nelson initially questioned the need for a mental health counseling center. He was concerned about ethical implications, particularly the management of confidentiality and multiple roles. After further discussion, Mr. Nelson agreed to secure intern counselors and facilitate clinical supervision.
During group supervision, Mr. Nelson recognized a client’s presenting problem as one disclosed by a current student. The counseling intern used alias names to increase student confidentiality. However, the case was unique, and could potentially cause conflicts in the client’s treatment.
The student was recently assigned to work study in the General Education department. Mr. Nelson anticipated working closely with this student throughout the quarter. He felt uncomfortable with discussing the case without the student’s knowledge.
How would you practice professional ethics in this situation?
Inform the student
The student should be informed of consumer rights in therapeutic services. Client information may be shared during clinical supervision to develop the appropriate course of treatment. An important question is whether it’s appropriate to introduce the clinical supervisor. Is this significant to the client’s therapeutic process? How would knowledge of the instructor’s dual role affect the client?
Resign as Clinical Supervisor
A special consideration in college counseling services is separating the role of clinician and educator. Because psychology instructors might also be involved in clinical work, ethical implications should be considered in providing guidance in and outside the classroom. Mr. Parsons would benefit from consulting with his mentor regarding the appropriateness of dual roles within the college.
Reassign the work study to a different student
While this is an option to avoid ethical conflicts, reassigning the student may be deemed as punitive or capricious. Consulting with student services may also violate confidentiality of the client’s treatment. Mr. Parson’s will need to further process his initial concerns with developing the counselor center.
Objectivity and Transference
Your textbook presents several examples of situations where objectivity and transference might impact a therapeutic relationship. There is often a continuum that ranges from emotional objectivity to transference that can completely impair judgment. Select a scenario from the Cooperative Learning Exercise on page 260 of your textbook, or provide an example from your experience where there was a real or potential loss of objectivity or transference.
In your initial post, describe the difference between emotional objectivity and transference. Describe the scenario you selected and explain where or how the loss of objectivity or transference might occur in the scenario.
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