Case+7,+Question+1

__Define the Problem/Dilemma__: What are the core problems (legal, ethical, clinical, professional, moral or a combination)?

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(1) Codes of ethics advise against "dual relationships" (COMAR), "nonprofessional" or "potentially beneficial interactions" (ACA), and "dual or multiple relationships" (APA). In the reality of professional practice, however, these relationships or interactions may be unavoidable. This reality is particularly evident in rural or congregational contexts -- as apply in this case. Research by Schank and Skovholt (1996) shows that while "psychologists [know] the content of the ethics codes, they [admit] that they often struggle in choosing how to apply those codes to ... rural practice" (Corey, Corey & Callanan, 285). Carol faces this __ethical dilemma__: the apparent disconnect between code and practice. (sd)

(2) In the light of actual practice, the codes do acknowledge that in some cases, these relationships or interactions cannot be avoided. So, the codes advise several strategies to manage potential risks. While Carol has stressed "confidentiality," she needs to take additional steps in her professional practice. Marianne Schneider Corey reflects on her own experience as a counselor in rural practice and she affirms, "Being a practitioner in a small community demands flexibility, honesty, and sensitivity" (Corey, Corey, & Callanan, 287). So that Carol can manage potential risks, she must adapt her professional practice to best meet the needs of her clients. If she does not adapt her practice, it will become a __professional problem__. (sd)

(3) When counselor and client are engaged in these relationships or interactions, several __clinical problems__ may arise. There may be role confusion for both counselor and client, and potential harm to the client. Public perception of the counselor or client may be jeopardized. Someone observing a public interaction between Carol and her client, for example, might wonder about the content of the interaction or the nature of the relationship. They might wonder about the steadfastness of confidentiality. They might question the counselor's motives or perceive her work outside of counseling as motivated by desire for personal or professional gain. These relationships or interactions may do harm to the client and individuals related to the client, as well as to the counselor's practice. (sd)

(4) These relationships and interactions can be beneficial, i.e. therapeutic, for the client, so avoiding them altogether could be an __ethical problem__. It seems Lazarus (1994a) goes the farthest in his assertions that "some dual or multiple relationships can enhance treatment outcomes" (Corey, Corey, & Callanan, 279). His "keynote article caused a good deal of controversy:" several "authors were invited to respond," and he himself then offered a "rejoinder" (Corey, Corey & Callanan, 279). In the rejoinder, he emphasizes his focus "mainly on the potential advantages that may occur when certain boundaries are transcended" and his belief that "professionals who hide behind rigid boundaries often fail to be of genuine help to their clients" (Corey, Corey, & Callanan, 280). (sd)

(5) Is the relationship "harmful" or "beneficial?"

(6) Should/will/can the relationship be continued?

(7) Legal (p. 102, Wheeler ff): risk of licensing board complaints, etc. ....


 * Discussion for Question 1**include component="comments" page="Case 7, Question 1" limit="40"

Hi, guys, just something I noticed the other day that may be relevant to our case...According to Wheeler (2008), "for privilege to apply...the communication generally must NOT be made in the presence of third persons or the privilege will be considered waived," (p.66). This may not apply to our case, but I'm wondering another clinical issue here might be the inadvertent waiving of client privilege.... Mike