Ethics, a form of philosophy involves dealings with morality and

judgements of proper conduct (Frankena, 1973), denoting the significance of

psychotherapists moral obligation towards the client. Its purpose is to reflect a
straightforward value system, and to communicate decisional and behavioural
rules with clarity To illustrate this further, the Australian Psychological Society
(APS) Code of Ethics specifies ethical principles and accepted guidelines
governing the psychologists actions and methods to make the public known of
their professional practices. The ethical standards define the best practices of
professionals and ensure the high quality of practice.

A psychologist must bring and maintain appropriate skills and learning
within her area of practice. Falling under the Prudence principle, The Code of
Ethics (2007) section B.1.2 states that a psychologist may only provide
psychological services within boundaries of their professional competence,
where a) working within their limits of training, education, and experience and
b) basing their service on established knowledge of discipline and profession of
psychology. However, the psychologist concerned is specialized in clinical
psychology for adults, and now is dealing with adolescents, whom are clients
beyond her scope of expertise. This raises the issue of limited professional
competence. Nonetheless, rural regions often see a high demand due to lack of
specialists normally found in urban locations. A change to the rural location
brings pressure toward the psychologist to practice beyond their capability. The
ethical trap possibilities lay in the fact that her qualification does not apply for
the therapy, however there is no other way to go about it. Deemed as the
Circumstantiality trap by Steinman et al (1998), it entails the circumstances on
which they occurred must be taking into consideration for the decision.
Therefore, the psychologists should determine which cases take precedence in
importance to those that need psychotherapy the most. This abides with section
6.2 APS guideline for rural settings (2007) where strategies of triage, backed by
both sound knowledge of resources in the local area, should be incorporated into
rural psychologists practice.

Within a rural is setting, it is harder to maintain anonymity as it is a smaller,
close-knit community. This is so as psychologists are more likely to encounter
their clients in settings outside their therapy sessions as other roles. This creates
the issue of dual-relationship, which poses as a potential difficulty for both
psychologists and clients as the professional boundaries are blurred. A multiple
relationship occurs when a psychologist, whom is giving psychological service to
a client within the current period, engages in a non-professional relationship
with the client or a non-professional relationship with an associated party (Code
of Ethics, 2007). The strategy of referral options in rural settings do not apply, as
it was made known that mental health services are limited. Therefore, the
psychologist must take precautions to ensure their strategies with the client.
However, Case 2 shows the psychologist not wanting to damage her relationship
with Jenny, placing the client in possible lethal danger. Within APS Guidelines for
Young People (2007), it is stated, when making judgement whether to disclose a
young persons information, psychologists consider the young persons best
interest as paramount. The concern for Jennys feelings signals a non-
professional relationship being formed. The psychologists decision puts Jennys
wellbeing at risk, overriding the aforementioned ethical code. The psychologist
should have made clear boundaries with her client. She should also not forget
her rights as a psychologist regarding the rules and terms of informed consent,
where a breach of confidentiality is agreed to by the client in permitted
circumstances.

Before a psychologist begins any counseling with a client, informed consent
is necessary. Within code of ethics (2007), section A.3.1 states psychologists
must fully inform clients regarding the psychological services they intend to
provide. A psychologist has to make sure that consent is informed by explaining
what nature, procedure, how information would be collected and kept, the
confidentiality and limits to confidentiality, and making clear the conditions
where psychological services may be terminated. According to the Child Act
(2001), a child is defined as a person under the age of eighteen years. Being a
minor, a young person is only capable to give informed consent if the adolescent
achieves a sufficient understanding and intelligence to enable him or her to
understand fully what is proposed(APS, 2007). The psychologist has to establish
whether the young person client is of sound intelligence by determining if he or
she can understand the nature of the proposed psychological service, the
benefits and risks, and can understand confidentiality limits. According to
Mitchell (2002), adolescents 14 years or older are perceived to be just as capable
as adults when it comes to decision-making concerning entering therapy.
Moreover, Croston, Churchill, and Fellin (1988) asserted the consideration for 14
years of age to be the standard for consent to counseling. Thus, It can be
assumed Jenny is of reasonable intelligence and understanding, thus entitled to
receive, engage, continue or terminate psychological services, with the
understanding that the psychologist would respect the clients confidentiality.
However, circumstances of rural settings may fare differently, as they dont have
the same opportunities within metropolitan settings as those in Croston et als
(1988) study. Furthermore confidentiality is limited to legal requirements and
whether there are risks to the young person or others.

Confidentiality is the common standard for professional conduct, which
obliges one not to discuss information regarding the client with anyone
(Koocher, 2007). In this case, the ethical problem arises when the psychologist
faces the dilemma of whether to remain silent to preserve confidentiality, or to
inform parents, those involved, and medical authorities of the risk the client
faces thus breaching confidentiality. The ethical traps possibly present within
this are deemed as the Commonsense, objectivity trap (Steinman et al, 1998)
where the client is in dilemma to break confidentiality and embarrass her within
a small community, or to keep silent while her health and others involved are at
grave stake. The violation of confidentiality constitutes as the main question
concerned. If breached, it poses a threat for legal claim of negligence,
infringement of contract, violation of confidence, and having professional
conduct complaints brought against the psychologist (Kampf, Mchsherry,
Thomas, & Abrahams, 2008). However, psychologists may also have an ethical or
legal duty to disclose information, providing the circumstances permit. Failure to
disclose may cause the psychologist to be legally liable for non-disclosure and
risking their client to be in harms way or putting others in danger.


The main key principle concerned is Suffering Prevention, which involves
not only the prevention of suffering, but its allevation (Francis, 2009). Applying
this principle would mean the psychologist ought to not engage in activities that
would produce or increase suffering (Francis, 2009). Therefore, a psychologists
decision to breach confidentiality is well understood to the extent mandatory to
prevent clients causing harm to others or themselves (Koocher, 2007). This is in-
line with the code of ethics (2007), where section A.5.2 states that psychologists
may disclose confidential information if there is an immediate and specified risk
of harm to an identifiable person or persons that can only be averted by
disclosing information. Lamb, Clark, Drumheller, Frizzel & Surrey (1989) argued
that the diagnosis of HIV positivity is made by a physician, thus the
incompetence for a non-medical professional (a psychologist) may raise
questions on the confidentiality breach. However, this was strongly refuted by
the Management of People with HIV Infection Who Knowingly Risk Others
(2007) issued by Australian HIV Laws. Section 4.1 within the guideline states If a
responsible person is responsible for the care, support or education of a
suspected HIV person and is aware or has reason to believe that the person
engages in activity that carries a risk of exposure to HIV to another person, she
has the responsibility under the ACT Public Health 1997 to take reasonable
measures to ensure that others are not unknowingly placed at risk of infection.
Similarly in accordance with the 1974 Tarasoff court case, it was concluded,
When a doctor or a psychotherapist in the exercise of his professional skill and
knowledge determines, or should determine, that a warning is essential to avert
danger arising from medical or psychological condition of his patient, he incurs a
legal obligation to give that warning.

Therefore, it can be said that the psychologist decision to prolong
psychotherapy while Jenny is still sexually active is inappropriate. This is
because the risk of her partner to contract the virus in between the prolonging is
high. The principle of Goodwill refers to building a reputation through actions,
being concerned for others, and having concern of others interest, not just self-
interest (Francis, 2009) Applying this principle entails doing more than the
minimum for the client. Section 5.2.1 of APS (2007) states that disclosure of a
young persons information should be in the best interest of the minor. In regard
with informed consent, Section 5.2.3 asserts that it is a psychologists duty to
maintain the young persons confidentiality, and to limit any disclosure in
accordance with the express wishes of the young person, unless there is a clear
risk of the young person of other. Based on the aforementioned codes, the
psychologist would have the responsibility and authorization to disclose Jennys
health status for her own wellbeing and those involved. The information should
however, only be disclosed to those concerned; the parents, since they have legal
responsibility over the young person (APS, 2007), medical officials, to handle
Jennys heath situation appropriately, and her sexual partner, as the psychologist
has the duty to warn.

In order to come to a probable resolution, the ethical decision making
model may prove useful. To begin, it entails identifying the ethical standard
involved. With the main key principles being Suffering Prevention, Goodwill, and
prudence. This covers the general principles of Respect for the rights and dignity
of people and peoples, Propriety, and Integrity (Code of Ethics, 2007).
Confidentiality falls under this, of which the legal requirement to disclose is
involved. Step 2 is the determination of ethical trap possibilities, which in this
case is the Commonsense Objectivity Trap. Step 3 involves framing a
Preliminary Response. The code mentions an immediate and specified risk of
harm to an identifiable person or persons that can only be averted by disclosing
information of which the law supports. Step 4 involves consequences to be
considered. Short term consequences may involve the client to feel humiliated.
However, long term consequences involve appropriate medical care for the
client, resulting with improved health and not putting others in danger. Step 5
requires preparing ethical resolutions. With consideration of the codes and laws
previously stated, a proposed action would be to notify parents, sexual partner,
and medical authorities of the health danger. Step 6 involves getting feedback
from reliable sources. Lastly, action is taken to conclude the dilemma.

1570 words.


































References

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