Develop Ethical Sensitivity
My initial reaction to this ethically complex case concerned the potential boundary violations and conflicts of interest if Dr Morales allowed her daughter Isabella to attend the same camp as her client Jaqueline. As Jaqueline’s therapist, Dr. Morales has an ethical responsibility to maintain appropriate professional boundaries and avoid relationships that could impair her objectivity or judgment. Allowing their lives to intersect in this way in a non-therapeutic setting seems problematic from that perspective. I felt apprehension about the blurred personal and professional roles.
However, upon further reflection, I recognized the nuances of this situation that require a nuanced analysis. The camp provides a significant cultural opportunity for Isabella and Jaqueline to connect with their Latino heritage through traditional dance. As a Mexican American psychologist who specializes in treating trauma in adolescent girls, Dr. Morales likely appreciates the value of this culturally affirming experience for the psychological well-being of minority youth like Isabella and Jaqueline (Lipkin et al., 2021). Withdrawing Isabella could negatively impact their mother-daughter relationship and take away this meaningful experience from Isabella.
Additionally, if Jaqueline were to find out Isabella withdrew due to her attendance, it could adversely influence the therapist-client relationship between Dr. Morales and Jaqueline. There are no easy solutions that would eliminate boundary concerns while also serving the best interests of all involved parties. Careful analysis weighing the benefits and risks within the sociocultural context is needed to find an ethical resolution (Hoffman et al., 2021). This will require nuance rather than a blanket decision without consideration of the particular circumstances.
Stakeholders and Sociocultural Context
The main stakeholders in this ethically complex case are:
Dr. Morales: The Mexican American psychologist who specializes in treating trauma in adolescent girls and is currently treating Jaqueline. She is faced with deciding whether to allow her daughter, Isabella, to attend the same camp as her client, Jaqueline.
Isabella: Dr. Morales’s 16-year-old daughter who was invited to attend this culturally affirming camp focused on traditional Mexican dance (Lipkin et al., 2021). She is eager to participate.
Jaqueline: Dr. Morales’s 16-year-old Mexican American client who is recovering from prolonged childhood sexual abuse and suffers from an eating disorder. Jaqueline will be attending the camp as a camper.
The Latino Cultural Center: The non-profit community organization sponsoring this camp provides Latino youth in the community an opportunity to connect with their cultural identity through traditional dance.
This case is shaped by salient sociocultural factors, namely the ethnicity of the main stakeholders and the context of trauma that Jaqueline has experienced. Both Dr. Morales and Jaqueline are Mexican American. Dr. Morales’s expertise is specifically in treating Latina adolescents who have endured trauma. The camp, sponsored by the Latino Cultural Center, aims to provide an immersive experience connecting Latino youth to their cultural roots and traditions through traditional dance. For minority youth, experiences that affirm racial and ethnic identity can be critical for positive psychological adjustment and building self-esteem. However, Jaqueline’s ethnicity also shapes her experience as a trauma survivor. An applicable multicultural practice guideline emphasized by the APA is that psychologists should recognize culture-specific trauma reactions in clients and conduct culturally-informed trauma assessments (Hoffman et al., 2021). Jaqueline’s trauma as a survivor of prolonged sexual assault must be understood and treated within the context of her cultural background as a Latina adolescent. This sociocultural context is essential for trauma-informed practice.
Central Issues and Generate Options
Several pressing ethical issues emerge at the intersection of Dr. Morales’s roles as a mother, community member, and therapist to Jaqueline:
Boundary violations: If Dr. Morales allows her daughter to attend the camp with her client, Jaqueline, this could blur and confuse the boundaries between personal and professional relationships. Attending the camp together merges the therapist-client relationship with a non-therapeutic setting and relationship.
Conflicts of interest: Dr. Morales must balance her responsibilities as a mother to Isabella, her duty as a community member to support this culturally affirming experience for Latino youth, and her obligations as a psychologist to protect Jaqueline’s confidentiality and maintain appropriate professional boundaries (Hoffman et al., 2021). Her interests across her multiple roles have the potential to compete.
Confidentiality: Interacting in a non-professional setting at the camp could make it difficult for Dr. Morales to protect Jaqueline’s confidentiality as her client. If they interact at camp, Dr. Morales may be forced to reveal her identity as Jaqueline’s therapist.
Child welfare and best interests: Withdrawing her daughter Isabella from this meaningful cultural experience could negatively impact Dr. Morales’ relationship with her daughter. It could also damage the therapeutic alliance with Jaqueline if she discovers why Isabella withdrew.
This multifaceted ethical dilemma has no perfect solution, but several options could be considered:
Allow Isabella to attend the camp fully and set clear boundaries with Jaqueline if they interact to maintain roles.
Withdraw Isabella from attending the camp to eliminate any risk of boundary violations with Jaqueline.
Refer Jaqueline temporarily to another psychologist during camp so there is no conflict.
Seek Jaqueline’s perspective and preferences about how to navigate the situation.
Attend only parts of the camp program as a parent to limit interactions (Lipkin et al., 2021).
If they interact, disclose transparently to Jaqueline at camp that Isabella is her daughter.
Decline to attend the parent program at camp as planned initially, so interactions are limited.
Consult Ethical Standards and Law.
Several relevant ethical standards and laws should guide Dr. Morales’ decision-making process:
APA Standard 3.05, Multiple Relationships: This standard states that psychologists should refrain from entering into multiple relationships if there is a risk of impairment or exploitation (Hoffman et al., 2021). Attending the camp blurs the lines between Dr. Morales’ role as a parent and her professional role as Jaqueline’s therapist, constituting an ethically problematic multiple relationship.
APA Standard 3.04, Avoiding Harm and Boundary Violations: This standard emphasizes that psychologists must avoid harming clients and are responsible for setting clear boundaries that separate therapeutic from non-therapeutic roles (Beshara, 2022). The camp environment merges these roles and relationships, creating boundary confusion.
APA Standard 10.10, Terminating Therapy: To avoid ending therapy prematurely, psychologists take reasonable steps to avoid multiple relationships that could impair objectivity. Here, withdrawing her daughter could damage the therapeutic relationship and lead to early termination.
Illinois Mental Health and Developmental Disabilities Confidentiality Act: This state law protects the confidentiality of mental health patients. Disclosure of treatment information requires client consent. Jaqueline has not consented to disclosure of her treatment relationship to others at the camp.
Consult Research Findings
The research literature provides some helpful insights, though limited, given the specific nuances of this case. Research demonstrates that multiple relationships and boundary crossings between therapists and current or former clients often result in exploitation or harm to clients. However, some researchers emphasize that context matters greatly. For psychologists practising in small or rural communities, some non-sexual boundary crossings are often unavoidable due to close community ties. Research also demonstrates the importance of culturally-affirming experiences and activities for the psychological adjustment of minority youth. A study on Navajo adolescents found that ethnic identity affirmation through cultural activities boosted self-esteem and reduced depression (APA, 2010). Attending a traditional dance camp aligns with Jaqueline’s Latino identity, which could aid her trauma recovery. If she discovers the reason, withdrawing her daughter from this meaningful experience could detrimentally impact Dr. Morales’ therapeutic relationship with Jaqueline.
The research highlights the need for nuance based on contextual factors and careful consideration of potential benefits versus risks on a case-by-case basis when navigating multiple client relationships and boundaries. No blanket decision will fit all situations. Harm can occur both through boundary violations with clients and also through limiting meaningful cultural experiences for minority youth.
Apply Relevant Ethical Principles
Several ethical principles should guide decision-making:
Respect for autonomy (Principle E):An important priority should be respecting the autonomy of stakeholders, mainly the two adolescent clients, Jaqueline and Isabella. Jaqueline’s preferences and perspectives about handling the situation should be elicited and guided toward resolution (Hoffman et al., 2021). Her autonomy in the therapist-client relationship should be honoured. Isabella’s autonomy and desires as a youth also warrant respect.
Beneficence (Principle A): Decisions should promote the well-being, health, and best interests of all involved. For Jaqueline, both psychological risks regarding boundaries and clinical benefits regarding culture must be weighed (Duffey, 2019). For Isabella, the relational impact of her mother matters. Beneficence requires considering short and long-term well-being.
Nonmaleficence (Principle A): Psychologists have an ethical duty to avoid harm. Here, harm could arise through boundary violations eroding Jaqueline’s clinical progress but also through damage to the therapist-client relationship or Isabella’s relationship with her mother and cultural identity. Any option should minimize overall harm.
Fidelity and Responsibility (Principle B): Psychologists should uphold professional responsibilities, including maintaining boundaries and protecting confidential information. Dr Morales must balance her duties across her roles thoughtfully.
In summary, this complex case requires applying ethical decision-making skills with nuance rather than a generalized determination. I recommend that Dr. Morales thoughtfully discuss options and priorities with both Jaqueline and Isabella in an age-appropriate manner. Their perspectives should help guide a customized decision that respects their autonomy, preserves significant therapeutic and cultural benefits, and minimizes overall harm through appropriate professional boundaries.
References
Duffey, T. (2019). American Counseling Association (ACA). In Encyclopedia of Couple and Family Therapy (pp. 109–112). Cham: Springer International Publishing.
American Psychological Association. (2010). American Psychological Association ethical principles of psychologists and code of conduct.
Beshara, M. (2022). Adequate Clinical Supervision: Assisting Trainees in Managing Common Therapist/Client Sexualized Feelings (Doctoral dissertation, University of Hartford).
Hoffman, A. J., Kurtz-Costes, B., & Shaheed, J. (2021). Ethnic-racial identity, gender identity, and well-being in Cherokee early adolescents. Cultural Diversity and Ethnic Minority Psychology, 27(1), 60.
Lipkin, P. H., Macias, M. M., Norwood, K. W., Brei, T. J., Davidson, L. F., Davis, B. E., … & Voigt, R. G. (2020). Promoting optimal development: identifying infants and young children with developmental disorders through developmental surveillance and screening. Pediatrics, 145(1).
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