Vignette 1:
Dr. Thomas is a psychologist who is a part owner of a private practice in which they offer Employee Assistance Program (EAP) services. The EAP service provides a solution-focused, three-session benefit for companies within Pennsylvania. Dr. Thomas normally does not handle EAP services. Several staff members were either ill or overbooked, so Dr. Thomas responds to EAP requests during the day.
When dealing with the EAP program, she thinks her title of “doctor” might put people off, so she announces herself as “Sue” when dealing with EAP clients. When returning a call from Chuck who works for a company with the EAP benefit, the psychologist indicates that she is “Sue” from the EAP program. Chuck is a 20-year old man who immediately expresses a great deal of agitation and anger. He complains loudly about his parents and his girlfriend. In the process of conversation, Dr. Thomas realizes that Chuck is the son of her next-door neighbors. While Chuck now lives in an apartment in town, she remembers him well. She actually attended his graduation party briefly and hired him to cut her lawn for two years.
Also during the course of the phone contact, Chuck expresses some homicidal rage toward his parents, particularly around financial issues and early childhood sexual abuse from his father. Dr. Thomas wants him to come in immediately for a more in-depth evaluation. Chuck hesitated to have a face-to-face interview at the practice, but agreed only if he can talk with Sue. Sue schedules the appointment for early in the evening.
Questions to address:
A. What are the ethical concerns in this scenario?
B. How would you advise Dr. Thomas to handle them?
C. If you were a co-owner of the business, how would you feel about this situation?
Vignette 2:
Dr. Goodfriend receives a call from Buddy, his very close high school friend. Dr. Goodfriend speaks with Buddy about once every six to nine months. During those calls, the conversations typically focus on careers, family members, and the whereabouts about other classmates.
Buddy phoned Dr. Goodfriend in an apparent emotional anguish by the tone of his voice. Buddy states that he has been feeling “stressed” over the last month. He explains that he recently lost his job and has been worrying about the financial impact that this is having on his family. Buddy adds that he has had trouble sleeping, has stopped exercising, has little energy, and fleeting thoughts of hurting himself. Buddy also shares that he has been short tempered with his wife and kids.
During the 90-minute call, Dr. Goodfriend tries to be a good listener, empathizes with Buddy’s difficult situation, offers advice on ways that Buddy can better manage his stress, provides him with general encouragement, and suggests a book that outlines stress management and anxiety reduction strategies.
At the end of the call, Buddy tells Dr. Goodfriend that he is feeling much better. Just as he is about to hang up, Buddy says, “Thanks. My wife told me that I should see a therapist but I told her that I could talk with you and that it would be much cheaper.”
Dr. Goodfriend is unclear whether Buddy is serious or joking.
Questions to Address:
A. If you were Dr. Goodfriend, how do you feel about the phone call?
B. Does Dr. Goodfriend need to phone his high school friend to clarify his last comment?
C. Does Dr. Goodfriend need to encourage Buddy to become involved in therapy if symptoms persist?
D. Should Dr. Goodfriend call Buddy and offer a few referrals? What factors influence this decision?
Vignette 3:
A female psychologist works with a male patient for about one year in a suburban area. They agreed to meet weekly for the first four months of psychotherapy, and then they agreed to meet twice per month. They developed a good therapeutic alliance. During the course of their work, he discussed significant facts about his troubled past, numerous details about failed past relationships, and sexual fantasies. The main therapeutic issues are depression and loneliness.
During the current session, the patient related having made a new female friend. As social isolation, loneliness and depression are regular themes in treatment; the psychologist frames this as positive progress.
As the conversation continues, the psychologist is surprised to learn that the patient’s new friend is the ex-wife of the psychologist’s husband. The patient reveals that he became aware of that information after several dates and recently felt comfortable revealing this to the psychologist. He also indicated that the relationship is taking on a more serious tone.
The ex-wife moved back to the area about six months ago. The psychologist knows that the ex-wife had been struggling with isolation and loneliness as well. The psychologist, her husband, and his ex-wife are on good terms. They see her regularly for informal family events and do holidays together with their adult children and grandchildren.
After the session is over, the psychologist has time to reflect on her concerns. The psychologist feels stuck and overwhelmed by her present situation. She calls you for an ethics consult.
Questions to Address:
A. What are the ethical issues involved?
B. What would you suggest that she does?
C. With whom does the psychologist discuss the multiple roles?
D. Do you think the psychologist should continue the treatment relationship with the patient?
E. Even if they terminate therapy, how does the psychologist cope with family gatherings since she knows significant details about her patient’s life?
vignettes source: https://www.ethicalpsychology.com/p/vignette-warehouse.html
