Ethical Dilemma Scenarios (Oral Exam Prep)

Question 1

A psychologist works in an outpatient substance abuse treatment facility. His patient reveals, during the course of therapy, that a staff person paid to have sex with another patient, who is a prostitute. The staff member works in another department in the agency. And, according to the psychologist’s patient, the patient is not aware that one of her customers works in another part of that facility.

The psychologist does not know the therapist well, but has provided some consultation for the therapist in the past.

The psychologist does not dwell on the situation with the patient. However, after the session, the psychologist feels uneasy about what his patient revealed.

Answer 1

Use Ethical Decision making model to solve:

1. Identify individuals and groups involved
2. Identify ethically relevant issues and practices, as well as the context
3. Consider your own biases/pressures/personal needs/self-interest
4. Develop alternative courses of action
5. Analysis of short-term, ongoing, and long-term risks/benefits for each option
6. Choice of option (after codes, laws, regulations, etc. are applied/ considered)
7. Action (and assuming responsibilities for consequences)
8. Evaluation of results of the action
9. Assumption of responsibility of action (correction of negative outcomes, re-engaging in the process)
10. Appropriate proactive action to prevent future dilemmas

Question 2

A colleague of yours, Dr. Solomon, contacts you for advice regarding a new client she has just seen. The client, Mr. Don Tellanyone, is a 47-year-old man who is seeking services for depression. During the initial phone contact, he asked repeatedly about privacy and wanted assurances that information discussed in session was confidential. The patient repeated this line of questioning during the first face-to-face session.

As the session progressed, he revealed that the source of his depression was the death of his mother one year ago. His mother had suffered from a combination of severe respiratory problems and Alzheimer’s. Mr. Tellanyone had been caring for her and his father in his home for 6 years prior to her death. During the last two years, she required total care. He revealed that she had been suffering greatly and, out of compassion for her, he gave her an excess dose of her sleeping and pain pills. Medical personnel never questioned the death as the woman had been quite sick and “It was only a matter of time.”

Mr. Tellanyone goes on to explain that he is now caring for his father in similar circumstances, although there is no dementia. His father has declined rapidly since the death of his wife and now requires total care. Mr. Tellanyone reveals that recently he had a conversation with his father in which the father commented how peaceful his wife’s death was and how he hoped for a similar passing.

Mr. Tellanyone is feeling quite guilty about his mother. Simultaneously, he strongly believes he made the right decision. He would like help to work through the issues. He is also very concerned about confidentiality and wants assurances from Dr. Solomon.

Dr. Solomon, feeling uncomfortable with the situation, contacts you for a consultation about the potential ethical issues for this case.

Answer 2

Use Ethical Decision making model to solve:

1. Identify individuals and groups involved
2. Identify ethically relevant issues and practices, as well as the context
3. Consider your own biases/pressures/personal needs/self-interest
4. Develop alternative courses of action
5. Analysis of short-term, ongoing, and long-term risks/benefits for each option
6. Choice of option (after codes, laws, regulations, etc. are applied/ considered)
7. Action (and assuming responsibilities for consequences)
8. Evaluation of results of the action
9. Assumption of responsibility of action (correction of negative outcomes, re-engaging in the process)
10. Appropriate proactive action to prevent future dilemmas

Question 3

A psychologist had an intake appointment with a new client. As soon as he looked at the intake form, he realized that she is the ex-wife of his former client. The therapy with the ex-husband was brief, and he focused on how he wanted to leave the marriage. The prospective client was using her maiden name and gave no indication that she had known about her ex-husband’s treatment with the psychologist.

When asked about the reason for the referral, she said that her physician had referred her for anxiety. During the session, she stated that he is still in communication with her ex-husband because they share three children.

Answer 3

Use Ethical Decision making model to solve:

1. Identify individuals and groups involved
2. Identify ethically relevant issues and practices, as well as the context
3. Consider your own biases/pressures/personal needs/self-interest
4. Develop alternative courses of action
5. Analysis of short-term, ongoing, and long-term risks/benefits for each option
6. Choice of option (after codes, laws, regulations, etc. are applied/ considered)
7. Action (and assuming responsibilities for consequences)
8. Evaluation of results of the action
9. Assumption of responsibility of action (correction of negative outcomes, re-engaging in the process)
10. Appropriate proactive action to prevent future dilemmas

Question 4

A psychologist is treating a client who is involved in a legal proceeding. The client presents the psychologist with information about a well-known, local psychologist who released confidential information to an attorney without a signed release or court order. After the psychologist reviews the information presented, it is clear to the treating psychologist that other psychologist breached confidentiality.

The treating psychologist knows the local psychologist who released the information, but does not have a strong relationship with him. The treating psychologist is questioning what to do.

Answer 4

Use Ethical Decision making model to solve:

1. Identify individuals and groups involved
2. Identify ethically relevant issues and practices, as well as the context
3. Consider your own biases/pressures/personal needs/self-interest
4. Develop alternative courses of action
5. Analysis of short-term, ongoing, and long-term risks/benefits for each option
6. Choice of option (after codes, laws, regulations, etc. are applied/ considered)
7. Action (and assuming responsibilities for consequences)
8. Evaluation of results of the action
9. Assumption of responsibility of action (correction of negative outcomes, re-engaging in the process)
10. Appropriate proactive action to prevent future dilemmas

Question 5

Dr. Smith is a psychologist who has worked with a young woman for about 9 months. The patient presents with a history of rejection and abandonment as well as persons of power misusing her. She recently received an offer to become a sales representative for a pharmaceutical company. The psychologist and patient discussed the type of job she was entering because she may experience rejection from doctors, nurses, and other office personnel.

After her 6 weeks of training, the company assigns her to a regional director that the psychologist knows personally. Along with the initial anxiety of the new job, her territory, and her boss, she reports a fear of failure and other anxiety related symptoms. The psychologist knows her new boss, Mr. Biggy. The psychologist seeks to reassure the patient that he, the psychologist, knows Mr. Biggy on a personal basis and that “he is a really a good guy” that seems bright, friendly, and fair. He indicates that Mr. Biggy is a good “family man”. The patient is reassured, and reported less anxiety. In actuality, Mr. Biggy’s wife is a very close friend of Dr. Smith’s wife. They have dinner as couples several times per year.

Several weeks into going on sales calls, your patient reports that Mr. Biggy is complimenting her on the way she looks and her ability to make the sale. They start spending more time together. However, she begins to feel uncomfortable as she feels like they are spending too much time together. Mr. Biggy starts asking questions that are more personal, forwards her “funny” emails, and texts some inappropriate remarks to her, mainly about her alluring power that helps make sales.

Mr. Biggy and Dr. Smith meet in an unplanned social venue. Mr. Biggy pulls Dr. Smith aside and explains how he has become very attracted to a new sales representative. He thinks that she is young and impressionable. He confides that he would like to have an affair with her.

Dr. Smith politely explains that he feels uncomfortable with them discussing his more personal marital issues. Mr. Biggy indicates that he wants to talk more about his feelings. Dr. Smith suggests a referral to a psychologist, but Mr. Biggy states that he feels more comfortable talking with Dr. Smith. After some other small talk, Dr. Smith leaves to mingle with other friends.

Dr. Smith is now worried about the entire situation.

Answer 5

Use Ethical Decision making model to solve:

1. Identify individuals and groups involved
2. Identify ethically relevant issues and practices, as well as the context
3. Consider your own biases/pressures/personal needs/self-interest
4. Develop alternative courses of action
5. Analysis of short-term, ongoing, and long-term risks/benefits for each option
6. Choice of option (after codes, laws, regulations, etc. are applied/ considered)
7. Action (and assuming responsibilities for consequences)
8. Evaluation of results of the action
9. Assumption of responsibility of action (correction of negative outcomes, re-engaging in the process)
10. Appropriate proactive action to prevent future dilemmas

Question 6

A psychologist receives a phone call from a well-known internist in her area. The psychologist is involved in a busy practice, specializes in treating eating disorders, and receives only occasional referrals from this physician. The physician wants the psychologist to treat his 17-year-old daughter, who suffers with what he describes to be an eating disorder and perhaps some Borderline Personality Disorder traits.
The physician explains that he has been medicating her for about four months with Prozac and Klonopin, once he became aware of her eating disordered behavior. Because of his status as a well-known internist, he does not want to refer his daughter to a psychiatrist because he believes that he can handle the medication piece of her treatment. He will also pay for all treatment in cash, as he wants as few people and organizations to know about his daughter’s issues.
Feeling somewhat uncomfortable with the medication management issue, the psychologist indicates that she will have to call him back after looking at her schedule. The psychologist then phones you for an informal consultation. The psychologist expresses her concerns about working with a patient whose father is prescribing medication.

Answer 6

Use Ethical Decision making model to solve:

1. Identify individuals and groups involved
2. Identify ethically relevant issues and practices, as well as the context
3. Consider your own biases/pressures/personal needs/self-interest
4. Develop alternative courses of action
5. Analysis of short-term, ongoing, and long-term risks/benefits for each option
6. Choice of option (after codes, laws, regulations, etc. are applied/ considered)
7. Action (and assuming responsibilities for consequences)
8. Evaluation of results of the action
9. Assumption of responsibility of action (correction of negative outcomes, re-engaging in the process)
10. Appropriate proactive action to prevent future dilemmas

Question 7

ou are checking your email after a busy day. The following email catches your attention.

==================================
From: PsychBuilder – High Tech Psychology at Low Cost
Sent: Monday, November 10, 2011 6:37 PM
Subject: Online Assessment Tool to Promote your Practice

Dear Psychologist,

My name is Dr. Rob West, President and CEO of PsychBuilder Inc. located in San Jose, California. My company has developed a unique opportunity for you and your associates. PsychBuilder Inc. developed the first internet-based administration and scoring of the Personality Assessment Symptom Scale-2, the PASS-2. Psychologists have used the PASS-2 for psychological diagnoses and evaluations for a number of years. The PASS-2 is administered online, from any computer, iPad, or iPhone connected to the internet. The test usually takes approximately 40 to 60 minutes to administer. Results will be available to you and the patient online.

Important to an entrepreneurial psychologist like you, this assessment bridges the gap between psychology and primary care. Numerous patients from family practice offices can be given the internet link (http://www.psychbuilder.org/) and a security code to complete the PASS-2. The test is designed to determine if the patient can benefit from psychotherapy, psychotropic agents, or other psychological services. While it is not a complete assessment, it can guide patients to you for further psychological consultation.

After a patient completes the assessment, an email will be sent to you (based on the security code) and the patient within 24 hours, providing a secure link to review the results of the PASS-2. Patient contact information will be part of the administration process.

The cost of the online administration is $25, to be paid by the patient. For this to be a successful venture, we ask you to promote this program to your referring physicians, nurse practitioners, and physician assistants in order to enhance their ability to identify, evaluate and provide needed treatment for their patients.

We have great data on the PASS-2 for reliability and validity in identifying primary care patients who can benefit from psychological services. Unfortunately, many patients struggling with mental health issues in primary care settings are not properly identified or treated.

Because of busy primary care practices, the PASS-2 can be completed at home, if the office does not have internet access for patient use.

The physician, nurse practitioner, or physician’s assistant will offer patients this important opportunity via a specially designed 4 x 6 card. On that card, there will be information that explains the importance of completing this assessment, the cost, and that a licensed psychologist will review the results and contact the patient by phone within 3 to 5 business days.

An important factor is that there is no cost to you, as the psychologist. You will receive a high quality report that offers diagnostic possibilities, suicide potential, and treatment planning options for new patients.

I encourage you to review our web site at http://www.psychbuilder.com/. If you have further questions, feel free to contact me.

Sincerely,

Robert West, PhD, ABPP
Psychologist

Answer 7

Use Ethical Decision making model to solve:

1. Identify individuals and groups involved
2. Identify ethically relevant issues and practices, as well as the context
3. Consider your own biases/pressures/personal needs/self-interest
4. Develop alternative courses of action
5. Analysis of short-term, ongoing, and long-term risks/benefits for each option
6. Choice of option (after codes, laws, regulations, etc. are applied/ considered)
7. Action (and assuming responsibilities for consequences)
8. Evaluation of results of the action
9. Assumption of responsibility of action (correction of negative outcomes, re-engaging in the process)
10. Appropriate proactive action to prevent future dilemmas

Question 8

Dr. Faye Miller receives a referral for a 35-year-old female, Betty Drapier, who is both feeling depressed and experiencing marital problems. During the first few sessions, Mrs. Drapier indicates that her husband, Don, is depressed and in treatment. Part of her struggle is that she sees her husband as more depressed now than when he started treatment. By Mrs. Drapier’s report, he appears more stressed because of his job and drinking alcohol more frequently. She reports that his treating psychologist, Dr. Cooper, is working with her husband and has allegedly advised him to discontinue his medication in favor of an herbal remedy (St. John’s Wort). Dr. Miller suggests that she meet with both Mr. and Mrs. Drapier to evaluate the marital situation.

At that time, Dr. Miller not only wanted to evaluate the marriage, but to evaluate how impaired the husband was, and Mrs. Drapier’s ability to assess her husband and the marriage accurately.

During the next session, Mr. and Mrs. Drapier arrive separately, but on time. Mr. Drapier acknowledges many cognitive, behavioral, and physical symptoms of serious depression. Mr. Drapier smelled as if he had been drinking. Mr. Drapier also admits that his alcohol use has increased. He also divulged that his risk-taking behavior has increased as well, such as speeding. During the session, Mr. Drapier verbalized suicidal ideation in a flip manner (“Sometimes I think it would be better if I just killed myself”). The marital situation appears deteriorated and Mr. Drapier appears significantly depressed.

As the session winds down, Mr. Drapier spontaneously asks for a second opinion about his treatment with Dr. Cooper. He indicated that Dr. Cooper recommended that he discontinue a psychotropic medication in favor of an herbal remedy. Mr. Drapier mentions that Dr. Cooper sells St. John’s Wort to him directly.

After reiterating the purpose of the session (which was to assess the marital situation and not to assess his current treatment), Dr. Miller states that she feels uncomfortable with the request, although she is concerned about the psychologist’s reported behavior. She is also concerned about Mr. Drapier’s level of depression, alcohol use, and suicidal statement.

Abruptly, Mr. Drapier looks at his watch and leaves the office explaining that he is late for a business meeting.

Answer 8

Use Ethical Decision making model to solve:

1. Identify individuals and groups involved
2. Identify ethically relevant issues and practices, as well as the context
3. Consider your own biases/pressures/personal needs/self-interest
4. Develop alternative courses of action
5. Analysis of short-term, ongoing, and long-term risks/benefits for each option
6. Choice of option (after codes, laws, regulations, etc. are applied/ considered)
7. Action (and assuming responsibilities for consequences)
8. Evaluation of results of the action
9. Assumption of responsibility of action (correction of negative outcomes, re-engaging in the process)
10. Appropriate proactive action to prevent future dilemmas

Question 9

A psychologist receives a phone message from a former patient. The former patient is asking for the psychologist to be a “character witness” as he has an upcoming hearing for a minor criminal offense. His attorney believes that some good, written character references will really help out with the case.

The psychologist pulls the former patient’s chart. The psychologist has not worked with the patient for about two years. Additionally, none of the treatment issues had to do with impulse control or antisocial tendencies. Therapy lasted about a year and focused on depression and relationship issues. The psychologist recalls that the patient had always been good-natured, attended appointments regularly, and worked well in therapy. The psychologist remembers the former patient as a likeable person.

Answer 9

Use Ethical Decision making model to solve:

1. Identify individuals and groups involved
2. Identify ethically relevant issues and practices, as well as the context
3. Consider your own biases/pressures/personal needs/self-interest
4. Develop alternative courses of action
5. Analysis of short-term, ongoing, and long-term risks/benefits for each option
6. Choice of option (after codes, laws, regulations, etc. are applied/ considered)
7. Action (and assuming responsibilities for consequences)
8. Evaluation of results of the action
9. Assumption of responsibility of action (correction of negative outcomes, re-engaging in the process)
10. Appropriate proactive action to prevent future dilemmas

Question 10

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.

Answer 10

Use Ethical Decision making model to solve:

1. Identify individuals and groups involved
2. Identify ethically relevant issues and practices, as well as the context
3. Consider your own biases/pressures/personal needs/self-interest
4. Develop alternative courses of action
5. Analysis of short-term, ongoing, and long-term risks/benefits for each option
6. Choice of option (after codes, laws, regulations, etc. are applied/ considered)
7. Action (and assuming responsibilities for consequences)
8. Evaluation of results of the action
9. Assumption of responsibility of action (correction of negative outcomes, re-engaging in the process)
10. Appropriate proactive action to prevent future dilemmas

Question 11

A psychologist receives a letter from an attorney indicating that he inherited an old car from Frank Palmer. Upon reflection, the psychologist recalls that he had treated Mr. Palmer a number of years ago. Looking through his files, the psychologist cannot find his file, so it must have been more than five years ago.

The psychologist phones the attorney and discovers that Mr. Palmer left him a 1993 four-wheel drive Ford Explorer. He asked the attorney if anyone is contesting the will. Apparently, no one is. The executor is Mr. Palmer’s brother, who lives in a different state.

The psychologist obtains the keys and title for the vehicle. He drives the car to a local dealer who indicated that the Explorer is worth about $3,500.

The psychologist cannot remember many details about the patient. He recalled that he was an older person with significant depression who eventually became better. There is nothing unusual that stands out about their therapeutic relationship.

Feeling guilty, the psychologist calls you on the phone to discuss his feelings and any possible ethical concerns.

Answer 11

Use Ethical Decision making model to solve:

1. Identify individuals and groups involved
2. Identify ethically relevant issues and practices, as well as the context
3. Consider your own biases/pressures/personal needs/self-interest
4. Develop alternative courses of action
5. Analysis of short-term, ongoing, and long-term risks/benefits for each option
6. Choice of option (after codes, laws, regulations, etc. are applied/ considered)
7. Action (and assuming responsibilities for consequences)
8. Evaluation of results of the action
9. Assumption of responsibility of action (correction of negative outcomes, re-engaging in the process)
10. Appropriate proactive action to prevent future dilemmas

Question 12

Dr. Lilith Crane, a psychologist from a small rural campus, calls you on the phone for a consultation.
Dr. Crane currently works with an undergraduate student, Dan, on issues related to self-esteem and depression. An ongoing theme in therapy revolves around his sexual orientation. Dan recently came out to his parents, who were accepting of his gay orientation and lifestyle. From that positive experience, Dan wants to start a support organization for other GLBTQ students on campus.

Dan explained to Dr. Crane that this group would be student-led and meet on campus. He does not view it as a therapy group. Dan’s vision is that the group would meet periodically to provide one another with support, to do problem solving, to share information and personal struggles, and perhaps to provide some psycho-educational work on campus. Dan indicates that they may also want to engage in fundraising in order for GLBTQ students to attend state or national events.

Dan asked a number of faculty members to be the faculty advisor of this group. While most were supportive, all declined the invitation (likely because the campus is small and in a conservative area of the state).
Out of options, Dan asked Dr. Crane to be the faculty advisor. Dr. Crane applauded and appreciated the student’s energy and creativity, but indicated some concern about dual role with the student. She told the student that she would think about the request prior to answering.

Dr. Crane is questioning the pros and cons of being the psychologist and the faculty advisor. Dr. Crane feels ambivalent because of their therapeutic relationship, but also wants to help Dan because he appears to have limited options.

Answer 12

Use Ethical Decision making model to solve:

1. Identify individuals and groups involved
2. Identify ethically relevant issues and practices, as well as the context
3. Consider your own biases/pressures/personal needs/self-interest
4. Develop alternative courses of action
5. Analysis of short-term, ongoing, and long-term risks/benefits for each option
6. Choice of option (after codes, laws, regulations, etc. are applied/ considered)
7. Action (and assuming responsibilities for consequences)
8. Evaluation of results of the action
9. Assumption of responsibility of action (correction of negative outcomes, re-engaging in the process)
10. Appropriate proactive action to prevent future dilemmas

Question 13

You are a psychologist in a busy acute care hospital where you receive frequent consultation requests by the trauma service. A physician requests a psychological evaluation of a 46-year-old man who attempted suicide via over dose of prescription medications along with alcohol. You arrive in the intensive care unit where the patient’s respiratory status is rapidly deteriorating. He is marginally coherent and unable to give any consistent responses. However, upon his arrival in the emergency department, the medical record quotes the patient as saying, “This wasn’t supposed to have happened.”

The ICU nurse asks you to offer an opinion regarding the patient’s capacity to accept or refuse intubation.

While you are there, a family member arrives with a copy of a notarized advance directive, created within the last year, which specifically outlines the patient’s wishes not to be placed on a ventilator or any artificial life support. The ICU staff asks for your input.

Answer 13

Use Ethical Decision making model to solve:

1. Identify individuals and groups involved
2. Identify ethically relevant issues and practices, as well as the context
3. Consider your own biases/pressures/personal needs/self-interest
4. Develop alternative courses of action
5. Analysis of short-term, ongoing, and long-term risks/benefits for each option
6. Choice of option (after codes, laws, regulations, etc. are applied/ considered)
7. Action (and assuming responsibilities for consequences)
8. Evaluation of results of the action
9. Assumption of responsibility of action (correction of negative outcomes, re-engaging in the process)
10. Appropriate proactive action to prevent future dilemmas

Question 14

Dr. Ron Popeil, a local psychologist, is upgrading his web site. Along with a variety of upgrades, the web developer/consultant suggests that he add a testimonial page where former patients describe their positive experiences in therapy. Since the web developer/consultant wants to get that page up and running, he suggests that they use some positive ratings and responses from Angie’s list and several other ratings sites that tell positive stories and experiences with Dr. Popeil.
Dr. Popeil thinks these ideas are good. However, he researches the APA Ethics Code and believes that he may be acting inappropriately. To discuss the matter in further detail, Dr. Popeil calls you for an ethics consult.

Answer 14

Use Ethical Decision making model to solve:

1. Identify individuals and groups involved
2. Identify ethically relevant issues and practices, as well as the context
3. Consider your own biases/pressures/personal needs/self-interest
4. Develop alternative courses of action
5. Analysis of short-term, ongoing, and long-term risks/benefits for each option
6. Choice of option (after codes, laws, regulations, etc. are applied/ considered)
7. Action (and assuming responsibilities for consequences)
8. Evaluation of results of the action
9. Assumption of responsibility of action (correction of negative outcomes, re-engaging in the process)
10. Appropriate proactive action to prevent future dilemmas

Question 15

Dr. Joey Bishop has been conducting pre-ordination evaluations for a religious institution for many years. The purpose of these psychological evaluations is to identify individuals who have gross psychopathology, strong personality disorders, or other characteristics that would make them incapable of performing their religious duties adequately. Dr. Bishop developed a strong relationship with this institution and they have been quite satisfied with his work.

One day, Dr. Bishop receives a phone call from his contact at the institution. The contact is now requesting that Dr. Bishop begin to screen individuals for “homosexual tendencies” because, according to the doctrines of the denomination, such individuals are not eligible to become clergy.

Dr. Bishop feels uneasy about this situation, as “homosexuality” has not been considered a mental illness since the 1970s. Simultaneously, the religious institution is adamant about this requirement.

Answer 15

Use Ethical Decision making model to solve:

1. Identify individuals and groups involved
2. Identify ethically relevant issues and practices, as well as the context
3. Consider your own biases/pressures/personal needs/self-interest
4. Develop alternative courses of action
5. Analysis of short-term, ongoing, and long-term risks/benefits for each option
6. Choice of option (after codes, laws, regulations, etc. are applied/ considered)
7. Action (and assuming responsibilities for consequences)
8. Evaluation of results of the action
9. Assumption of responsibility of action (correction of negative outcomes, re-engaging in the process)
10. Appropriate proactive action to prevent future dilemmas

Question 16

A psychologist receives a call from an attorney wishing to seek services for depression, anxiety and substance abuse. The psychologist screens the potential patient and she believes that she can help him. When she asks about insurance, he indicates that he will use cash payments. The psychologist explains the fee structure for the initial appointment as well as ongoing psychotherapy sessions. The lawyer-patient comments that this seems low. The psychologist ignores the comment and finishes by setting their initial appointment.

The psychologist and the attorney-patient meet for the initial session. At the end of the session, the psychologist asks for the requisite fee as stated on the phone. The attorney-patient indicates that he earns about 2.5 times what the psychologist asked. He indicates that, in order for him to benefit from the treatment, he feels a need to pay what he makes an hour. He also states that if she does not accept what he is offering, he will lose respect for her as a professional and probably not return for treatment.

Not knowing what to do, the psychologist takes the cash and sets up another appointment. At the end of the day, the psychologist reflects on the interaction between she and her new lawyer-patient. She does not feel right taking a fee larger than her usual and customary rate. She is struggling that the situation is not right and feels very uneasy about the arrangement that the lawyer-patient foisted upon her.

Uncertain, she calls you for an ethics consultation.

Answer 16

Use Ethical Decision making model to solve:

1. Identify individuals and groups involved
2. Identify ethically relevant issues and practices, as well as the context
3. Consider your own biases/pressures/personal needs/self-interest
4. Develop alternative courses of action
5. Analysis of short-term, ongoing, and long-term risks/benefits for each option
6. Choice of option (after codes, laws, regulations, etc. are applied/ considered)
7. Action (and assuming responsibilities for consequences)
8. Evaluation of results of the action
9. Assumption of responsibility of action (correction of negative outcomes, re-engaging in the process)
10. Appropriate proactive action to prevent future dilemmas

Question 17

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.

Answer 17

Use Ethical Decision making model to solve:

1. Identify individuals and groups involved
2. Identify ethically relevant issues and practices, as well as the context
3. Consider your own biases/pressures/personal needs/self-interest
4. Develop alternative courses of action
5. Analysis of short-term, ongoing, and long-term risks/benefits for each option
6. Choice of option (after codes, laws, regulations, etc. are applied/ considered)
7. Action (and assuming responsibilities for consequences)
8. Evaluation of results of the action
9. Assumption of responsibility of action (correction of negative outcomes, re-engaging in the process)
10. Appropriate proactive action to prevent future dilemmas

Question 18

Dr. Jordan is a psychologist who typically works with a wide variety of patients. At the end of the day, he listens to voicemail messages to learn that a former patient is reaching out to him for a request.

Prior to returning the call, Dr. Jordan reviews the patient’s chart. The patient had been in treatment for about 10 months on a weekly basis. The treatment notes indicate that she dropped out of therapy about one year ago. She stopped therapy because her insurance changed and Dr. Jordan was not an in-network provider. The therapy focused on depression and anxiety related to work-related issues, interpersonal limitations, and relationship difficulties. Some of the sessions focused on a sexually abusive relationship between a basketball coach and the patient when she was age 13 to 16.

Dr. Jordan returns the phone call. After the initial greetings, the former patient indicates that she has finally started to write down more thoughts, memories, and recollections about her abusive experiences. She stated that Dr. Jordan recommended that she write down her memories. She recalled that he agreed that it could make a good book. She stated she wanted to include some education around sexual abuse and tell her story in a healthy, therapeutic manner.

When attempting to clarify the request, the former patient is not asking to return to therapy, but to have Dr. Jordan become the co-author or a consultant for the book. Dr. Jordan thanked her for the compliment and indicated that he needed to think about the request. He promised to call her back within a week.

Answer 18

Use Ethical Decision making model to solve:

1. Identify individuals and groups involved
2. Identify ethically relevant issues and practices, as well as the context
3. Consider your own biases/pressures/personal needs/self-interest
4. Develop alternative courses of action
5. Analysis of short-term, ongoing, and long-term risks/benefits for each option
6. Choice of option (after codes, laws, regulations, etc. are applied/ considered)
7. Action (and assuming responsibilities for consequences)
8. Evaluation of results of the action
9. Assumption of responsibility of action (correction of negative outcomes, re-engaging in the process)
10. Appropriate proactive action to prevent future dilemmas

Question 19

A psychologist has been working individually with a 17-year-old male for issues related to depression and family dynamics. The psychologist and the young man have been engaged in psychotherapy for the past 2 years. The patient has trust issues with his parents, especially his father.

Ten minutes prior the scheduled appointment, the patient’s mother calls the psychologist on the phone. The mother explains that the child has run away and the mother has reported the child missing to the police. The mother further reports that the patient’s cousin has been driving the patient around town. She wants the psychologist to phone the police immediately when the patient arrives in order to arrest the cousin for unlawfully detaining the minor child or kidnapping and recover her minor child.

After the phone call, the psychologist checks the waiting room and sees the patient there. He is talking with a young man, most likely his cousin.

Answer 19

Use Ethical Decision making model to solve:

1. Identify individuals and groups involved
2. Identify ethically relevant issues and practices, as well as the context
3. Consider your own biases/pressures/personal needs/self-interest
4. Develop alternative courses of action
5. Analysis of short-term, ongoing, and long-term risks/benefits for each option
6. Choice of option (after codes, laws, regulations, etc. are applied/ considered)
7. Action (and assuming responsibilities for consequences)
8. Evaluation of results of the action
9. Assumption of responsibility of action (correction of negative outcomes, re-engaging in the process)
10. Appropriate proactive action to prevent future dilemmas

Question 20

Dr. Plenty lives and practices psychology in a rural area. She began to provide psychotherapy to Mr. DiMencha, a 52-year-old, who suffered with depression. After six sessions, Mr. DiMencha suffered a significant concussion while at work. His impairment is noticeable by Dr. Plenty without any type of testing. He struggles with understanding concepts and becomes tangential during the next two sessions.

Mr. DiMencha’s co-worker, Janet, helped him find an attorney so that his rights are protected. Dr. Plenty had Mr. DiMencha sign a release to talk with the attorney as well as Janet. From a phone call with the attorney, Workers Compensation wants to work out a settlement. However, the attorney has little awareness about how impaired Mr. DiMencha is. The patient has never met the attorney face-to-face, just by email and phone contacts.

Mr. DiMencha demonstrates a variety of cognitive deficits. He needs assistance and monitoring with daily tasks, such as home care, shopping, transportation, understanding the settlement process, reading his mail, and paying his bills. He will likely need to go into an assisted living facility. His family lives at a distance and provides minimal help. Workers Compensation refuses to pay for the case management services of an independent social worker. Attempts to find social service agencies able to help him have not been successful. Mr. DiMencha doesn’t appear to understand his legal rights or the settlement process.

Prior to providing extra-therapy support, Dr. Plenty had Mr. DiMencha sign a document explaining her fees for the additional services. She is not sure that he completely understands what is happening or her version of informed consent for the additional services. The psychologist has been doing much of the case management work, e.g. locating a long-time friend who is willing to help him at home, referring him to a neuropsychologist for testing, engaging in lengthy discussions with his primary care physician and neurologist, participating in multiple conversations with the attorney, and trying to find a guardian or power of attorney.

In the midst of all of this activity, the psychologist contacts you for an ethics consultation.

Answer 20

Use Ethical Decision making model to solve:

1. Identify individuals and groups involved
2. Identify ethically relevant issues and practices, as well as the context
3. Consider your own biases/pressures/personal needs/self-interest
4. Develop alternative courses of action
5. Analysis of short-term, ongoing, and long-term risks/benefits for each option
6. Choice of option (after codes, laws, regulations, etc. are applied/ considered)
7. Action (and assuming responsibilities for consequences)
8. Evaluation of results of the action
9. Assumption of responsibility of action (correction of negative outcomes, re-engaging in the process)
10. Appropriate proactive action to prevent future dilemmas

Question 21

Dr. Tell worked with a woman for several months on issues related to depression, anxiety, and relationship issues. During one session, the patient indicated that her boyfriend has lost interest in sex and became more involved with online pornography. While discussing these issues, the patient suddenly stopped talking. Dr. Tell allowed several moments to pass before asking the patient what was happening.

The client indicated that she was hesitant to speak about the issue for fear of a breach of confidentiality. Dr. Tell reminded her about confidentiality and the laws in Pennsylvania that would override it. The client continued to struggle. She eventually blurted out that, during a heated discussion, her boyfriend indicated that looking at online pornography was not as bad as what his uncle did. She went on to detail how her boyfriend described how his uncle was involved in collecting and distributing child pornography but remained faithful to his aunt. The client’s boyfriend expressed that she should never discuss this with anyone. The client asked if she could just give Dr. Tell the information about the uncle so that she could report it to the authorities and leave her out of the situation. The client is feeling very helpless and vulnerable about this bind.

Dr. Tell explained that the alleged perpetrator was several times removed from their sessions and she did not believe that she had the obligation to report it. The client then asked if she could invite her boyfriend to the next session so that they could all discuss the information and the best way to handle the situation.

Dr. Tell focused the client on her dilemma as well as the relationship issues with her boyfriend. Dr. Tell agreed to contact someone to discuss whether Dr. Tell had to report this information to the police or Child Protective Services. And, Dr. Tell agreed to determine whether or not reporting this information would put her client’s confidentiality at risk. She also agreed to think about the need to bring in the boyfriend, because inviting him to therapy will not necessarily help the situation.

Answer 21

Use Ethical Decision making model to solve:

1. Identify individuals and groups involved
2. Identify ethically relevant issues and practices, as well as the context
3. Consider your own biases/pressures/personal needs/self-interest
4. Develop alternative courses of action
5. Analysis of short-term, ongoing, and long-term risks/benefits for each option
6. Choice of option (after codes, laws, regulations, etc. are applied/ considered)
7. Action (and assuming responsibilities for consequences)
8. Evaluation of results of the action
9. Assumption of responsibility of action (correction of negative outcomes, re-engaging in the process)
10. Appropriate proactive action to prevent future dilemmas

Question 22

Dr. Smith was treating Mrs. Drapier for depression precipitated, in part, by a separation and pending divorce. There were contentious issues dealing with the custody arrangements of the children. A court appointed custody evaluator performed a child custody evaluation. Among other things, the report contained a psychological evaluation of the patient.

Mrs. Drapier thought it would be good for Dr. Smith to review the report in order to help him with their therapy. Mrs. Drapier read the report and admitted that she did not understand some of the psychological jargon used in the report and had difficulty understanding what the conclusions of the report were.

Dr. Smith decided to review the report. He believed that the custody evaluator had made several significant errors in the report concerning the psychological health of his patient. Additionally, Dr. Smith believed that some of the conclusions were in error, and had little support for those opinions in the body of the report.

Prior to their next session, Dr. Smith calls you for a consultation.

Dr. Smith asked if he needed to inform the patient of his impressions of the report and the seemingly erroneous conclusions. He feels stuck between being faithful to the patient and her needs without crossing a boundary as a treating psychologist.

He also wondered if he should contact the patient’s lawyer, with her permission, to disclose his perceptions about the quality of the report and his perceptions about the conclusions.

Dr. Smith also wondered if it was appropriate to bill Mrs. Drapier for his time in reviewing the report.

Dr. Smith also asked if it is ethical to bill the patient’s insurance company to review his impressions of a forensic report during a psychotherapy session.

Answer 22

Use Ethical Decision making model to solve:

1. Identify individuals and groups involved
2. Identify ethically relevant issues and practices, as well as the context
3. Consider your own biases/pressures/personal needs/self-interest
4. Develop alternative courses of action
5. Analysis of short-term, ongoing, and long-term risks/benefits for each option
6. Choice of option (after codes, laws, regulations, etc. are applied/ considered)
7. Action (and assuming responsibilities for consequences)
8. Evaluation of results of the action
9. Assumption of responsibility of action (correction of negative outcomes, re-engaging in the process)
10. Appropriate proactive action to prevent future dilemmas

Answer 23

Use Ethical Decision making model to solve:

1. Identify individuals and groups involved
2. Identify ethically relevant issues and practices, as well as the context
3. Consider your own biases/pressures/personal needs/self-interest
4. Develop alternative courses of action
5. Analysis of short-term, ongoing, and long-term risks/benefits for each option
6. Choice of option (after codes, laws, regulations, etc. are applied/ considered)
7. Action (and assuming responsibilities for consequences)
8. Evaluation of results of the action
9. Assumption of responsibility of action (correction of negative outcomes, re-engaging in the process)
10. Appropriate proactive action to prevent future dilemmas

Question 24

Dr. Solomon, a psychologist on an inpatient psychiatric treatment team, is concerned about the pending discharge of a current inpatient. The patient admitted herself to the unit, with some persuasion by the local police, for making loud threats and menacing gestures in her neighbor’s driveway. Hence, the admission is voluntary.

Currently, the patient is denying the fact that she has made past threats toward her neighbor. However, the police report indicated she has made such verbal threats in the past but also, on several occasions, has damaged her neighbors property including scratching the paint on their car and throwing rocks at their house. Innuendos are that she allegedly killed her neighbors pet, but this has been unproven by the police.

During some individual time, the patient indicated to the psychologist that she has “had it” with her neighbor and has “something planned that will make you all finally understand” once she is discharged.

While the treatment team does not share Dr. Solomon’s concern and has started to make discharge plans, they have not spent as much individual time with the patient as Dr. Solomon. In fact, the patient has made no such comments to anyone else other than to Dr. Solomon and has been a model patient on the unit. The days allocated for her stay by her insurance are ending in two days. The attending psychiatrist concurs with the discharge plan and advised Dr. Solomon “not to worry about it.” In fact, the psychiatrist encouraged the psychologist to omit any reference to the patient’s comments about the neighbor in treatment summaries or clinical notes as “hysterical nonsense.”

Answer 24

Use Ethical Decision making model to solve:

1. Identify individuals and groups involved
2. Identify ethically relevant issues and practices, as well as the context
3. Consider your own biases/pressures/personal needs/self-interest
4. Develop alternative courses of action
5. Analysis of short-term, ongoing, and long-term risks/benefits for each option
6. Choice of option (after codes, laws, regulations, etc. are applied/ considered)
7. Action (and assuming responsibilities for consequences)
8. Evaluation of results of the action
9. Assumption of responsibility of action (correction of negative outcomes, re-engaging in the process)
10. Appropriate proactive action to prevent future dilemmas

Question 25

Dr. Betty Frances has been treating Peggy Olson for anxiety and depression related to job stress and intermittent spousal bullying. During their course of treatment, Mr. Olson physically abused Mrs. Olson to the point where the police arrested him on charges of domestic violence and terroristic threats. Because of the seriousness of his threats and prior criminal behavior, Mr. Olson’s family could not bail him out of prison.

After this event, Mrs. Olson became more forthcoming with Dr. Frances. His behavioral history includes stalking, assault, battery, public disturbance, public intoxication, and other out of control behaviors. Dr. Frances continues to treat Mrs. Olson for anxiety and depression on a weekly basis.

Dr. Frances arrived at her office one day and found a letter with the return address of Mr. Olson at the local detention facility. Dr. Frances feels an anxiety reaction in her body.

Answer 25

Use Ethical Decision making model to solve:

1. Identify individuals and groups involved
2. Identify ethically relevant issues and practices, as well as the context
3. Consider your own biases/pressures/personal needs/self-interest
4. Develop alternative courses of action
5. Analysis of short-term, ongoing, and long-term risks/benefits for each option
6. Choice of option (after codes, laws, regulations, etc. are applied/ considered)
7. Action (and assuming responsibilities for consequences)
8. Evaluation of results of the action
9. Assumption of responsibility of action (correction of negative outcomes, re-engaging in the process)
10. Appropriate proactive action to prevent future dilemmas

Question 26

Dr. Fair performs child custody evaluations. She is well known in both the legal and psychological communities. Recently, Dr. Fair received solicitations for contributions from a candidate for judge in her county, Deloris True. She has worked with Attorney True on numerous occasions and believes that she would be a real asset as a judge in her community. She clearly wants this individual to be elected as a judge.

However, if Attorney True is elected as judge, Dr. Fair will likely appear before her in court as an expert witness. Will contributing to the campaign of the judicial candidate be contraindicated because it could lead to a perception of bias in future court cases? Is the contribution warranted because Dr. Fair believes that Attorney True is highly qualified for that position?

In her state, political contributions over $50 are in the public domain and anyone could see that Dr. Fair made the contribution. Dr. Fair would like to show her financial support by contributing more than $50. (Dr. Fair has already ruled out giving 10 checks for $49.95.). Concerned about ethics and reputation, Dr. Fair contacts you for a consult.

Answer 26

Use Ethical Decision making model to solve:

1. Identify individuals and groups involved
2. Identify ethically relevant issues and practices, as well as the context
3. Consider your own biases/pressures/personal needs/self-interest
4. Develop alternative courses of action
5. Analysis of short-term, ongoing, and long-term risks/benefits for each option
6. Choice of option (after codes, laws, regulations, etc. are applied/ considered)
7. Action (and assuming responsibilities for consequences)
8. Evaluation of results of the action
9. Assumption of responsibility of action (correction of negative outcomes, re-engaging in the process)
10. Appropriate proactive action to prevent future dilemmas

Question 27

Dr. Logan Earthski works with adolescents and their families. During the course of treating one adolescent male, the parents, Mr. and Mrs. Hawk, expressed frustration with their son Tony’s lack of involvement with sports. The Hawks detailed how Tony enjoyed team sports in the past, but has not enjoyed participating due to anxiety and constantly comparing himself to others.

In order to bond and connect with the family, Dr. Earthski explained from his experience with teens, some male teens function better with individual sports. Dr. Earthski disclosed that he grew up skateboarding and taught lessons for several years. A few of the children and adolescents he taught fit the description of Tony. In those cases, the adolescent tried soccer or baseball, but did not really like it because they felt too anxious and overly competitive.

When it came to individual sports, like skateboarding, teens that became involved with individual sports usually showed a decrease in anxiety and an increase in self-confidence. However, sometimes, when adolescents first show up at the skate park, they may experience a similar level of anxiety and heightened self-awareness that Dr. Earthski helped remediate during his coaching sessions.

Dr. Earthski also revealed that he worked with one particular teenager who became very anxious and experienced episodes of panic related to going to the skate park. That adolescent did not think he was good and was weary of other kids watching and judging him. Dr. Earthski gave him some coaching on anxiety reduction techniques and worked through those negative, anxiety-provoking emotions. Further, he did very well at skateboarding once he conquered his symptoms of anxiety and panic. The teenager’s self-confidence grew as he performed better at the skate park. Based on Dr. Earthski’s revelations, the parents seemed reassured.

Prior to the next session, Dr. Earthski received a voicemail message from Mrs. Hawk asking if he could coach Tony on skate boarding.

Answer 27

Use Ethical Decision making model to solve:

1. Identify individuals and groups involved
2. Identify ethically relevant issues and practices, as well as the context
3. Consider your own biases/pressures/personal needs/self-interest
4. Develop alternative courses of action
5. Analysis of short-term, ongoing, and long-term risks/benefits for each option
6. Choice of option (after codes, laws, regulations, etc. are applied/ considered)
7. Action (and assuming responsibilities for consequences)
8. Evaluation of results of the action
9. Assumption of responsibility of action (correction of negative outcomes, re-engaging in the process)
10. Appropriate proactive action to prevent future dilemmas

Question 28

A psychologist who completes evaluations for the Bureau of Disability Determination (BDD) calls you for a consultation.

Earlier in the day, the psychologist evaluated a 48-year-old male with a history of chronic pain. The only documentation received from BDD was a list of medications, which included an antidepressant and a prescription sleep aid.

The disability applicant arrived late for the evaluation, reporting that his pain prevented him from being on time. He shuffled his feet, walked in a hunched manner, used a cane, shifted in his seat frequently, and groaned throughout the evaluation. He described rather significant cognitive and vegetative symptoms of depression. He began to cry softly at one point when discussing the negative consequences of chronic pain. When asked about outpatient psychological treatment, the disability applicant explained he did not know that psychotherapy could help, and he would be anxious to try therapy.

At the end of the evaluation, the patient left, shuffling and making muffled groans as he left the office and the waiting room. When the psychologist returned to his office, he remembered a lunch date for which he was late. As he was leaving the office building, the psychologist saw the disability applicant in the parking lot laughing with another person. He twirled his cane with one hand. He stood upright and seemed genuinely happy. When the disability applicant met the psychologist’s gaze, the applicant immediately hunched over, grabbed his back, groaned loudly, and used the cane to steady himself. The psychologist hopped in his car for lunch without any discussion with the applicant.

Answer 28

Use Ethical Decision making model to solve:

1. Identify individuals and groups involved
2. Identify ethically relevant issues and practices, as well as the context
3. Consider your own biases/pressures/personal needs/self-interest
4. Develop alternative courses of action
5. Analysis of short-term, ongoing, and long-term risks/benefits for each option
6. Choice of option (after codes, laws, regulations, etc. are applied/ considered)
7. Action (and assuming responsibilities for consequences)
8. Evaluation of results of the action
9. Assumption of responsibility of action (correction of negative outcomes, re-engaging in the process)
10. Appropriate proactive action to prevent future dilemmas

Question 29

Psychologist Dr. Shermer learns from a colleague that she has been described in very unfavorable terms in a blog posted by an individual who publicly identifies herself as a patient of Dr. Shermer.

Dr. Shermer reviews the blog information. The author is likely not a current patient.

The blogger insults Dr. Shermer’s appearance, her style of dress, and her office. In essence, the blogger combines factual and inaccurate information into a well-formed, yet highly erroneous, description about Dr. Shermer’s role in the community and in the legal system.

There are many descriptions of Dr. Shermer that are blatantly false or misleading. Some of the falsehoods on the blog would be serious violations of the Ethics Code.

Upon reviewing the charts of several possible candidates as the offensive blogger, Dr. Shermer believes the blogger to be someone she evaluated in the past for a national security position. The likely blogger can be emotionally labile and frequently feels a victim of “the system.” Dr. Shermer indicated a number of pathological characteristics in the report. Dr. Shermer does not make the determination for the security clearance, but serves as a consultant for the government agency.

Dr. Shermer has a presence on social media and fears how her online reputation may be adversely affected by these ongoing blog posts. She also fears that if she draws too much attention to the blog, then the blogger will gain greater traction.

Dr. Shermer fears the risk that the information could go to a licensing board and result in an investigation. Although completely unwarranted, an investigation would add unnecessary stress in her life. There is also a risk that her reputation could be ruined if the former client’s blog posts gain a larger following.

Answer 29

Use Ethical Decision making model to solve:

1. Identify individuals and groups involved
2. Identify ethically relevant issues and practices, as well as the context
3. Consider your own biases/pressures/personal needs/self-interest
4. Develop alternative courses of action
5. Analysis of short-term, ongoing, and long-term risks/benefits for each option
6. Choice of option (after codes, laws, regulations, etc. are applied/ considered)
7. Action (and assuming responsibilities for consequences)
8. Evaluation of results of the action
9. Assumption of responsibility of action (correction of negative outcomes, re-engaging in the process)
10. Appropriate proactive action to prevent future dilemmas

Question 30

Dr. Eddy Kessler received a referral from the Office of Vocational Rehabilitation (OVR) to work therapeutically with Enoch Thompson, who suffers with symptoms of a panic disorder. Dr. Kessler accepted the referral and started to work with Mr. Thompson on his symptoms of panic and anxiety, as these have interfered with Mr. Thompson’s ability to maintain employment. Treatment started well, with Mr. Thompson developing better cognitive and behavioral skills to manage his anxiety after the initial eight sessions funded by OVR. With Mr. Thompson’s consent, Dr. Kessler sent a letter to OVR requesting 10 more sessions over the next five months to reinforce the gains made in treatment. Dr. Kessler viewed Mr. Thompson as moving toward stable employment with ongoing treatment. As Mr. Thompson was improving, they agreed to meet in two weeks.

Upon his return two weeks later, Mr. Thompson informed Dr. Kessler that he was recently evaluated by his wife’s psychologist, Dr. Gillian Darmody. As the patient described it, Mr. Thompson took his wife to her therapy session. Dr. Darmody asked him to join the session. The outcome of the session was that Dr. Darmody would be able to get Mr. Thompson on Social Security Disability as she “knows how to write psychological reports” in a way that almost guarantees a favorable disability decision. She also gave him the name of an attorney to represent him. He also felt positive about the experience as Dr. Darmody agreed to bill his health insurance for the disability evaluation. He has a meeting scheduled with the attorney in two weeks. Mr. Thompson also believes that the consultation with the attorney is free, and that the attorney is paid after disability benefits are awarded.

Dr. Kessler inquired as to why he agreed to the disability evaluation if OVR is trying to return him to work. Mr. Thompson disclosed that the job market is tough, so he wanted a backup plan in case he gets better and cannot find work. Mr. Thompson stated he disclosed their treatment relationship. However, Dr. Darmody deemed their treatment relationship to be inconsequential to the disability evaluation. The session then focused on Mr. Thompson’s ability to manage anxiety via psychological skills. Dr. Kessler manages his anger sufficiently to get through the session and scheduled Mr. Thompson in two weeks.

After the session, Dr. Kessler phones you for a consultation. Dr. Kessler is morally outraged at the other psychologist’s behavior, if true.

Answer 30

Use Ethical Decision making model to solve:

1. Identify individuals and groups involved
2. Identify ethically relevant issues and practices, as well as the context
3. Consider your own biases/pressures/personal needs/self-interest
4. Develop alternative courses of action
5. Analysis of short-term, ongoing, and long-term risks/benefits for each option
6. Choice of option (after codes, laws, regulations, etc. are applied/ considered)
7. Action (and assuming responsibilities for consequences)
8. Evaluation of results of the action
9. Assumption of responsibility of action (correction of negative outcomes, re-engaging in the process)
10. Appropriate proactive action to prevent future dilemmas

Question 31

Dr. Miller is a psychologist who consults with local nursing homes and hospitals when a patient’s capacity to make medical decisions is in question. Dr. Miller receives an urgent call from an attorney to evaluate Willie Loman at a local trauma unit. The attorney explains that Mr. Loman is looking for an objective opinion about his ability to make medical decisions.

Mr. Loman is a 52-year-old male with a wife and two kids (both in college). He works as a financially successful salesman. Over the previous weekend, Mr. Loman was involved in a serious boating accident. He did not experience any head trauma; however, his physical situation is dire. The trauma team needs his consent to perform a lifesaving surgery. If successful, Mr. Loman can live many years. However, there is a high probability that he will require full-time nursing care.

Mr. Loman has been active man who enjoyed many physical activities. Furthermore, he believes if he has the surgery and ends up confined to lifetime nursing care, he will exhaust all the funds he has saved for the benefit of his family. Mr. Loman believes he will be an emotional burden to his family and lose his dignity. Knowing that he will be physically compromised and a burden on his family, Mr. Loman is asking to die in peace. He does not want to live in an incapacitated state of existence.

Without the surgery, Mr. Loman can be kept alive for about two weeks. The family filed an emergency petition to obtain guardianship. The trauma team believes that the patient is not thinking clearly about his demise. They have already called in their psychiatrist-consultant.

Upon examination, Dr. Miller finds Mr. Loman’s mental status is within normal limits. He demonstrates appropriate memory capabilities and reasoning skills. He articulates his dilemma well and understands that he will die without surgery. There is no evidence of hallucinations, delusions, or psychotic processes.

In order to clarify his thinking, Dr. Miller calls you to review this case.

Answer 31

Use Ethical Decision making model to solve:

1. Identify individuals and groups involved
2. Identify ethically relevant issues and practices, as well as the context
3. Consider your own biases/pressures/personal needs/self-interest
4. Develop alternative courses of action
5. Analysis of short-term, ongoing, and long-term risks/benefits for each option
6. Choice of option (after codes, laws, regulations, etc. are applied/ considered)
7. Action (and assuming responsibilities for consequences)
8. Evaluation of results of the action
9. Assumption of responsibility of action (correction of negative outcomes, re-engaging in the process)
10. Appropriate proactive action to prevent future dilemmas

Question 32

Dr. Roger Sterling is a training director at a doctoral-level training program. The training program has rigorous admissions standards and has a prestigious reputation. Pete Campbell is a second year student who has excelled academically. As Pete is preparing for an off-campus pre-doctoral internship, Dr. Joan Holloway (faculty member) approaches Dr. Sterling about Pete. Apparently, there are a number of internet sites that feature Pete as a soft-core pornography actor. Dr. Holloway asks Dr. Sterling to prevent Pete from off-campus training experiences until the department can address the potential ethical and moral issues with Pete.

Dr. Sterling agrees to talk to Pete. Pete openly admits that he was a soft-core pornography actor. He is no longer in the industry. He cannot pull down pictures of his past work because the pictures and videos are outside of his control.

Answer 32

Use Ethical Decision making model to solve:

1. Identify individuals and groups involved
2. Identify ethically relevant issues and practices, as well as the context
3. Consider your own biases/pressures/personal needs/self-interest
4. Develop alternative courses of action
5. Analysis of short-term, ongoing, and long-term risks/benefits for each option
6. Choice of option (after codes, laws, regulations, etc. are applied/ considered)
7. Action (and assuming responsibilities for consequences)
8. Evaluation of results of the action
9. Assumption of responsibility of action (correction of negative outcomes, re-engaging in the process)
10. Appropriate proactive action to prevent future dilemmas

Question 33

Dr. Jesse Pinkman has been working with a 26-year-old professional for about a year, Ms. Skyler White. They have been working on managing her symptoms of depression and anxiety. The patient smokes marijuana regularly, which has been a concern for Dr. Pinkman.

Skyler arrives late to her appointment, looking frazzled. She explained her friend overdosed on heroin the prior evening. She has been in the ER for the past 12 hours. Her friend will likely survive, but she may have residual cognitive problems.

Skyler reported feeling horribly guilty because she introduced her friend to her next door neighbor, who is the drug dealer. Her friend always stops by to see Skyler first, before purchasing drugs. Skyler purchases her marijuana from the same dealer.

After processing the events of the previous evening, Skyler stated she will move away from the drug dealer. She no longer wants to be this close or indirectly cause harm to someone else. The police are actively investigating, but Skyler does not want to divulge any information. She does not want to get involved. Skyler makes an appointment for next week, and then leaves feeling somewhat better.

Dr. Pinkman becomes preoccupied about what Skyler reported. Dr. Pinkman knows the dealer’s name from previous sessions and can figure out the address of dealer, based on his patient’s address.

Dr. Pinkman is contemplating calling in an anonymous tip to the police. Dr. Pinkman is aware of the increase in heroin use in his community. He also recognizes his struggle with moral outrage and sense of injustice in this situation. Struggling with the emotions to report or not report anonymously, Dr. Pinkman calls you for a consultation.

Answer 33

Use Ethical Decision making model to solve:

1. Identify individuals and groups involved
2. Identify ethically relevant issues and practices, as well as the context
3. Consider your own biases/pressures/personal needs/self-interest
4. Develop alternative courses of action
5. Analysis of short-term, ongoing, and long-term risks/benefits for each option
6. Choice of option (after codes, laws, regulations, etc. are applied/ considered)
7. Action (and assuming responsibilities for consequences)
8. Evaluation of results of the action
9. Assumption of responsibility of action (correction of negative outcomes, re-engaging in the process)
10. Appropriate proactive action to prevent future dilemmas

Question 34

Dr. Vanessa Ives works in a solo private practice. She has been working with Mr. Dorian Gray for several months for signs and symptoms of depression. Mr. Gray comes to some sessions as emotionally intense, and high strung. Dr. Ives has considered the possibility that Mr. Gray suffers with some type of cyclic mood disorder.

As part of treatment, Mr. Gray admitted to experiencing anger management problems, to the point where he described physically intimidating his wife and pushing her down. They worked on anger management skills. Mr. Gray reported progress in this area.

Dr. Ives receives a phone message from Mr. Gray’s wife. In the voicemail, Mrs. Gray reports that Mr. Gray has become more physically intimidating and has starting to push her around. The voicemail indicated he has not caused her any significant harm. She requested a session to see Dr. Ives to explain what is happening between them. Dr. Ives only met Mrs. Gray informally while she sat in the waiting room before and after several sessions.

Dr. Ives wants to be helpful, but she is struggling with whether she should even return Mrs. Gray’s phone call. Dr. Ives has a personal history of being involved in a physically abusive relationship herself and is concerned about both the clinical and ethical issues involved regarding calling Mrs. Gray back.

Feeling uncomfortable about what is happening with this patient and his wife, Dr. Ives calls you for a professional consultation. She wants to make an appointment to talk with you candidly about her history as well as the dynamics of the current case.

Answer 34

Use Ethical Decision making model to solve:

1. Identify individuals and groups involved
2. Identify ethically relevant issues and practices, as well as the context
3. Consider your own biases/pressures/personal needs/self-interest
4. Develop alternative courses of action
5. Analysis of short-term, ongoing, and long-term risks/benefits for each option
6. Choice of option (after codes, laws, regulations, etc. are applied/ considered)
7. Action (and assuming responsibilities for consequences)
8. Evaluation of results of the action
9. Assumption of responsibility of action (correction of negative outcomes, re-engaging in the process)
10. Appropriate proactive action to prevent future dilemmas

Question 35

Dr. Larry Ellison, a psychologist colleague, contacts you about a marketing plan for his telepsychology services. He has over 1,000 followers on Twitter and a strong social media presence on Facebook. His plan is this: He wants to offer one free psychotherapy session to potential patients. He explains he is trying to promote his telepsychology practice and show that psychologists are open, friendly, and willing to help, potentially for free to get treatment started. The overarching goal is to develop a robust telepsychology practice.

Knowing the rules of his state, Dr. Ellison will make it clear that services are only available in the states that he is licensed. Dr. Ellison will use a HIPAA-compliant videoconferencing service. He is looking for general feedback, such as thoughts on a good marketing plan or any ethical concerns.

Answer 35

Use Ethical Decision making model to solve:

1. Identify individuals and groups involved
2. Identify ethically relevant issues and practices, as well as the context
3. Consider your own biases/pressures/personal needs/self-interest
4. Develop alternative courses of action
5. Analysis of short-term, ongoing, and long-term risks/benefits for each option
6. Choice of option (after codes, laws, regulations, etc. are applied/ considered)
7. Action (and assuming responsibilities for consequences)
8. Evaluation of results of the action
9. Assumption of responsibility of action (correction of negative outcomes, re-engaging in the process)
10. Appropriate proactive action to prevent future dilemmas

Question 36

Dr. Wendy Malik operates an independent practice in a suburban area. She receives a referral from a physician, with whom she has a positive working relationship. Dr. Malik contacts the patient, completes a phone screening, and sets up an appointment with Mr. Larry David.

As is her practice, Dr. Malik sends a confirmation email, attaching her version of informed consent. She instructs Mr. David that he does not have to print it out, only review it and they would discuss any questions at the initial appointment.

Several days later, Dr. Malik checks her email. In it, Mr. David sent her an email with an attachment. Mr. David asks Dr. Malik to review his edits on the informed consent document.

While Dr. Malik notes some suggested corrections on the document, Mr. David modified the cancellation policy. Dr. Malik’s form (and standard policy) is appointments cancelled with less than 24-hour notice will be charged to the patient. Mr. David added a sentence that if Dr. Malik cancels an appointment with less than 24 hours, Mr. David expects Dr. Malik to pay him an amount equal to her hourly rate.

Flustered by this edit, Dr. Malik contacts you for a consultation.

Answer 36

Use Ethical Decision making model to solve:

1. Identify individuals and groups involved
2. Identify ethically relevant issues and practices, as well as the context
3. Consider your own biases/pressures/personal needs/self-interest
4. Develop alternative courses of action
5. Analysis of short-term, ongoing, and long-term risks/benefits for each option
6. Choice of option (after codes, laws, regulations, etc. are applied/ considered)
7. Action (and assuming responsibilities for consequences)
8. Evaluation of results of the action
9. Assumption of responsibility of action (correction of negative outcomes, re-engaging in the process)
10. Appropriate proactive action to prevent future dilemmas

Question 37

Dr. Krista Gordon received an email from E Corp, the employer of a current patient Mr. Elliot Alderson (someone she provided psychotherapy for over a year, but has cancelled multiple appointments recently due to some family issues). Dr. Gordon has not seen him for over a month, and he is not scheduled until the following month.

The email from E Corp was for the purposes of letting Dr. Gordon know that her patient had submitted documentation to E Corp (supposedly from Dr. Gordon), and they wanted to confirm that these documents were legitimate and unaltered.

To Dr. Gordon’s disappointment, she saw one legitimate letter (an older letter she wrote for Alderson to submit to his boss, confirming regular 4:30 pm appointment times, which allowed Alderson to leave 30 minutes early on those days), and one entirely questionable, clearly altered letter.

Apparently, Mr. Alderson copied Dr. Gordon’s letterhead and pasted it as an image for the false documentation. The body of the letter is something Gordon never wrote (saying that Dr. Gordon assessed Alderson and determined he is unfit to return to work for an indefinite period). Dr. Gordon’s signature is also copied and pasted on the fake letter. The fake letter was shoddily done, the footer is cut-off, some of the text is cut-off, and most of the text appears to be slightly at an angle. The letter clearly did not come from Dr. Gordon.

Of course, this a huge breach of trust and Dr. Gordon struggling to organize her thinking as she feels incredibly violated by Mr. Alderson. Dr. Gordon calls you for a consultation.

Answer 37

Use Ethical Decision making model to solve:

1. Identify individuals and groups involved
2. Identify ethically relevant issues and practices, as well as the context
3. Consider your own biases/pressures/personal needs/self-interest
4. Develop alternative courses of action
5. Analysis of short-term, ongoing, and long-term risks/benefits for each option
6. Choice of option (after codes, laws, regulations, etc. are applied/ considered)
7. Action (and assuming responsibilities for consequences)
8. Evaluation of results of the action
9. Assumption of responsibility of action (correction of negative outcomes, re-engaging in the process)
10. Appropriate proactive action to prevent future dilemmas

Question 38

Beau Propion sought therapy from Dr. Pfizer. At the initial session, Dr. Pfizer evaluated the patient as suffering with a moderate form of depression. Mr. Propion indicated he did not want to take antidepressant medication, because he had read all the horrible adverse effects of antidepressant medication on the internet. Given the moderate signs and symptoms, Dr. Pfizer understood the patient’s decision and agreed to engage in a psychotherapy relationship with the patient. The main treatment goal was to decrease signs and symptoms of depression.

As treatment progressed, Mr. Propion became more significantly depressed. He presented with more significant symptoms of depression. Signs and symptoms included sleeping too much, weight gain, fatigue, passive suicidal ideation, procrastination, and poor concentration. He recently started taking days off from work because of the severity of the depressive symptoms.

During a session, Dr. Pfizer broached the subject of antidepressants, because Dr. Pfizer knows that medication can be helpful, especially in more significant forms of depression. As expected, Mr. Propion declines a referral for medication evaluation. Dr. Pfizer is concerned about the patient and calls you for a consultation.

Answer 38

Use Ethical Decision making model to solve:

1. Identify individuals and groups involved
2. Identify ethically relevant issues and practices, as well as the context
3. Consider your own biases/pressures/personal needs/self-interest
4. Develop alternative courses of action
5. Analysis of short-term, ongoing, and long-term risks/benefits for each option
6. Choice of option (after codes, laws, regulations, etc. are applied/ considered)
7. Action (and assuming responsibilities for consequences)
8. Evaluation of results of the action
9. Assumption of responsibility of action (correction of negative outcomes, re-engaging in the process)
10. Appropriate proactive action to prevent future dilemmas

Question 39

Dr. Janssen has been treating Eli Lily for the past year. During a recent session, Mr. Lily stated that he had been having financial problems. When queried by Dr. Janssen, Mr. Lily detailed that he can sell his medication to co-workers and neighbors. Dr. Janssen asked a few other questions, then Mr. Lily changed the subject. While writing notes, Dr. Janssen reviewed note from the initial intake. Mr. Lily takes a variety of controlled substances, including Adderall for ADHD and Ambien for insomnia. Mr. Lily receives these prescriptions for Adderall and Ambien, as well as other medication, from his physician’s associate (PA).

At the next session, Dr. Janssen asked more questions about the medications he had been selling. Mr. Lily reported he sells Adderall and Ambien intermittently. However, Mr. Lily has had a medical marijuana card and has being selling various forms of medical marijuana on a regular basis to friends and family. Mr. Lily obtained a medical marijuana card through a process independent of the PA, and indicated the PA does not know about the medical marijuana.

Dr. Janssen in clearly concerned about these legal and clinical issues. Dr. Janssen wants to just forget he asked these questions, but calls you for a consultation.

Answer 39

Use Ethical Decision making model to solve:

1. Identify individuals and groups involved
2. Identify ethically relevant issues and practices, as well as the context
3. Consider your own biases/pressures/personal needs/self-interest
4. Develop alternative courses of action
5. Analysis of short-term, ongoing, and long-term risks/benefits for each option
6. Choice of option (after codes, laws, regulations, etc. are applied/ considered)
7. Action (and assuming responsibilities for consequences)
8. Evaluation of results of the action
9. Assumption of responsibility of action (correction of negative outcomes, re-engaging in the process)
10. Appropriate proactive action to prevent future dilemmas

Question 40

A psychologist is treating a client who discloses during therapy sessions that they have been experiencing intense anger and have thoughts of harming their ex-partner. The client refuses to consent to contacting the ex-partner or involving authorities. The psychologist grapples with maintaining the confidentiality of the therapeutic relationship while also feeling ethically compelled to warn the potential victim and prevent harm.

Answer 40

Use Ethical Decision making model to solve:

1. Identify individuals and groups involved
2. Identify ethically relevant issues and practices, as well as the context
3. Consider your own biases/pressures/personal needs/self-interest
4. Develop alternative courses of action
5. Analysis of short-term, ongoing, and long-term risks/benefits for each option
6. Choice of option (after codes, laws, regulations, etc. are applied/ considered)
7. Action (and assuming responsibilities for consequences)
8. Evaluation of results of the action
9. Assumption of responsibility of action (correction of negative outcomes, re-engaging in the process)
10. Appropriate proactive action to prevent future dilemmas

Question 41

A psychologist specializing in trauma therapy is approached by a refugee from a war-torn country who has experienced severe psychological distress. The client’s cultural background includes strong beliefs in traditional healing practices that contradict Western therapeutic approaches. The psychologist faces the challenge of providing effective treatment while respecting the client’s cultural beliefs and ensuring they receive appropriate care within the Western mental health system.

Answer 41

Use Ethical Decision making model to solve:

1. Identify individuals and groups involved
2. Identify ethically relevant issues and practices, as well as the context
3. Consider your own biases/pressures/personal needs/self-interest
4. Develop alternative courses of action
5. Analysis of short-term, ongoing, and long-term risks/benefits for each option
6. Choice of option (after codes, laws, regulations, etc. are applied/ considered)
7. Action (and assuming responsibilities for consequences)
8. Evaluation of results of the action
9. Assumption of responsibility of action (correction of negative outcomes, re-engaging in the process)
10. Appropriate proactive action to prevent future dilemmas

Question 42

A psychologist is treating an elderly client with early-stage dementia who expresses a desire to continue living independently and making decisions about their finances and healthcare. However, the psychologist observes signs of cognitive decline and worries about the client’s safety and well-being if they continue to live alone. The psychologist must navigate the delicate balance between honoring the client’s autonomy and intervening to ensure their safety and quality of life.

Answer 42

Use Ethical Decision making model to solve:

1. Identify individuals and groups involved
2. Identify ethically relevant issues and practices, as well as the context
3. Consider your own biases/pressures/personal needs/self-interest
4. Develop alternative courses of action
5. Analysis of short-term, ongoing, and long-term risks/benefits for each option
6. Choice of option (after codes, laws, regulations, etc. are applied/ considered)
7. Action (and assuming responsibilities for consequences)
8. Evaluation of results of the action
9. Assumption of responsibility of action (correction of negative outcomes, re-engaging in the process)
10. Appropriate proactive action to prevent future dilemmas

Question 43

A psychologist is conducting a study on the long-term effects of childhood trauma on adult mental health. The study involves participants who have experienced significant trauma, including abuse and neglect. While the psychologist provides detailed information about the study and its potential risks, some participants may not fully comprehend the implications of participating due to their own trauma-related symptoms. The psychologist faces the dilemma of ensuring informed consent while also striving to advance knowledge in the field and potentially benefit future generations of trauma survivors.

Answer 43

Use Ethical Decision making model to solve:

1. Identify individuals and groups involved
2. Identify ethically relevant issues and practices, as well as the context
3. Consider your own biases/pressures/personal needs/self-interest
4. Develop alternative courses of action
5. Analysis of short-term, ongoing, and long-term risks/benefits for each option
6. Choice of option (after codes, laws, regulations, etc. are applied/ considered)
7. Action (and assuming responsibilities for consequences)
8. Evaluation of results of the action
9. Assumption of responsibility of action (correction of negative outcomes, re-engaging in the process)
10. Appropriate proactive action to prevent future dilemmas

Question 44

A psychologist working in a rural community becomes romantically involved with a former client who sought therapy for depression and anxiety. The psychologist terminated the therapeutic relationship ethically before pursuing a romantic relationship with the client. However, the rural community lacks mental health resources, and the former client expresses a strong preference to continue therapy with the psychologist due to their established rapport and trust. The psychologist must navigate the ethical complexities of dual relationships while also considering the client’s ongoing mental health needs and the limited access to alternative care options in the community.

Answer 44

Use Ethical Decision making model to solve:

1. Identify individuals and groups involved
2. Identify ethically relevant issues and practices, as well as the context
3. Consider your own biases/pressures/personal needs/self-interest
4. Develop alternative courses of action
5. Analysis of short-term, ongoing, and long-term risks/benefits for each option
6. Choice of option (after codes, laws, regulations, etc. are applied/ considered)
7. Action (and assuming responsibilities for consequences)
8. Evaluation of results of the action
9. Assumption of responsibility of action (correction of negative outcomes, re-engaging in the process)
10. Appropriate proactive action to prevent future dilemmas