Making Ethical Decisions
The decision making process can sometimes be a difficult one. There are many factors that may go into the process of decision making. Some of these factors may include who will be affected by the decision, how will they be affected, and is the decision ethical. Many times it is not easy to know what is considered ethical or unethical when making decisions. For example, a client has been terminated by their employer. The client offers other forms of payment for their therapy sessions. This presents an ethical dilemma. Often times people base their ethical decision making skills on what they have learned and been taught by their parents, school, and in life experiences. While this may work the majority of the time, there are many steps in the ethical decision making process. In this paper, I will examine and discuss the ethical dilemma from the previous example, while considering the steps taken in making an ethical decision.
The scenario of the ethical dilemma I am describing would be after a client had already started therapy. When the client began their therapy sessions, they were employed, had insurance, and were able to pay for their therapy sessions. After being laid off or terminated from their job, the client no longer has the funds to pay for his therapy sessions. In his last therapy session, the client asks the therapist if they could accept any other type of payments such as gifts, favors, or work outside of therapy. If the therapist is a female, a male client may even go as far as offering payment in the form of sexual favors or vice versa. These types of situations put the therapist in an awkward position because they have the potential to break boundaries between the therapist and the client. While some therapists believe that boundaries should be managed case by case, I believe that boundaries should be enforced with all clients. If another client finds out about the alternative payment method, they may expect the same treatment because it seems as if other clients are receiving special treatment. Also, any type of sexual activity between a therapist and client is completely unethical. It puts the therapist in danger of having a lawsuit against them for sexual harassment or rape, which may result in the therapist losing their license to practice. It is surprising to learn that these types of situations between a therapist and clients arise fairly often.
Steps in Ethical Decision Making
When it comes to making ethical decisions, psychologists have several steps that should be taken before making a final decision. Step one is “Identify the situation that requires ethical consideration and decision making.” (Pope & Vasquez, 2007). In this case, the situation that needs ethical consideration would be the possibility of accepting an alternative method of payment. If the alternative method of payment was doing yard work for the therapist, some therapist may consider it to be beneficial to them because it would keep them from having to do it, and they would have more time to get other things done. However, it breaks most therapist/client boundaries. If the client was in therapy for being a kleptomaniac, the therapist could possibly be robbed by his own client. Also, it allows the client knowledge and access to the therapist’s home and family. The client may use this type of access to their advantage and possibly be able to blackmail the therapist.
The second step is to “anticipate who will be affected by your decision.” (Pope & Vasquez, 2007). When making a decision, it is important to consider who will be affected by the final decision. In this situation, if the therapist is married with children, it may affect the therapist’s family because the client would be working at their home as payment for their therapy sessions. Also, the therapist must take into consideration his other clients. They may be affected if they learn that their therapist is accepting alternative payments. It is possible that the other clients may prefer other forms of payment rather than spending their own money. They may feel that the therapist is giving other clients special treatment as well.
In the third step, “figure out who, if anyone, is the client” (Pope & Vasquez, 2007), there may be some confusion of who the client is. Since the client is currently unemployed, the therapist might be paid by a relative or spouse of the client. This may cause the therapist to have a division of loyalty between the person receiving therapy and the person making the payment. The therapist would need to consider anything that may impair their judgment and decision making skills.
Step four requires a therapist to “assess your relevant areas of competence-and of missing knowledge, skills, experience, or expertise-in regard to the relevant aspects of the situation.” (Pope & Vasquez, 2007). In this situation, a therapist may consider other options that may help them to control or manage the clients request in a professional manner. A therapist may want to research how to handle unethical situations. They may also consider referring the client to another therapist if they are not able to come to an agreement of the request.
In step five, a therapist should “review relevant formal ethical standards.” (Pope & Vasquez, 2007). If a client offers sexual favors as an alternative form of payment, the therapist should refer to the American Psychological Association’s ethical standards. According to the American Psychological Association (2008),
“Psychologists do not engage in sexual harassment. Sexual harassment is sexual solicitation, physical advances, or verbal or nonverbal conduct that is sexual in nature, that occurs in connection with the psychologist's activities or roles as a psychologist, and that either (1) is unwelcome, is offensive, or creates a hostile workplace or educational environment, and the psychologist knows or is told this or (2) is sufficiently severe or intense to be abusive to a reasonable person in the context. Sexual harassment can consist of a single intense or severe act or of multiple persistent or pervasive acts.”
Steps six and seven consist of reviewing legal standards as well as research and theory. (Pope & Vasquez, 2007). In the situation of the request of an alternative payment, it would be a good idea for a therapist to review legal standards before making a decision. If a therapist was offered sexual favors by a client as payment for therapy, they would be committing adultery if they were married, which may result in divorce. Also, it may result in the loss of their license to practice as a therapist. It may be beneficial for a therapist to review research and theories from other psychologists. It could help in understanding why it would be unethical to accept an alternative form of payment.
In steps eight and nine, a therapist may “consider how, if at all, [their] personal feelings, biases, or self interest might affect [their] ethical judgment” as well as “consider what effects, if any, that social, cultural, religious, or similar factors may have on the situation.” (Pope & Vasquez, 2007). In this situation, self interest may have an effect on a therapist’s ethical judgment. If a client has offered to do yard work for the therapist, in a quick decision, the therapist may think it is not a bad idea. However, with more thought, the therapist should consider step two and who else will be affected by the decision. If the therapist is religious, his or her religious beliefs may be a factor in this situation. The therapist’s religious values and beliefs may help them to make a good ethical decision.
Step ten in ethical decision making is “consider consultation.” (Pope & Vasquez, 2007). It may be a good idea for a therapist to consider speaking to another psychologist who has experienced a client offering an alternative payment for their therapy sessions. They may be able to the therapist to understand the best action to take in regards to the client’s request.
Steps eleven and twelve go hand in hand. Developing and evaluating an alternative course of action should always be taken into consideration. If a client does not accept the answer that the therapist provided to their request, it is a smart idea to have an alternative course of action. I consider it a back-up plan for when things do not go as planned. However, before using an alternative course of action, it is a good idea to consider the best and worst case scenario and who and how each person will be affected by the alternative course of action.
Step thirteen is “try to adopt the perspective of each person who will be affected.” (Pope & Vasquez, 2007). I think this might be the most difficult of the ethical decision making steps. It requires the therapist to step outside of themselves and to put themselves in the position of other people. It is hard to know how other people will react or view the situation unless you know those people really well. However, doing this may help a therapist to gain a better perspective of how other will be affected by the final decision.
In step fourteen, a therapist needs to “decide what to do and then review it and reconsider it.” (Pope & Vasquez, 2007). Once the therapist has decided how to handle the client’s request of an alternative payment plan, whether it is doing yard work or of a sexual nature, the therapist should review and reconsider the decision. They may want to look for loopholes that the client may find around their final decision. It is a good time to reflect and see if the final decision is the best decision for everyone involved.
When it comes to making ethical decisions and depending on the ethical dilemma, it may take a therapist many steps to accomplish their final decision. They should take into consideration all people who will be affected by the decision as well as consider ethical and legal standards. It may be a situation that could cause them to lose their license to practice as a professional psychologist. For this reason alone is why it is so important for psychologists to be aware the ethical decision making process and not be influenced to make bad ethical decisions by other factors and influences.
American Psychological Association. (2008). Ethical principles of psychologists and code of
conduct. Retrieved from http://www.apa.org/ethics/code2002.html#3_02 on December 8, 2008.
Pope, K.S. & Vasquez, M.J.T. (2007). Ethics in psychotherapy and counseling. San Francisco,
CA: Josey Bass