Ethical Decision-Making Flow Chart

This paper presents an ethical decision-making flow chart for use in situations involving sexual/relational involvement of a therapist with a client. The flow chart is constructed in terms of discrete sequential steps.

Step 1: Identify Ethical Dimensions of the Issue

The first step the therapist must take is to bring conceptual clarity to the problem. This involves consideration of the ethical dimensions of the problem, the ethical principles involved, and the possible consequences of decision-making options. The fundamental guide to adequate fulfillment of this step is identification of the primary ethical dimension.

With respect to the foregoing, it can be noted that this dimension relates to client choice. Feinberg (1986) has noted that our society does not consider choices to be valid when made under conditions where a person's decision-making capacity is substantially impaired, or when the person is coerced into making the decision, or when the decision is based on fraudulent representation by one of the interested parties. Legally, the occurrence of two or more of the just cited factors, even if no one of them is by itself sufficiently pronounced to justify disregard of a person's choice, increases the likelihood that the decision will not be recognized as legally competent.

It is this critical conceptual dimension that serves as the foundation for the unwillingness of ethical decision-making bodies (APA,

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s a result of sexual contact with their therapists. However, if the therapist waits for a considerable period of time (one to two years) before dating the now ex-client, the consequences may not be negative. Consulting with another therapist may or may not be of help in such situations. This judgement is based on findings of Gartrell, Herman, Olarte and Feldstein (1987) in their survey of 1,423 psychiatrists responding to a national survey on therapist-client sexual involvement. The authors found that 65% reported treating patients who had been sexually involved with previous therapists. Psychiatrists saw these prior involvements as harmful in 87% of cases but reported the sexual abuse in only 8% of cases. Approximately 6.4% of the psychiatrists reported that they themselves had been sexually involved with patients. Thus, the likelihood that colleagues may help to resolve the issues is not large. Step 4: Determine All Persons or Systems Affected Sexual/relational involvement with a client affects the following people and collectives: (1) the therapist and all people who are affected by his/her behavior (e.g. family, friends, children); (2) the client and all people who are affected by his/her behavior; and (3) socie

Category: Psychology - E