Abstract
In family therapy, various therapies are applied in dealing with various problems that face families. In counseling, a family is viewed as a social institution governed by a set of rules, morals, values, and beliefs. Each family is therefore considered unique in its way and therefore, generalizations of family problems are not encouraged. The main objective of family therapy is to advance the welfare of the family and that of its members. In some cases, therapeutic decisions may conflict with the existing laws and as a result, it requires the family therapists to have a thorough understanding of all the professional codes of ethics and the existing laws. This paper looks at a case study and the ethical dilemmas involved. It uses Kitchener’s ethical decision-making model to resolve the ethical dilemmas in the case. It also incorporates the relevant professional codes of ethics such as the American Association for Marriage and Family Therapy (AAMFT) and the American Counseling Association (ACA).
Family Therapy Case Study
In case 3, 6 individuals are directly or indirectly involved. They include Breen who is 16 years old, Breen’s boyfriend who is 18 years old, Breen’s parents, and the parents of Breen’s boyfriend. The problem which is presented in the case is that Breen is engaged in unprotected sex with her boyfriend. As a result, she is concerned that she may become pregnant. However, her worst fear is that if her parents would know about her relationship with her boyfriend, they would kill her. She is also concerned about the reactions of the parents of her boyfriend if they would know about her relationship with him. These fears and concerns have made Breen depressed. She does not want anyone to disclose her sexual relationship with her boyfriend lest she kills herself.
Therapeutic Concerns
Breen’s behavior presents various risks. First of all, having unprotected sex exposes her to sexually transmitted infections and unwanted pregnancies. This behavior is also risky because she is in school and therefore, she would not be able to concentrate on her education, which would ruin her future life because she would either drop out of school or attain bad grades. If she would attain bad grades, then her parents would have wasted their money paying for her school fees. There is also the risk of killing herself if anyone discloses to her parents about her relationship with her boyfriend.
The presenting therapeutic concern, in this case, is that of depression. According to the diagnostic and statistical manual of mental disorders, depression is a mental illness that makes a person experience prolonged feelings of sadness and lack of interest in everything. It is also known as major depressive disorder, clinical depression, or major depression. Depression negatively affects a person’s thinking, feelings, and behaviors (Spiegler & Guevremont, 2010). It also interferes with a person’s ability to do his or her daily chores due to emotional disturbance. The person may also think that life is meaningless. The major symptoms of depression include despair, loneliness, sadness, low self-esteem, loss of appetite, insomnia, and withdrawal from peers (Beck & Alford, 2009).
The Ethical Dilemmas
One of the ethical dilemmas in the case is that of deciding whether or not to disclose the information about Breen’s relationship with her boyfriend to her parents. If the information is disclosed, there is the risk of Breen killing herself due to the fear of her parents. According to the AAMFT and the ACA ethical guidelines, family therapists are required to safeguard the information given to them by their clients. The reason is that clients usually feel insecure when dealing with therapists who they do not trust. If they lack trust in their therapists, clients do not fully disclose their problems to the therapists and therefore, treatment becomes difficult. The trust is necessary for ensuring that the information given by the clients during the counseling process is not used for other purposes except for treatment. Clients should also be assured that their privacy is protected (Corey, 2008). The AAMFT Code of ethical principles in particular states that family therapists are supposed to dedicate themselves to advancing the welfare of individuals and families (AAMFT, 2015). However, this requirement presents an ethical dilemma when the interests of individuals contradict those of the family. The other dilemma is that if Breen’s secrets are not disclosed to her parents, they would not be able to understand what is ailing her. The failure to inform them would violate their right to information about their daughter (Hecker, 2012).
The ethical decision-making model which is applicable in this case is Kitchener’s model of ethical justification (Zygmond & Boorhem, 1989). This model is based on the argument that all ethical decisions are dependent on the situation (Zygmond & Boorhem, 1989). As per the model, a decision may be ethical under some circumstances and be unethical under other circumstances. According to the model, therefore, therapists must be guided by the situation, their moral judgment, common sense, and theory. The model envisages two types of ethical reasoning namely intuitive and critical-evaluative reasoning (Goldenberg & Goldenberg, 2012).
Therapists using this model usually start by analyzing the facts of a case using their ordinary moral sense. At this level of analysis, they may be able to find solutions to the case. However, if they are not able to do so, they apply intuitive reasoning where they construct arguments and counterarguments about the case. If they are not able to find solutions, they move to the critical-evaluative level, where they apply the rules, principles, and theories of counseling to find solutions to the case. The strength of the model is that it operates progressively, that is, it moves from a specific approach to a general approach in finding solutions to family problems. As a result, therapists do not have doubts about their therapeutic interventions. If applied well, the model leads to effective treatment with few instances of relapse (Reimers & Treacher, 2014).
Synopsis of State Laws
In the United States, family therapy is governed by ethical codes of ethics and state laws. The reason is that therapy is a form of treatment just like any other treatment. The need to have the ethical codes of ethics and state laws is to protect clients from unethical and illegal practices. One of the state laws which pertain to this case is the law that touches on legal issues in therapy with minors. According to the law, family therapists must obtain informed consent before they start the treatment process. If the client is a minor, that is, a person below the age of 18 years, the law requires that informed consent for treatment is obtained from the parents or guardians (Zur, 2015). This law would affect the analysis and resolution of the case because Breen is a minor and as a result, she cannot provide informed consent for treatment. It would mean that her parents would be informed to provide informed consent on her behalf. However, the problem would arise because Breen does not want her parents to know about her relationship with her boyfriend.
The other legal issue of the case is that of confidentiality. According to state laws, family therapists are supposed to treat the information given to them by their clients as confidential. The reason is that confidentiality ensures that the clients have trust in the therapists, which enables the clients to own the outcomes of therapy. This legal issue would affect the analysis and resolution of the case because, on one hand, Breen is not willing to have her secrets disclosed to her parents. On the other hand, the therapist must involve the parents because Breen is a minor (Koocher & Keith-Spiegel, 2012). It would mean that at some point, the parents would want to know exactly what is ailing their daughter. As a result, there would be a risk of Breen killing herself due to the fear of punishment by her parents.
The other legal issue about the case is that of the client’s legal capacity to enter into a therapeutic relationship with a therapist. According to the state laws, clients must be of sound mind for them to enter into a therapeutic relationship with a therapist. If they are not, then somebody else, who is appointed by a court of law is supposed to be enjoined in the therapy sessions. This legal issue would not affect the analysis and resolution of the case because Breen is of sound mind. However, her parents would need to be involved because she is a minor.
Resolution of the Ethical Dilemmas
My resolution of the ethical dilemmas would be based on Kitchener’s model of ethical decision-making. When resolving the dilemmas, I would be aiming at an outcome that would produce the least amount of avoidable harm to all parties of the case and the maximum benefit to them. My intervention would be based on two options. Option one: I would not inform Breen’s parents about Breen’s sexual relationship with her boyfriend. By so doing, I would be assuming that Breen would stop her relationship with her boyfriend after therapy, or she would disclose it to her parents. Option two: I would let Breen’s parents know about the relationship between Breen and her boyfriend.
If I would choose option one, I would be upholding the principle of confidentiality which requires the client’s information to be treated as confidential. By choosing option one, I would not only remain faithful to Breen but I would also respect her right to privacy as a client. However, if I would choose option one by not disclosing Breen’s secrets, I would be denying her parents their right to information about their daughter. According to state laws, parents have the right to information regarding their children, especially those who are below the age of 18 years.
The other effect of choosing option one is that I would be going against the principle of justice, which states that parties to a therapeutic case have the right to know all the details of the case (Lehr & Sumara, 2004). As a result, denying Breen’s parents all the details of the case would be doing an injustice to them. Since they are the parents, they have the first responsibility of taking care of Breen and protecting her from physical, emotional, psychological, and social harm. If they would know about the relationship between Breen and her boyfriend, they would be in a position to advise her to abandon her bad and risky behavior (Fisher, Chamberlain & Leve, 2009).
If I would choose option two by letting Breen’s parents know about her secrets, I would uphold their right to information about their child. It would be better for them to know it from me than knowing it from Breen or other people. The reason is that if I would inform them, I would do so in a private session with them and advise them on the dangers of overreacting. As a result, they would not punish Breen. However, if they would know it from another person or Breen, they would be agitated and punish her, which would provoke her to kill herself. However, if I would reveal Breen’s secrets to her parents, I would go against the principle of confidentiality, which requires therapists not to disclose the secrets of their clients to anyone. As a result, the trust between me and Breen would be lost.
The two options are based on different and conflicting ethical principles (Zygmond & Boorhem, 1989). The two options also touch on matters of the law. As a result, balancing all these conflicts and considering the effects of the decisions on all the parties involved in the case would be a priority.
In resolving the dilemmas, I would ask myself which of the two options would produce the least amount of avoidable harm to all parties involved (Evans, Levitt & Henning, 2012). I would then narrow down to the question of whether or not to protect Breen’s confidentiality. If I would protect it, there would be no guarantee that she would stop her risky behavior of engaging in unprotected sex with her boyfriend. As a result, the benefits of disclosing Breen’s secrets to her parents would be more than the harm of the disclosure. In other words, if I would remain faithful to Breen, I would do more harm than good as far as the sustainability of the treatment is concerned (Kerr, Leve & Chamberlain, 2009). On the other hand, if I would inform her parents, Breen would get agitated with me and would lose trust in the therapy. However, her parents would talk to the parents of her boyfriend and as a result; the intervention would be sustainable even though it would hurt Breen.
My resolution of the case would however be influenced by biases, values, and emotions. For instance, Breen would become angry with me for disclosing her secrets to her parents. The success of my resolution would depend on the values and biases of Breen’s parents. If they would decide to uphold the values of dignity and morality, they would take action to help their daughter stop her risky behavior. However, due to personal biases, they may decide to place the blame on Breen’s boyfriend, which would be counterproductive.
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