Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, philosophy and health care

Monday, July 8, 2013

Vignette 27: To Skate or Not to Skate


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.

After thinking about this request, Dr. Earthski calls you for a consult.  Dr. Earthski puts forward the following concerns:

1.  Is coaching a teenager-patient on anxiety-related issues in context of a skate boarding lessons definitively a dual relationship?

2.  What if the coaching is time-limited, informed consent is given, and this activity is viewed as the exception rather than the rule?  (“Time-limited” means between one and six sessions, depending on his response to treatment.)

3.  Can time-limited skateboard coaching be incorporated as part of an in-vivo anxiety reduction technique and billed as therapy services?

4.  Would Dr. Earthski’s malpractice insurance likely cover this activity?

5.  What would happen if the teen-patient injured himself as part of coaching?

6.  Dr. Earthski asks about the use of self-disclosure.  What feedback might you give to Dr. Earthski about what he disclosed about himself?

7.  Given everything you know about the case, what is/are the final recommendation(s) about this scenario?

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