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Friday, April 22, 2011

Vignette 1: Psychologist in the Middle



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.

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Are there any ethical obligations of the psychologist who hears this information?

What are potential ethical pitfalls in this scenario?

What, if anything, should the psychologist do?

2 comments:

Anonymous said...

One place to start coud be to assume that, in addition to the patient being unaware of her customer, the staff member may also be unaware that his after hours liaisons are with a facility patient. Is this an ongoing arrangement or a chance encounter? While the discussion with the colleague would be awkward, I would make sense to determine if there is an ongoing relationship that would raise a concern of a dual relationship. Not all dual relationships are harmful. With great anticipation, I will leave it to others to comment on whether they think this scenario may be an indicator of an impaired professional.

Don McAleer Psy.D.

PPA's Ethics Committee said...

From my perspective, the psychologist needs to weigh the patient's confidentiality with the possible harm to other patients (if any) or the organization's reputation (if it ever comes to light).

The nature of the relationship between the therapist and the other patient remains unclear. My thought is for the psychologist to process the information with the patient.

What were the patient's expectations?

Does the patient want the psychologist to do anything with the information?

Was the patient trying to report information to "the institution" by talking with the psychologist?

I think the psychologist needs to clarify exactly what she was trying to communicate to the psychologist and what, if any, expectations the patient had about what the psychologist would do with that information.

John Gavazzi, PsyD (not the entire Ethics Committee)