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Friday, September 9, 2011

Vignette 5: A Tricky Situation

Dr. Smith is a psychologist who has worked with a young woman for about 9 months. The patient presents with a history of rejection and abandonment as well as persons of power misusing her. She recently received an offer to become a sales representative for a pharmaceutical company. The psychologist and patient discussed the type of job she was entering because she may experience rejection from doctors, nurses, and other office personnel.

After her 6 weeks of training, the company assigns her to a regional director that the psychologist knows personally. Along with the initial anxiety of the new job, her territory, and her boss, she reports a fear of failure and other anxiety related symptoms. The psychologist knows her new boss, Mr. Biggy. The psychologist seeks to reassure the patient that he, the psychologist, knows Mr. Biggy on a personal basis and that “he is a really a good guy” that seems bright, friendly, and fair. He indicates that Mr. Biggy is a good “family man”. The patient is reassured, and reported less anxiety. In actuality, Mr. Biggy’s wife is a very close friend of Dr. Smith’s wife. They have dinner as couples several times per year.

Several weeks into going on sales calls, your patient reports that Mr. Biggy is complimenting her on the way she looks and her ability to make the sale. They start spending more time together. However, she begins to feel uncomfortable as she feels like they are spending too much time together. Mr. Biggy starts asking questions that are more personal, forwards her “funny” emails, and texts some inappropriate remarks to her, mainly about her alluring power that helps make sales.

Mr. Biggy and Dr. Smith meet in an unplanned social venue. Mr. Biggy pulls Dr. Smith aside and explains how he has become very attracted to a new sales representative. He thinks that she is young and impressionable. He confides that he would like to have an affair with her.

Dr. Smith politely explains that he feels uncomfortable with them discussing his more personal marital issues. Mr. Biggy indicates that he wants to talk more about his feelings. Dr. Smith suggests a referral to a psychologist, but Mr. Biggy states that he feels more comfortable talking with Dr. Smith. After some other small talk, Dr. Smith leaves to mingle with other friends.

Dr. Smith is now worried about the entire situation.

In hindsight, what triggered some possible difficulties in this situation?

What are the ethical issues involved in this scenario?

How are the client’s emotional and interpersonal issues related to the psychologist’s dilemma?

What are the options for the psychologist for both his relationship with his patient and his relationship with Mr. Biggy?

2 comments:

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Indian Curry said...

I think the psychologist had good intentions to help the client but it was probably a 'boundary crossing' when he disclosed to her that he knew her boss and reassured her that he is nice. I cannot explain with clarity why it's a boundary crossing but it is.

Now, the most ethical course of action for the psychologist would be:
be firm in his refusal to counsel or allow Mr. Biggy to see him citing conflict of interest as they are friends and psychologists don't counsel friends.
If this lady-client seeks further counselling from him and if she expresses distress about the situation with the boss, the psychologist should counsel her as he would any other client in the same situation. For example, he should encourage her to deal with the situation by being assertive, do what she thinks is right, remain empowered and see that she is not exploited, etc.

I also think this psychologist should bring up and discuss with this client the fact that he gave a positive report about her current boss rather than pretending it did not happen and try to sweep it under the carpet. This would possibly go a long way in helping the client realize that the psychologist made an honest mistake. If the psychologist apologizes or at least discuss with her his role when he reassured her about this boss, it would help in not undermining this client's trust in people.