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

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

Friday, June 17, 2016

Vignette 34: A Dreadful Voicemail

Dr. Vanessa Ives works in a solo private practice. She has been working with Mr. Dorian Gray for several months for signs and symptoms of depression. Mr. Gray comes to some sessions as emotionally intense, and high strung.  Dr. Ives has considered the possibility that Mr. Gray suffers with some type of cyclic mood disorder.

As part of treatment, Mr. Gray admitted to experiencing anger management problems, to the point where he described physically intimidating his wife and pushing her down. They worked on anger management skills. Mr. Gray reported progress in this area.

Dr. Ives receives a phone message from Mr. Gray’s wife.  In the voicemail, Mrs. Gray reports that Mr. Gray has become more physically intimidating and has starting to push her around.  The voicemail indicated he has not caused her any significant harm.  She requested a session to see Dr. Ives to explain what is happening between them.  Dr. Ives only met Mrs. Gray informally while she sat in the waiting room before and after several sessions.

Dr. Ives wants to be helpful, but she is struggling with whether she should even return Mrs. Gray’s phone call.  Dr. Ives has a personal history of being involved in a physically abusive relationship herself and is concerned about both the clinical and ethical issues involved regarding calling Mrs. Gray back.

Feeling uncomfortable about what is happening with this patient and his wife, Dr. Ives calls you for a professional consultation.  She wants to make an appointment to talk with you candidly about her history as well as the dynamics of the current case.

What are the ethical issues involved in this case?

What are the pertinent clinical issues in this case?

How would you help Dr. Ives deal with her emotions related to this situation, given how her history relates to this patient and his wife?

Would you recommend Dr. Ives return the call or not?

What are some possible options should Dr. Ives return the phone call?

How much transparency would you suggest to Dr. Ives with Mr. Gray about the phone message?

1 comment:

Indian Curry said...

The psychologist HAS to return the call. Ethically, she cannot ignore, when someone has left a message indicating they are being harmed. Even if the degree of harm is 'not significant'. The repercussions are many if the psychologist does not respond. The wife may not report again and may be in danger if her husband's abuse escalates. The wife may lose trust in this psychologist or in the entire profession of psychologists itself. The psychologist is going to be left with guilt at her inaction when someone is in harm's way, sought help and she ignored it. She may wonder about her skills, ethics and develop low-self-esteem, anxiety, etc. The husband may possibly continue abusing his wife, unaware or indifferent to the effects his abuse has on his wife.

I am unsure about the extent of transparency the psychologist has to practice... Ethically, she has to be transparent/honest with her client and tell him that his wife called. But, it's highly likely he will be even more violent or abusive to his wife, when he hears that his wife has called or that she has complained to his therapist. Therefore not being transparent, in theory is unethical. However, in practice, being non-transparent is ethical i.e. you are keeping the wife safe from potential escalation of abuse from husband if and when he hears that his wife has complained.

The psychologist could ask him to bring his wife for a session so that she can get his wife's perspective about his depression and if she has noticed any changes. She would be less than transparent by not telling she has received the phone call but she would be doing it for the 'greater good' . This would give the wife a chance to talk about her concerns, in her husband's presence to the psychologist . This would give the psychologist an opportunity to review the husband's issues in future sessions based on the objective and new perspective given by the wife and to maybe refer both for marriage counselling to another therapist.