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Sunday, February 4, 2018

Vignette 37: The Fabricated Letter

Dr. Krista Gordon received an email from E Corp, the employer of a current patient Mr. Elliot Alderson (someone she provided psychotherapy for over a year, but has cancelled multiple appointments recently due to some family issues).  Dr. Gordon has not seen him for over a month, and he is not scheduled until the following month.

The email from E Corp was for the purposes of letting Dr. Gordon know that her patient had submitted documentation to E Corp (supposedly from Dr. Gordon), and they wanted to confirm that these documents were legitimate and unaltered.

To Dr. Gordon’s disappointment, she saw one legitimate letter (an older letter she wrote for Alderson to submit to his boss, confirming regular 4:30 pm appointment times, which allowed Alderson to leave 30 minutes early on those days), and one entirely questionable, clearly altered letter.

Apparently, Mr. Alderson copied Dr. Gordon’s letterhead and pasted it as an image for the false documentation.  The body of the letter is something Gordon never wrote (saying that Dr. Gordon assessed Alderson and determined he is unfit to return to work for an indefinite period).  Dr. Gordon’s signature is also copied and pasted on the fake letter.  The fake letter was shoddily done, the footer is cut-off, some of the text is cut-off, and most of the text appears to be slightly at an angle.  The letter clearly did not come from Dr. Gordon.

Of course, this a huge breach of trust and Dr. Gordon struggling to organize her thinking as she feels incredibly violated by Mr. Alderson.  Dr. Gordon calls you for a consultation.

What are the clinical issues involved in this situation?

What are the ethical issues involved in this scenario?

What are the ramifications about the therapeutic relationship?

How does Dr. Gordon respond or not respond to E Corp?

Are there any other legal issues that may be in play?

What course of action would you suggest to Dr. Gordon?

1 comment:

Indian Curry said...

This is a really tough one! The texts and ethics only talk about psychologists ethics and there is virtually no information about unethical acts of clients and how to deal with it!

The psychologist should first talk to the client and present the two letters and ask him to explain. Get his side of the story, try to understand why he fabricated the letter. Next, irrespective of what reasons made him forget the letter, she should explain clearly to him that what he has done is wrong and explain the different consequences of his (1) fabrication of the letter and (2)submitting to his employer (3)the employer contacting her (4) her response to the employer(5) the employer's reaction to him, depending on her response. The client, should be made aware that forging her signature and submitting a letter purportedly written by her amounts to 'impersonating her' and that is unacceptable.
The psychologist should definitely not pretend that she wrote the 2nd letter to the employer as she would become guilty of colluding with the client in cheating or lying to the employer. She should definitely tell the client she is not going to lie to his employer saying that she wrote that letter as it's unethical and she is an ethical psychologist. She is not going to compromise her ethics for him or anyone else. That being said, I don't know, how she can respond to the employer, without throwing this client under the bus.

She should seriously consider whether she has the right emotions, degree of objectivity and right frame of mind to CONTINIUE to work with this client or if it's better for her to refer him to a different professional due to her current inability to work with objectivity and neutral emotions or positive emotions with this client. All said and done, it's takes a saint to continue dealing with a person when trust is shaken.
I don't know the "ideal" way of how to respond to the employer in a way which minimizes the potential anger of the employer toward the employee/client.

The motive behind the forgery should be analyzed...is this client a habitual liar or someone who cheats in various ways to get what he wants? Is it something he did in desperation and only once? Is he experiencing remorse or thinks he can get away with it? Is he a person with low IQ and a person easily pushed into doing things by someone else who has a great deal of influence over him? Was he drunk when he did it and he would never have done it otherwise? The motive would determine the psychologist's attitude towards him and this act of his.
She should probably let him know that she is going to tell the employer that she did not write the letter; she should tell him, if he will listen to her, how to cope with the repercussions. She may have to be supportive i.e. continue with a few sessions or refer him to someone else, anticipating that he will definitely experience distress if the employer's response to the forgery is harsh.
But it is a huge ethical dilemma for the psychologist if the employer's response is extremely harsh such as firing him. Is firing him proportionate to his act of forgery ? The psychologist then has to deal with her own feelings of guilt if he gets fired and or if he deals with the employer's reaction with increased depression, etc.
I hope others give their own take on dealing with this.