Ethic Counselling Case Study PDF

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This assignment require we conduct an case study on ethical decision making for counsellors....

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Case Study Analysis Ethical Issues The current essay will provide details and analysis on a real-life NSW Health Care Complaints Commission (HCCC) case study about a psychologist named Mr. Daniel Stanton1. This essay starts with a summary of the case study and an analysis of its ethical, legal and social elements. More discussion will be devoted towards the ethical elements given its central role in maintaining professionalism as a psychologist. Finally, this essay will end with an analysis of the response and outcomes by the NSW Civil and Administrative Tribunal (thereafter to be referred as “the Tribunal”).

Case summary and context A previously registered 42-years-old psychologist, Mr. Daniel Stanton2 entered into private practice as a psychologist in Sydney while he was also practicing as a masseur in 2014. During the period between September 2014 and March 2016, he had an on-going number of sexual misconducts concerning two female clients, Client A and Client B (HCCC, 2009). In 2014, Client A visited Mr. Stanton’s psychological service twice about work-related challenges, marriage problems and alcohol addiction. After the second session, Client A contacted Mr. Stanton about his massage service via Facebook. Mr. Stanton responded to Client A by being engaged with her through several highly sexualized text and Facebook messages concerning a proposed massage. On 28 September 2014, during the third session, Mr. Stanton initiated an unscheduled 1 Summary of the case from HCCC can be found from this link: https://www.hccc.nsw.gov.au/Publications/Media-releases/2019/Mr-Daniel-Stanton---Professionalmisconduct---Disqualified-and-Prohibition-Order 2 Details of this case can be found from this link: https://www.caselaw.nsw.gov.au/decision/5cb7c7d3e4b0196eea406347

2 massage with Client A within the psychological service center setting, where Client A was partly unclothed with her breasts exposed. Mr. Stanton afterwards sent Client A many text messages to prose another “sensuous and indulgent” massage for “the most deeply satisfying and blissful night” at the client’s home. Client A later responded to a text message by expressing her discomfort of the unplanned massage and then lodged an official complaint against Mrs. Stanton (HCCC v. Stanton, 2019). As for Client B, between 2015 and 2016, she consulted Mr. Stanton about her depression and domestic abuse. In March 2016, Client B recognized Mr. Stanton’s profile on a hook-up website called “Red Hot Pie” after being prompted by a friend. Client B later found out that this same friend had sex with Mr. Stanton. Client B mentioned this incident to her sister, who later initiated contact with Mr. Stanton and started being engaged in several sexualized text messages with him. Weeks later, Mr. Stanton mentioned his profile at the “Red hot Pie” website to Client B during a psychological session. After that, Client B began messaging Mr. through a string of sexualized text messages. On 29 March 2016, Mr. Stanton visited Client B’s home for a planned sexual encounter. After that, Client B texted Mr. Stanton to express her unhappiness about the what happened. To respond, Mr. Stanton tried to persuade Client B not to submit a formal complaint against him by referring to his mental illness and his fear of losing his career and family. He also revealed that he almost committed suicide 18 months ago with hospitalization. Much of these incidents and communications with Client A and Client B were not documented and discussed with his supervisor by Mr. Stanton (HCCC v. Stanton, 2019). Having summarized the case, the following session analyze ethical elements for this case by quoting specific information from Codes of Ethics (2007) published by Australian Psychological Society (there after referred to as “APS Code”).

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Analysis of ethical elements According to APS 2007 Code, the two key general principles that Mr. Stanton breached were integrity and propriety with more specific ethical elements analyzed below. Integrity

Regarding integrity, psychologists should understand that they are placed in a position of trust, and should maintain appropriate boundaries with clients, preventing any potential conflicts of interest and avoid any exploitation (APS, 2007:26). Mr. Stanton undoubtedly breached the code of non-exploitation by engaging highly sexualized text messages with (1) Client A and Client B, (2) performed a sexualized massage on Client A, and (3) by having sex with Client B. Concerning the massage, while use of physical touch as healing tool in therapeutic relationship has always been a controversial topic, the therapist should clearly be aware of what kind of physical touch might cause harm for the client. The bottom line is that the psychologist should understand that boundaries plays an essential function in “the maintenance of a safe and predictable therapeutic relationship” (Bonitz, 2008:397). The “slippery slope”, that is when one repetitively extends and muddles boundaries, is an indication that the situation is going towards direction of serious boundary violations, such as sexual misconduct (Bonitz, 2008:397). This is exactly what happened between Mr. Stanton and Client B, Client B, the sexualized massage was a bodily intrusive act which indicates Mr. Stanton has an extreme deficiency in understanding of physical boundaries. As for the act of having sex with Client B who is also his client for psychological service at the same time, Mr. Stanton’s behavior seriously damaged his

4 client’s psychological welfare and caused her harm. This is prohibited in the APS Code that practitioners are not permitted to “engage in sexual activity with a client or anybody who is closely related to one of their clients” (APS, 2007: 29). Such that, Mr. Stanton abused both “the trust and the power differential” between himself and these two clients to please his own needs, leaving Client B in a damaged state (Yahav & Oz, 2006:306). Both of these situations with Client A and Client B posed as multiple boundaries violations; a “harmful crossing, a transgression, of a boundary” (Pope & Keith-Spiegel, 2008: 630). Here, Mrs. Stanton breached the code of conflict of interests when Mr. Stanton engaged in sexual relation and interactions with Client B’s sister and friend. Of course, the “slippery slope” started much earlier when Mr. Stanton decided to practice both as psychologist and masseur in Sydney, and also to post a causal dating profile with clearly recognizable photo on a public website. It was clear that Mr. Stanton did not refrain himself from any of these situations that involved high risks of multiple relationships with potential conflict of interest. He allowed himself in a position where his objectivity as a counselor was seriously impacted (Capawana, 2016), and eventually leading to destruction of the therapeutic relationship and causing harm for his clients (Nigro, 2004). Moreover, he has impaired his “competence, effectiveness, objectivity, or ability to render a psychological service” (APS, 2007:28). Additionally, Mr. Stanton breached the code of reputable behavior when he posted his recognizable profile on a hook-up behavior and offer a massage to a client within a psychological service setting. Such dishonorable acts reveal his disability to practice as a psychologist and reflects damagingly on his profession (APS, 2007:26).

5 Propriety

According to the principle of propriety in APC Code, psychologists should prioritize “the welfare of clients and the public, and the standing of the profession” over his self-interest. (APS, 2007:18). Mr. Stanton clearly prioritized his own needs and self-interest over his clients or his profession. He also failed to ensure his competence to practice in the profession and harmed these two clients. As such, Mr. Stanton breached the code of professional responsibility by not acting with care and expertise expected of a competent psychologist. He certainly did not take any responsibility for the predictable outcomes of his behavior (APS, 2007:20). This is particular so when he asked a vulnerable client with marital difficulties to take off her bra during a psychological session, indicating an astonish lack of care and respect for his client. Worst of all, it is evident that Mr. Stanton acted in a way that breached the code of competence as he was not monitoring his professional performance and certainly did not become aware of his problems that might damage his ability to offer “competent psychological services” (APS, 2008:19). And if he did, he should have stop offering psychological service once he realized that his emotional and mental state would impair his ability to practice as a psychologist (APS, 2008:19). To maintain his professional competence through self-monitoring, he should have been maintaining record-keeping regarding the sexualized interactions and misconduct with these two clients and seek supervision before these misconducts occurred (APS, 2007:19). Indeed, part of his ethical responsibility as a psychologist is to “keep adequate, honest, and accurate records” of these circumstances develop (Pop & KeithSpiegel, 2008:649).

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Analysis of legal elements Mr. Stanton was prosecuted by the HCCC in May 2019 regarding a complaint of his “unsatisfactory professional conduct” and “professional misconduct”. The legislations involved in this case include Health Practitioner Regulation National Law (NSW) 2009 (referred later as “National Law”) and Health Care Complaints Act 1993 (NSW). The table below listed the key legal issues raised and findings and reasons responded by the Tribunal:

Table 1: Key legal issues raised in this case

Key legal issues raised by the Tribunal 1. Is Mr. Stanton’s conduct of such seriousness determined to be a “professional misconduct” 2. What role does Mr. Stanton’s diagnosed mental illness play in the tribunal’s assessment of the seriousness of his professional misconduct? 3. What are the protective orders?

Findings and reasons from the Tribunal A sexual relation between psychologist and client is almost always deemed a professional misconduct3 due to “inherent power imbalance in the treating relationship” The Tribunal did not accept his mental illness as a way to alleviate the seriousness of his misconduct

The Tribunal decided that “cancellation of registration is the only appropriate order to protect the health and safety of the public in these circumstances” for three years because he will require a long period for rehabilitation and reform himself.”

Analysis of social elements Power can differ significantly across different people and contexts depending on “status, influence, and control of psychologist and his/her clients” (Capawana, 2016:3). For this case, the two important social elements that point to power imbalance are the nature of therapeutic relationship and unequal sociocultural

3 Professional misconduct is defined as “more than one instance of unsatisfactory professional conduct that, when the instances are considered together, amount to conduct of a sufficiently serious nature to justify suspension or cancellation of the practitioner’s registration” (National Law, 2009:102)

7 positions between female client and male psychologist. Firstly, there is the inherent asymmetrical nature within therapeutic relationship, where there is a lot of power invested in the therapist due to their professional authority as a result of their training and experiences (Yahav & Oz, 2006:317). Poignantly, such hierarchical nature of therapeutic relationship is designed to be an instrumental help to clients to success in their healing. This at the same time poses risks for any clients with possibility for exploration (Yahav & Oz, 2006:317). Secondly, the unequal sociocultural positions between female and male also lend itself to an even higher extend of power imbalance between a female client and male psychologist. Although the social power imbalance between female and male has improved significantly since the feminist movement in the 70s, one cannot deny that “social conditioning and an institutionalized sexual class system” is still playing its role in the modern-day society (Thomas, 1977:447). This is particularly the case when it comes to psychology and psychotherapy, where women were psychologically oppressed having historically suffered concerning “self-concept, identity formation, intellectual development and aspirations, and overall emotional well-being as a result of the socialization they have undergone and the sociopolitical status assigned them” (Thomas, 1977:447). Such influences relating to hierarchical nature of therapeutic relationship and gender dynamics are possibly key factors that put Client A and Client B in vulnerable positions.

Analysis of responses from tribunal

8 The Tribunal found Mr. Stanton guilt of the complaint regarding “unsatisfactory professional conduct” and “professional misconduct”. His conduct was described as “calculated, pre-meditated and predatory in nature”. Such that, he showed “a concerning lack of insight or remorse and an almost narcissistic lack of empathy”. He was ordered not to be allowed to re-register for three years, given that he was not registered at the time. He was also prohibited from offering any healthrelated services during this period (HCCC, 2009). Indeed, I agree with the Tribunal that Mr. Stanton’s sexual conduct was “grievous abuse” of therapeutic relationship (HCCC, 2009). It has clearly been demonstrated through research that sexual misconduct has serious psychological damage for the clients (Sommers-Flanagan & Sommers-Flanagan, 2004). Such common damages include confusion, emotional, guilt, high risk for suicide and anger etc. (Capawana, 2016:4). Given such potential detrimental effects on clients, I personally feel that the order to prohibit Mr. Stanton to not to re-register to is not a sufficient form of penalty given the serious damage and mis-use of trust and power. Clearly, the legal system has its limitation and might not always be the most effective means to ensure that practitioners like Mr. Stanton refrain himself from acting damaging behavior on his clients. From that perspective, I agree with Gross (2001:207) that it is practitioners’ “personal integrity” that could be the ultimate protection for clients’ welfare, rather than legislations and the legal system. I personally believe that all therapists should follow “the principle of fidelity (keeping faith)” where they should keep faith with themselves and their profession. One of the most important skills that a practitioner can develop is “critical selfreflection skills" to maintain and improve ethics and professional practices (Terry, 2010:24).

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Reference Australian Psychological Society (2007). Code of Ethics. Melbourne: Author. Bonitz, V. (2008). Use of physical touch in the “talking cure”: A journey to the outskirts of psychotherapy. Psychotherapy, 45(3), 391–404. http://dx.doi.org/10.1037/a0013311 Capawana, Michael R. (2016) Intimate attractions and sexual misconduct in the therapeutic relationship: Implications for socially just practice, Cogent Psychology, 3:1, 1194176, DOI: 10.1080/23311908.2016.1194176 HCCC (2009, May 1). Mr Daniel Stanton (also known as Daniel Rouse-Stanton) – Professional misconduct - Disqualified and Prohibition Order. HCCC. https://www.hccc.nsw.gov.au/Publications/Media-releases/2019/Mr-DanielStanton---Professional-misconduct---Disqualified-and-Prohibition-Order. HCCC v. Stanton (2019). HCCC v Stanton [2019] NSWCATOD. Civil and Administrative Tribunal New South Wales https://www.caselaw.nsw.gov.au/decision/5cb7c7d3e4b0196eea406347 National Law (2009) Health Practitioner Regulation National Law (NSW). Retrieved from https://www.legislation.nsw.gov.au/inforce/5f7cecec-66d4-c01e-92b1f8efa02f105c/2009-86a.pdf Health Care Complaints Act 1993 (NSW). Retrieved from https://www.legislation.nsw.gov.au/inforce/d133fbff-a3b9-46e7-f7ffc679017fb69a/1993-105.pdf Nigro, T. (2004). Counselors' experiences with problematic dual relationships. Ethics & Behavior, 14(1), 51–64.

11 Pope, K. S., & Keith-Spiegel, P. (2008). A practical approach to boundaries in psychotherapy: Making decisions, bypassing blunders, and mending fences. Journal of Clinical Psychology: In Session, 64(5), 638–652. Sommers-Flanagan, J., & Sommers-Flanagan, R. (2004). Counseling and psychotherapy theories in context and practice: Skills, strategies, and techniques. Hoboken, NJ:Wiley. Thomas, S.A. (1977). Theory and practice in feminist theory. Social Work, 22, 447454. Yahav, R., & Oz, S. (2006). The relevance of psychodynamic psychotherapy to understanding therapist-patient sexual abuse and treatment of survivors. Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry, 34(2), 303–331....