Scenarios For Discussion

After receiving your doctorate in psychology, you decide you want to live in an area of the country you have never visited before. After a long search, you secure a job at the only clinic in a small town. You'll be able to secure the year's worth of postdoc supervised hours required for licensing. You pack up and move and find you love the new town and your job at the clinic. Ten months into the year, your supervisor says, "I have some bad news. The clinic has decided to get rid of us psychologists, so we're both losing our jobs as of the end of this week. I've decided to retire and travel for the next year or so. I know that there's no other job for you here in town, and that leaves you without the supervised hours you need for licensure. But you've been a great supervisee and I'm willing to give you credit for the last two months. I'll just put down on the form that you worked under my supervision for a year."

2. How do you weigh the possibilities?

3. What would you like to say to your supervisor?

4. What do you think you would say to your supervisor?

You are conducting family therapy with a family of five. The mother, age thirty-one, is Caucasian. The mother's partner, age fifty-four, is Hispanic. The three children are preteens. You discuss with your supervisor the tensions that the family members are experiencing and your beliefs about the causes of those tensions. Your supervisor says: "I think maybe you're seeing it that way because you are [your own race or ethnicity]."

2. What do you think you might say to your supervisor?

3. What would you like to say to your supervisor?

4. Would your supervisor's race or ethnicity make any difference in how you feel or how you react to this situation? If so, what difference would it make, and why?

5. Did you imagine the mother's partner as male or female? What do you believe influenced whether you imagined the person as a man or a woman?

You have just completed an intake session with a person who is extremely fearful, hears voices, and seems to have a thought disorder. Your provisional diagnosis is some form of schizophrenia, although there are other possibilities you plan to explore during the next session. You meet with your supervisor, review your notes for the intake, state your opinion that the difficulty likely involves a schizophrenic process, and list the questions that you plan to address in your next session. Your supervisor's first comment is, "Boy, those schizos really are interesting, aren't they!"

2. What responses do you consider giving to this comment?

3. How do you think you actually would respond to this comment?

4. If this supervisor had a reputation as extremely thin-skinned and averse to criticism and if this supervisor were also someone with considerable power over your training, how, if at all, might this affect your decision about responding?

You are a supervisor who has had a very challenging supervisee. The supervisee has, for example, made demeaning and passive-aggressive comments to patients and often jokes about them in a cruel and disrespectful way. You have attempted to provide feedback throughout supervision, documenting these attempts and their (lack of) effect. The supervisee schedules an additional session with you and says, "I've been looking at my evaluation forms, and I think you've been very unfair with me. I've talked to some other people, and they agree with me. It is important that you change some of these ratings so that they reflect a fair and unbiased evaluation. If you don't, it will continue to hurt my career. My attorney believes that I have a legal right to a fair evaluation that does not defame me."

2. How, if at all, would your feelings differ depending on the supervisee's gender, race, age, or other demographics?

3. What are your options for responding?

4. How would you like to respond? How do you think you would respond? If there is any difference between your answers to these two questions, what causes the difference?

5. How, if at all, would the way you responded be affected by the supervisee's gender, race, age, or other demographics?

You have been working with a client who is in desperate need of treatment for multiple serious problems. Without treatment, the client, a single parent, is likely to decompensate and perhaps place the children at risk. Suicide is a possibility. Unfortunately, the client does not qualify for therapy in the light of the current symptoms and the terms of insurance coverage. Your supervisor and you discuss all the alternatives, none of which seems acceptable. Finally, your supervisor says,

292 ETHICS IN PSYCHOTHERAPY AND COUNSELING

"Look, the only way to get this client the help that is absolutely necessary is to come up with a diagnosis that will meet the terms of the insurance coverage." The supervisor then suggests a diagnosis that will ensure coverage but clearly does not fit the client in any way.

1. How do you feel? Are there any feelings that are difficult to acknowledge, disclose, or consider?

2. Aside from your feelings, what thoughts do you have about your supervisor's suggestion?

3. What courses of action do you consider in the light of your supervisor's suggestion? What are your feelings in regard to each one?

4. What do you think you would end up doing?

5. How, if at all, would your chart notes be affected by your supervisor's suggestion?

You are working with a client who describes graphic sexual fantasies that make you somewhat uncomfortable. At your next supervision session, you tell the supervisor about the counseling session and also about your discomfort with the fantasies. Your supervisor says, "So you are uncomfortable with that kind of sexual fantasizing. What kind of sexual fantasies are you comfortable with?"

2. What would you like to say to your supervisor?

3. What do you think you would end up saying to your supervisor?

4. If there is any difference between your answers to questions 2 and 3, why is there a difference?

5. Does the gender, sexual orientation, age, or race of your supervisor make any difference in terms of the feelings you experience or the responses you would make or would like to make?

You and your supervisor have had substantial disagreements about clients' diagnoses and treatment planning. You discuss your differences extensively, but neither convinces the other. During one supervision session, your supervisor says, "I've been concerned about the difficulties you seem to have in conceptualizing these cases and in formulating effective treatment plans. I believe that there are some personal factors interfering with your clinical judgment. I've discussed these issues with the director of clinical training and senior staff, and we think that you need to enter psychotherapy to address these problems."

1. How do you feel? Are there any feelings that are particularly hard to acknowledge, disclose, or discuss?

2. What are the possible ways you might respond to the supervisor's comments?

3. How would you like to respond to the comments?

4. How do you think you would end up responding to the comments?

5. If there is any difference between your response to questions 3 and 4, what is the difference, and what is the reason for the difference?

6. If you were the supervisor and you believed that the supervisee was experiencing personal problems that interfered with clinical judgment, how would you address it? What feelings would you experience as you addressed this situation? How, if at all, would your feelings affect your ability to address this situation effectively and humanely?

7. If you ever experienced problems that interfered with your clinical judgment or competence and you were unaware of the situation, how would you like others to respond? What would you find helpful and what would you find hurtful?

American Psychological Association Ethical Principles of Psychologists and Code of Conduct

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