Ethical standards Example included
Dr. Stephen Brewer. He is a board certified psychologist who works in San Diego California. His patient’s name is Bob Smith. There are some questions that Dr. Brewer has about Bob’s way of presenting himself to him during therapy versus the description of Bob that his friends are telling him. The two characterizations are not the same. Dr. Brewer is seeking to find which portrayal of Bob is closest to the truth (Brewer, & Simpelo, 2014). 2010 Amendments
Introduction and Applicability
If psychologists’ ethical responsibilities conflict with law, regulations, or other governing legal authority, psychologists make known their commitment to this Ethics Code and take steps to resolve the conflict in a responsible manner.
4.04 Minimizing Intrusions on Privacy Psychologists discuss confidential information obtained in their work only for appropriate scientific or professional purposes and only with persons clearly concerned with such matters.
4.06 Consultations When consulting with colleagues, (1) psychologists do not disclose confidential information that reasonably could lead to the identification of a client/patient, research participant, or other person or organization with whom they have a confidential relationship unless they have obtained the prior consent of the person or organization or the disclosure cannot be avoided, and (2) they disclose information only to the extent necessary to achieve the purposes of the consultation. (See also Standard 4.01, Maintaining Confidentiality.)
Bob Smith is thirty- six years old. He originally went to see Dr Brewer because he is concerned about his career choice and direction in life, currently. He graduated from University with a psychology degree. From there he went on to obtain a job as a psychiatric technician, working in a county in California (Brewer, & Simpelo, 2014).
Highlight the relevant information from the patient’s history you will use to inform your conceptualization of the patient’s problems and diagnosis.
Bob’s presenting symptom is anxiety. Dr. Brewer gave him a diagnosis of Adjustment Disorder with Anxiety. Bob is originally from Canada. He comes from a low income, very conservative family. His Father was in his life, however he was not there much of the time due to work responsibilities. His Mother is a hard worker, but her behavior is also explosive at times with anger and discipline, which left Bob to become somewhat afraid of her and being around her (Brewer, & Simpelo, 2014).
Bob’s Father died recently (one year ago). Bob’s Mother got a job at his own junior high school. Later when he was in high school, she then got a job there as a librarian. Bob moved to California at the time of college. During that time, Bob’s Mother also informed him she would be moving to California. In the present day, in therapy Bob all of a sudden changed his demeanor and his body language when the talk turns to talk of his Mother. The expression on his face melts in to one of anxiety, fear, and looking guarded (Brewer, & Simpelo, 2014).
At this present day, Bob denies any significant medical problems. He also denies any problem with drugs or alcohol. However his friends describe something different. They say his behavior has taken a sharp turn lately and he no longer acts like his old self. He has become with drawn. He is almost to the point of a recluse. His weight has dropped significantly and in a very short period of time. He was once happy, energetic and loved being around his friends. So, the Bob they describe now is different. When they invite him to any gathering, this is always declined, that is if they can even reach him at all. There are times when he does not even answer their calls. His friend suspect Bob is now taking drugs (Brewer, & Simpelo, 2014).
During the progression of therapy, there came a point when Dr. Brewer wished to speak with both Bob’s friends as well as Bob’s Mother. Bob signed the release form for the friends, but would absolutely not sign the form to allow any conversation with his Mother to take place about Bob. Dr. Brewer did what he could do legally, and hired a private investigator to at least obtain Bob’s Mother’s contact information (Brewer, & Simpelo, 2014).
Provide an evaluation of the degree to which the presenter followed the ethical standards outlined in Section 4 (Links to an external site.)Links to an external site. of the APA’s Ethical Principles of Psychologists and Code of Conduct: Including 2010 Amendments.
According to the APA’s Ethical Code of Conduct Guide, the presenter followed ethical guidelines here very well. Bob signed certain consent forms that are mandatory to move forward with things such as speaking with his friends about Bob. The only part that is questionable moving forward, is what is Dr. Brewer going to do with the information that was obtained by the private investigator. Dr. Brewer had this investigator find contact information on Bob’s Mother. However, Bob did not sign the consent form for Dr. Brewer to discuss Bob with Bob’s Mother. So, I would caution Dr. Brewer and remind him of this moving forward. So far, no rules were broken (American Psychological Association, 2010). However my question is what does Dr Brewer plan on doing with that information on Bob’s Mother that the investigator has provided for him? I would caution and advise that Dr. Brewer does not hold any meeting with her where Bob is the subject of conversation. If this were done, then this would be an ethical violation as consent forms to be signed are mandatory in order to move forward (American Psychological Association, 2010).
Provide an evaluation of the patient’s symptoms and presenting problems within the context of a theoretical orientation that seems to be most appropriate for the situation. Be sure to indicate which theory you are using for your evaluation and provide a justification for your choice. To get the most out of this assignment, you are encouraged to use the same theoretical orientation from which you chose to write your Week Two Initial Assessment discussion’s guided response.
With this case, I choose to use psychoanalytic orientation (Goldstone, 2017). The reason for this, moving forward, is that I already see that Bob’s family life from when he was growing up has some issues that could cause some conflict and bigger issues moving in to the stages beyond childhood and in to adulthood. It appears that Dr. Brewer may “value” what Bob’s Mom has to say about Bob. This to me is questionable. It is important to note that Bob has denied for his Mother to discuss him with the Doctor. He also has a group of friends. This group will provide plenty of additional information in addition to Bob’s own version of his story.
There are two main reasons as to why speaking about Bob with his Mother after he denied this, is not a good thing to pursue doing. One is that it would be an ethical violation on the part of the Doctor to do so. The only time this would not be an ethical violation is if Bob were in danger of hurting himself or another. Bob’s psychiatric condition in no way is near that level, at this current time. Number two reason is that with Bob’s group of friends, this will provide plenty of addition information about Bob; and from a source that is with in ethical guidelines to obtain information from, as he himself has already signed off on this.
With using psychoanalytic perspective, I will view Bob’s present status of mental health related issues and also obtain information from early childhood and other stages of early years. Then, I will look to find if there is any link with some trauma or events from childhood, and Bob’s present day issue of anxiety and uncertainty of what direction to go in his life with career. In my opinion, there looks already to be a link with someone from Bob’s past who has a history of causing him to feel this way. Why did Bob’s Mother keep getting jobs at the places where Bob spent most of his time while away from her home, which is at his schools. I think to get the one job one time, as a janitor that would have been one thing. But it did not stop there. When Bob transitioned to high school, she did too, with her new job that is. Then when Bob moved to California, she did too. That seems a bit creepy.
I am sorry but there is a difference between being a caring parent and following the child as thought he is in prison or a prisoner. It is healthy for a child to go through the stages of development in a normal way. This includes spending some time away from his parents. She did not really allow for this. And it is not normal that three staged of Bob’s life, she also changed her career and job in relation to what Bob was going through in his life.
I would not say this is normal or healthy relationship here with Bob’s Mother’s view of what is “OK” to do in the name of parenting, and what is not “OK”, normal or healthy. I can imagine how and why at this point even after making the big move to California, and she followed him there also, I can see how Bob is in a flustered state now mentally, emotionally and psychologically.
Provide a diagnosis for the patient based on one of the diagnostic manuals available (e.g., DSM-5, Psychodynamic Diagnostic Manual, etc.). Justify your choice of this diagnostic manual.
The diagnosis I have for Bob is clinical depression. I used the DSM-5 to help pin- point this diagnosis. This is a good reference to use because of its history of being a very reputable handbook to help with diagnosing psychological disorders (First, 2013). At this point, is debatable whether he is using dugs or not. However in my opinion, this would not change the diagnosis of his psychological disorder he is experiencing at this time.
Yes I will proceed to find whether he is or is not on drugs. If he has this in addition to the depression, I will treat that as well. If not, then the depression will be the focus of treatment. Bob tried moving away from his Mother (we see this with his move to California for college). His Mother obviously will not allow this to happen very easily if at all (Brewer, & Simpelo, 2014).
I do not think Bob has major depressive disorder. One reason is that there is no mention or any evidence this person has contemplated suicide or has had suicidal thoughts (DeFilippis & Wagner, 2014). In my opinion, Bob’s diagnosis is clinical depression. It is possible to treat this disorder with therapy that does not include drug therapy. This is how I will approach his treatment. It will involve CBT as the main therapeutic agenda. No drug therapy and no inpatient treatment program is needed at this time.
Describe at least one evidence-based treatment option for this diagnosis.
My advise at this time is that he should keep a healthy distance from her at this time. I do think his present of status of feeling upset and confused is linked to her obsessive behavior of following him around. I think the more he can detach from that obsessive person, the more he can get back to himself, nurturing himself, not feeling afraid, getting enough sleep at night etc. He needs to focus on his own life, one day at a time. He needs to re- commit to going to work every day. He needs to re commit to his own priorities, ethics, and goals.
I will use CBT Cognitive Behavior Therapy with in Bob’s treatment plan. This will include much of Bob being able to talk to me. We will meet two times per week. As he sees he has a trustworthy person to talk to, and he also has set boundaries his Mother cannot cross, he will begin to be less afraid. Then his clarity of thought will comeback to him. CBT that includes teaching Bob the importance of establishing and enforcing boundaries in one’s life, is an evidence based treatment option.
Thoughts are powerful. A person who is viewed as scary is also powerful. If she is allowed in his day- to- day life, the self views this as a threat. This of course will bring about a cycle that perpetuates fear, which then materializes as various things. “Uncertainty” (or constantly second guessing ones’ self) can be one of these things.
She has problems of her own it looks like. It is important for him not to fall in to a cycle of her guilt-ing him. This would only make his condition and confusion worse. She does not respect boundaries (Brewer, & Simpelo, 2014). Bob needs to establish boundaries and commit to enforcing those. Boundaries are important in any relationship. Boundaries must be enforced when necessary (Putwain, 2009). This is important to maintaining good mental health for any person who has good mental health or wishes to achieve this.
*and one non-evidence-based treatment option for this diagnosis.
A non- evidence based treatment option for Bob at this time is for Bob to have him choose a hobby that is a relaxing one (such as listening to relaxing music, sitting in a garden, owning a cat and taking care of it, etc). Bob is to have this in his life and spend at least one hour every other day with this item or hobby. This may have a positive effect on showing Bob what it feels like when he is engaged in something not threatening and not fear producing. Next we will take the subject of Bob’s Mother, and use this information Bob now has about what it feels like to be happy and not in fear. We will take the subject of Bob’s relationship and try to figure out if he should be in communication with her or not. I would use this option in conjunction with CBT. This is non evidence based, the fact that this sort of hobby can be good as a tool to aid treatment of depression. However, most likely in the process Bob will reap something positive from it (Goldstone, 2017).
Compare the benefits and costs of these treatment options.
The cost of this option would be out of Bob’s pocket. Cost includes for example if he chooses the small pet, option, would include the pet (cat) and the needs for the pet (water bowl, food etc). Thus, the cost is not phenomenal. It is minimal, and the purpose is to add something positive to his life. This, compared to the evidence based cost, which is CBT and the therapy would be with me, Bob’s Doctor. This is not covered under insurance usually, so cost for this is $300 per week. My charge is $150 per hour.
Based on specific theoretical and historical perspectives, provide questions for your colleagues seeking their thoughts and feedback.
Pose appropriate questions that may help refine the diagnostic impression of this patient.
The questions I have for my colleagues are what do they think Bob’s diagnosis is? Also, do they think it is a good choice to use psychoanalytic perspective to use with this case? Do they think Bob’s Mom has a negative, neutral, or positive impact on Bob’s life currently? Do they feel at this time, Bob should create a distance between he and his Mom? Do they think Bob is using drugs at this time? Should Bob inform his employer he needs to cut back his hours at work to part time? Also will he be willing to show them that he is currently in therapy and that this is the reason why he cannot be at work full time at this time?
