Integrative case study of family trauma and domestic violence

Integrative Case

The case involve M, a 35-year-old mother with three children from two fathers. He most recent boyfriend, the father of the youngest child, has beaten her twice, been arrested and jailed, but is about to be released. Despite a restraining order, Melissa is terrified. Her economic situation is dire -- she lives at an inexpensive motel, works part-time for under the table wages, and relies on WIC services. Most recently, her 12-year-old son was arrested for shoplifting and suspended from school for fighting. Melissa is aghast about her lifestyle, and heard about my sliding scale fees from a previous client whom I saw when I interned at a public mental health center.

Challenging Aspects -- There are several challenging aspects to this case: 1) Decisions on pro-bono work; 2) Services for those in need; 3) Family in crisis, son acting out, mother feeling frightened and family potentially in danger. Clinicians have been doing pro bono work for years. One of the reasons people choose a psychological career is to help people, and it depends on the fiscal resources of the particular counselor whether they can offer these services. Certainly, M is a prime candidate for those services, and even a sliding scale would likely put her at a zero pay rate. That being said, some studies have shown that if individuals pay some for their services, they are more likely to take them seriously. However, in this case, the family is in considerable crisis and requires at least a short-term intervention (New Benefit for Volunteer Clinicians, 2012).

Principles of ACA and CAMFT- The basic principles of an ethical code of conduct for CAMFT (California Association of Marriage and Family Therapists) and the ACA (American Counseling Association) Code of Ethics are both designed because ethical dilemmas are part of the human condition. It is often important and helpful to have a sponsored code that takes into consideration ethical theory and the needs of the modern therapist. Indeed, in this litigious society, it is important to note the complimentary nature and distance of legal vs. moral and ethical responsibilities for a professional. When one is licensed in their state as a counselor, one also agrees to abide by certain best practice and standardized rules. Both the ACA and the CAMFT recognize that in contemporary society there are numerous gray areas that require sound judgment and thought within the profession, yet both require that the professional, when in possession of information that a crisis situation is occurring, either do their best to help that patient or to find appropriate levels of assistance (American Counseling Association, 2012; California Association of Marriage and Family Therapists, 2012).

Decision Making Model - Ethics and morals are not clean cut, black and white philosophical tenets in modern society. There are principals to follow, many of which have been assessed over thousands of years. However, because human beings are unique, so are situational ethics within the construct of therapy. The bases of normative morality within therapy include four major theoretical principles that are useful in finding congruent, practical, decisions:

Autonomy -- In the setting of therapy, actions are taken without outside control, permission, and/or developing an independent program or action for the patient. Most therapists suggest, instead of autonomy, becoming less autonomous from each other and other health care professionals, thus allowing the interaction to enhance communication between all parties (Freeman and Francis, 2006).

Beneficence -- Beneficence is a moral obligation to act in ways that benefit in the interest of others. Most individuals enter into the vocation of therapy because they wish to help others, but there are risks (Cain, S., et al., 2003).

Nonmaleficence -- The principle of nonmaleficence states that there is a moral obligation to "do no harm." Essentially, the Hippocratic Oath, harm implies negativity -- but for the therapist, harm may include causing pain to heal; end-of-life care, and specific treatments that are quite uncomfortable (Guccione, 1998).

Justice -- Within the principles of healthcare, justice is an ethical issue focusing on the health care provider and the fair and equal treatment given to every patient -- regardless of ethnicity, gender lifestyle, etc. In addition, justice requires that every individual receive confidential, and equal access to treatment; and the advocation of that treatment to regulatory agencies, insurance companies, and any legal office. The core idea is to ensure that there are no "issues" of discrimination or bias that might interfere with proper and appropriate treatment (Rattskk-Dekruf & Chen-Hayes, 2007).

Ethical Considerations- Now that we have a basis for decision making, there are theoretical guidelines we can impose to help us with our decision process: 1) Teleology -- consideration of the conseque3nces of outcomes. What can the therapist do to help ensure the best possible consequences; 2) Deontology -- the requirement of duty, how the end result will benefit the situation; 3) Virtue Ethics -- The right action must be motivated from the right intention; 4) Ethic of Care -- Emphasizes a person as part of a very complex and interdependent relationship (Welfel, 2012). Of course, all models have positives and negatives, because they cannot take every single situation into consideration. The positives focus on the nature of the therapist's ability to use an ethical model to make a decision or at least guidance towards the decision process.

Conclusions- If we utilize the above models, we find that we can produce a template that will help us with our decision. We must ask ourselves several pertinent questions:

What legal and moral obligation do we have toward M. And her family?

Are M. And the family in imminent physical danger?

If therapy were not forthcoming, would M's family crisis deepen?

Do I have the fiscal resources to treat M. And the family pro-bono, since it seems that M. is quite motivated?

Can I assist M. In ways out of her situation?

Are there steps that can be taken to help her son out of his period of violence and acting out?

Autonomy

Beneficence

Non-Maleficence

Justice

Teleology

Consequences of action may place another human in danger.

Would consequence of action be moral?