The ideal resolution results when a decision can be made prior to the commission of an ethical infraction that would otherwise have untoward consequences. Often enough, however, the decision occurs in response to an already ongoing, problematic situation. Sometimes, the appropriate action involves simply ceasing and desisting from a practice that, after careful analysis, seems ethically risky even if no harm has yet occurred. Sometimes the best course of action is the recognition that one lacks some specific competencies and should now undertake continuing education or seek supervision. Often the implementation will involve the need to do something differently going forward, while making an attempt to ameliorate any damage now. Remediation attempts can range from making an apology to conducting an additional intervention to providing services or resources to those who were wronged. On occasion, the implementation will involve contacting an ethics committee or a licensing board to determine the appropriate resolution.
Because professional ethics codes are general proscriptive guidelines that cannot inform us of how to deal with specific ethical dilemmas and their associated variables, we suggest that all mental health professionals internalize a decision-making strategy to assist in coping with ethical matters as they arise. We expect that such a process will maximize the chances of an ethically sound result, although we also readily acknowledge that this does not always happen. Sometimes outcomes will remain unsettled no matter how hard one tries to resolve them. However, therapists who can document a sustained effort to deal with the dilemma, including well-reasoned accounts of their decision-making rationale, will have a distinct advantage should their actions ever be challenged.
About Affirmative Action, Diversity and Inclusion
In most states, the therapist would be obligated to breach the client's confidentiality by filing a report of suspected child abuse with child protection authorities. Doing so would protect the children, conform to state law, and constitute ethically acceptable behavior. The therapist could, however, go a step further by attempting to engage the client in collaborating in filing the report, and by attempting to engage the authorities in assisting the family while the client strives to restore her sobriety and find alternative employment. The first course of action addresses ethical necessity. The second alternative involves considerably more effort and advocacy, but also could yield a better outcome all around.
Ideally, information about the decision should be shared with all affected parties, or at least with some subset of representatives if a larger population is involved. Sometimes these people cannot be contacted, are unable to participate, or cannot give consent due to age or physical, mental, or other limitations. In such cases, additional responsibilities to protect their welfare apply. Special advocates or other safeguards may become necessary in complex situations.