An Integrated Approach to Clinical Practice

• Chapter 1, “An Integrated Approach to Clinical Practice,” pages 1–9.
• Chapter 2, “Key Issues in Clinical Practice,” pages 10–26.

Use the Capella University Library to read the following:

• American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.).
  • Section I, Introduction and Use of the Manual.
    • This will help you acquire a basic understanding of the manual.

Use the Internet to read the following:

• National Association of Social Work. (2005). NASW standards for clinical social work in social work practice [PDF]. http://www.socialworkers.org/
  • This resource guide on ethics within clinical social work will serve as a valuable resource in understanding ethical standards.

Reamer (1999) shares an ethical decision-making framework that explores a hierarchy of topics that supersede others. This framework includes the following concepts:

• Rules against basic harm to an individual’s survival take precedence over rules against harms, such as lying or revealing confidential information or threats to additive goods.
• An individual’s right to basic well-being takes precedence over another individual’s right to self-determination.
• An individual’s right to self-determination takes precedence over his or her right to basic well-being.
• The obligation to obey laws, rules, and regulations to which one has voluntarily and freely consented ordinarily overrides one’s right to engage voluntarily and freely in a manner that conflicts with these.
• Individuals’ rights to well-being may override laws, rules, regulations, and arrangements of voluntary associations in cases of conflict.
• The obligation to prevent basic harms and to promote public goods, such as housing, education, and public assistance overrides the right to complete control over one’s property.

Cooper and Granucci Lesser (2015) shared that cyber communication increases ethical and clinical concerns. Therapists who engage in emails with clients often face the ethical dilemma of timely and appropriate responses in addition to the expectation of clinicians being available at all times. This dilemma may test traditional professional boundaries and create ethical dilemmas.

Social workers have ethical guidelines, provided through the National Association of Social Work, to guide them through potential ethical dilemmas. This week’s reading of NASW “Standards for Clinical Social Work in Social Work Practice” provides a baseline of expectations for ethical standards within clinical social work.

Based on all of the above, read the following scenario and identify potential ethical dilemmas.

Scenario

Anna is a new licensed clinical social worker who has worked for a university counseling center for two months. Thomas is a student who was referred to her at the beginning of the semester for anxiety and depression. Anna has been seeing Thomas once a week. In addition, he checks in with her through e-mail when he becomes anxious. Anna typically responds to his e-mail during her office hours by assuring him and reminding him of their upcoming appointment. Thomas’s e-mails and phone calls have recently increased due to midterms over the next couple of weeks. On Monday Thomas left a phone message wanting to talk to Anna. He reported that he needed to talk to her sooner than their Thursday scheduled meeting but did not state why. Anna noticed that he sounded upset and slurred his words.

Anna saw Dr. Stance during lunch in the busy student center, Anna knows Dr. Stance is one of Thomas’s favorite professors. Anna shared with Dr. Stance that she was worried about Thomas because she had a strange phone call and stated that he sounded impaired. Anna asked Dr. Stance if Thomas had been in class and if he had been acting strange. Anna did not document the e-mail or the conversation with Dr. Stance as she was going to include these conversations within her weekly clinical note.

On Wednesday Thomas responded to Anna’s e-mail at 8 p.m., stating that someone stole his medication and he did not feel capable of going to class in fear of hurting himself or someone else. He also assured Anna that if he needed to call 911 on his behalf that he would and that she did not need to worry about him. Anna did not look at her e-mail on Wednesday night as she was not feeling well and decided to call in sick on Thursday.

You are Anna’s supervisor and covering Anna’s clients for the day on Thursday. Thomas does not come in for his appointment.

For this discussion:

• Consider this scenario in light of this week’s readings. Also consider ethical decision making in relation to self-determination and well-being based on Reamer’s framework.
• Identify one of the many potential ethical dilemmas within this case and discuss why you feel it is an ethical dilemma.
• Identify two standards provided through the NASW standards readings that you could apply to this situation to assist in the ethical decision-making process.
• Discuss how each standard applies to this case.

References

Cooper, M., & Granucci Lesser, J. (2015). Clinical social work practice: An integrated approach with enhanced Pearson eText (5th ed.). Pearson.

Reamer, F. G. (1999). Social work values and ethics (2nd ed.). Columbia University Press.

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