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Let's look at how our judgments can create a conflict-of-interest. Actually, in some cases, judging has gotten a "bad name," so to speak, because it has been confused with the assigning of blame. Judgments, of course, are, however, an essential part of the therapeutic responsibility. And to be effective, our judgments must be made objectively and soundly and based on acceptance of the client.
♦ The Individual View
For example in the case of a suicide risk...judgments regarding forced treatment, such as commitment to a hospital or placing the client under the constant care and surveillance of a significant other, violates much of the implicit and explicit contract boundaries and understandings between you and your client. Thus, the client's view is essential in assessing, for example, his or her fantasies associated with suicide. I have found, and perhaps you have too, that clients who have positive fantasies about their death may be more at risk for suicide than clients who have painful or difficult fantasies or no fantasies all.
♦ The Situational View
My individual view was Karen's negative fantasy as it related to how she applied it to the larger view, or situational view, of her children. This caused me to make a judgment that she was not at risk for suicide. Thus, the conflict-of-interest related to the client's right to self-determination. My duty to protect from harm-to-self was resolved based on my judgment by evaluating Karen's perspective as it related to her fear for her children's well-being.
The larger view, as well as all its ramifications, needs to be perceived. Conflicts-of-interest can be ethically resolved by understanding the client and the client's behavior within the context and interrelationships of the total situation. As you know, how wide an area this view must encompass will depend on the situation that the therapist must comprehend and deal with in order to assist the client.
Thus, therapy judgments made on the basis of the correlation of individual versus societal frames of reference are much more likely to possess the objectivity, which is essential to avoid the unethical judgments and condemning activities that tend to inhibit the formation of effective relationships. In summary, the 2 Sides of Reality are:
- Montgomery, Pamela R. ACSW and Still, Elizabeth D. MA. Management of Ethical Issues and Conflicts of Interest. U.S. Department of Health & Human Services.
Peer-Reviewed Journal Article References:
Hague, C., Holland, A. A., & Gottlieb, M. (2019). Selected ethical issues in computerized cognitive training. Clinical Practice in Pediatric Psychology. Advance online publication.
Sah, S., & Feiler, D. (2020). Conflict of interest disclosure with high-quality advice: The disclosure penalty and the altruistic signal. Psychology, Public Policy, and Law, 26(1), 88–104.
Samstag, L. (2012). Introduction to the special section on ethical issues in clinical writing. Psychotherapy, 49(1), 1–2.
What are the two sides of reality? To select and enter your answer go to Ethics CE Test.
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