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Ethical Dilemma
Stacey R. Ferrell
A comprehensive exam response submitted in partial
fulfillment of the requirements for the degree of
Master of Science in Psychology
Purdue University Global
April 11, 2022
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Ethical Dilemma
Supplying psychological care to individuals is an important field that requires adequate
knowledge and information. Ethical dilemmas occur in this specialty field much like in the
healthcare setting. As a psychological professional, one should be able to at once recognize any
situations that may occur that could lead to an ethical concern or a breach of the code of
standards that are put into place by the American Psychological Association (APA). The APA
has put into place a list of codes and standards that help protect not only the client but the
professional as well. While the ethics code or guidelines don't need to be followed when outside
of their professional roles, they should be always followed when providing care to the client
(Haeny, 2014). When providing care, it is important to remember that there is the possibility of
situations occurring when ethical standards will need to be broken. This does not mean that the
professional is not doing what is needed from them, it simply means the professional is adequate
and thorough with their clients. As a psychological professional, it is important to know and
understand the ethical guidelines that are in place, because they will help with ensuring the client
is receiving proper treatment while in the professional’s care.
Ethical Dilemma
Working in the field of psychology allows for several areas of expertise that a
professional could focus on. General psychology covers all aspects of possible reasons for an
individual to seek treatment from a psychological professional. A common ethical dilemma that
a psychological professional is likely to meet would be, providing treatment to an individual with
different ethnic backgrounds. There are children of all ethnicities who participate in receiving
mental health care, which would have them see a psychological professional. Take, for instance,
a 13-year-old Chinese female who is being treated for abuse and has expressed thoughts of
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suicide. She was sexually abused by her brother and his friend. Since the abuse occurred, she has
had thoughts of committing suicide and experiencing severe depression. The thoughts have
occurred more than once but are not currently experiencing any thoughts. She has shown the
failed attempts on her arms where she has cut herself repeatedly. She has not told her family
about this concern and does not want them to find out what she is telling the professional. The
depression is debilitating and prevents her from being able to focus on her schoolwork. Sounds
like a simple case; right? Wrong. Various ethical concerns within this dilemma could occur. For
one, the minor is of a different culture, which may not believe in the treatment for depression.
Two, she has the depression she is experiencing is overwhelming and preventing her from
performing to her ability in school. And finally, she has shown scars on her arm where she has
cut herself while trying to commit suicide.
First Response Option
The most common response the professional would consider is to continue to supply
treatment to the minor based on the reason for a referral from her pediatrician. Since the client is
of a different ethnic background, it is important to consider their beliefs when providing
treatment. According to the American Psychological Association (APA), Principal E: Respect
for People's Rights and Dignity states that the psychological professional is aware of respecting
all client’s cultural backgrounds while providing treatment (2017). The professional will provide
treatment to the client if they are able based on the individual and not their cultural background.
No judgment will be made toward the client or their family members. The professional should
also try to learn about the Chinese culture before providing treatment. If this is done correctly,
the professional will already be aware of what treatments will be allowed, and which may be
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refused by the client’s family members. This is vital information to understand because it can
affect the level of care that could be provided to the client.
Second Response Option
While speaking with the client, she has expressed the level of depression she is
experiencing as debilitating. She is unable to focus on school, no longer hangs out with her
friends, and only wishes to remain in her bedroom alone and away from family members.
Research has shown that adolescents aged 13-18 years old have a high-risk group with the
likelihood of developing a depressive disorder (Wang, et al., 2016). Keeping in mind the client is
a minor and that the total prevalence of a depression risk developing in quickly reaching 23.9%
(Wang, et al., 2016). Having an effective treatment plan available for this client would be
beneficial, especially when keeping the focus on the cultural history and treatment of depression.
The Oriental culture may have different beliefs than what the American culture has when it
comes to acceptable treatment options. Under the APA Code of Ethics, Section 2 Competence,
2.01(b) states the professional is to provide services only when they are within the boundaries of
their competence where there is knowledge of the client’s culture and ethnic background (APA,
2017). This means the professional should have adequate knowledge and training in providing
treatment with the Chinese/Oriental culture.
Third Response Option
Providing psychological care requires active listening skills. Although a client may have
been referred to the practice for depression, there may be underlying information that was not
previously addressed. In this case, the minor is being seen for depression, although, there is a
situation that may have occurred that may have led to the depressive state. The situation may
have also led the client to have failed suicide attempts. Active listening is a valuable tool to have
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when providing treatment because when the professional restates a paraphrased version of the
client’s message, this shows the client that there is an involvement in what is being said (Weger,
et al., 2014). In this situation, by actively listening to the client, the professional would know that
there have been suicide tries. While they were failed attempts, the concern is, that thoughts are
occurring within the child’s head of self-harm. She has also shown the scars on her arm showing
her attempts. While providing treatment to this individual, the professional must be mindful of
conversations and documenting pertinent information. The code of ethics standard 4.01
Maintaining Confidentiality states that the professional must protect a client’s personal
information obtained during treatment (APA, 2017).
Ethical Standards
Given the three options above on how to address this dilemma and provide treatment, the
professional has decided to continue to provide treatment. To continue to provide treatment, the
professional will have to obtain informed consent from the client’s family members as it is stated
in the code of ethics standard 10.01, Informed Consent to Therapy (APA, 2017). This informed
consent will allow the professional to ask questions and receive answers from the client even
though they are a minor (APA, 2017). Keep in mind also, that this minor child is of a different
ethnic origin. This does not mean that they do not qualify for care or treatment, it simply means
that the professional should make themselves familiar with the culture from which the client is
from. This would fall under section 2.01(b) Boundaries of Competence, the discipline of
psychology is proven to be an understanding of culture, ethnicity, and national origin (APA,
2017). While the client is being seen for a depressive state, there is an obligation from the
professional to ensure the reason behind the sudden bouts of depression. Although the
professional is trained in general psychology, they are not specialized in any specific areas,
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meaning that if any added concerns are brought up, the professional would then be providing
treatment under emergency care. Code of ethics standard 2.02, Providing Services in
Emergencies states that the professional may provide treatment only until the emergency is over
or another professional becomes available to address the specialized concern (APA, 2017).
However, psychological professionals are required by law to report suspected child abuse
(Fisher, 2003). Since the client has said that she has been sexually abused by her brother, it
would be mandatory for the professional to report the situation to the proper department. While
every state may have a different requirement put in place, it is important to know and understand
the duty to warn in the state in which one is practicing as a psychological professional. In the
state of Delaware for instance, under Chapter 54 Mental Health Services Providers of the code of
the State of Delaware, section 5402 Duty of mental health services, it states the mental health
provider must warn the proper officials if there is an imminent or suspected danger to the client,
those around them, or the psychological professional (Legislature, 2022). In case of a minor
client speaks of sexual abuse by her brother and her friends, the professional should report under
the duty to warn, which will overstep the code of ethics that has been put into place by the
American Psychological Association.
General Principles
Response option one says that the professional should continue to provide treatment to
the client based on an emergency basis. Since the client has expressed thoughts of suicide, an
evaluation should be done at once to determine if there is a cause of concern. Is the client
actively suicidal? Are they expressing concern about injuring someone else? Once these
questions have been answered, and it is determined there is no threat, the professional can
continue to treat the client under Principle A: Beneficence and Nonmaleficence, the professional
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will be safeguarding the client and protecting them from harm while they are together and
discussing what is occurring in the child’s life (APA, 2017). By creating a safe place for the
client, the professional is practicing the principle set forth by the American Psychological
Professional. While the situation may upset the professional, they do not let it interfere with the
care that is being provided to the client. This possibility applies to Principle B: Fidelity and
Responsibility, by obtaining a level of trust between themselves and the client (APA, 2017).
Beginning with the first session, the professional talks with the client in a way that allows them
to begin to build a bond, and to learn crucial details about what is bringing the client in for
treatment. Establishing trust is perhaps the most important aspect of developing a positive
relationship between professional and client (Simpson, 2007). When collaborating with minors,
this is perhaps the most important task that could be completed. General Principal C: Integrity
applies to this possible response choice because the professional is aiming to promote accuracy,
honesty, and truthfulness always during treatment (APA, 2017). Being open and honest with the
client shows that the professional is there to help them through the struggles they are facing. This
helps to show the bond of trust that one needs to be open and honest during treatment. Without
showing the connection based on being truthful, the client will not receive adequate treatment.
General Principal D: Justice applies to this response choice because the professional is providing
treatment regardless of a biased opinion if there are biases in place (APA, 2017). The situation
that the professional has been faced with could potentially cloud their judgment due to the nature
of the abuse that is occurring at the hands of the child’s family members. Under the code of
ethics, the professional is to remain unbiased, and not allow their judgment to interfere with any
treatment that may be provided. General Principle E: Respect for People’s Rights and Dignity
applies to response option one because the professional is respecting the client’s dignity and
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keeping details confidential (APA, 2017). All therapy sessions are to be kept confidential. There
are instances where this may have to be overlooked; however, regarding response option one, the
professional is providing treatment on an emergency basis. In this situation, if the professional
were to follow this response choice, they would be adhering to principal A, because they are
being responsible in their profession by providing emergency treatment to the client. Ensuring
the client is safe from harm is the main priority for the professional. By providing emergency
treatment, will be provided to the individual. While the goal of the professional is to stay within
the ethical guidelines, providing emergency treatment to a client could be violating the principle
stating that a relationship is established between the client and the professional (APA, 2017). At
the beginning of the treatment session, the goal of emergency treatment is to help until another
professional becomes available to continue collaborating with the client. At that time, this
professional will hand over the information and the professional relationship will be terminated
without a trusting bond established.
When a psychological professional is faced with a situation that requires emergency
treatment to be administered, there is a chance of the General Principals facing implications. In
response to option one, the professional faces the implications of possibly not establishing a
professional relationship with the client. When there is no professional/client relationship
formed, the chances of having a positive impact on the client begin to diminish. Since the main
goal of providing adequate treatment is to develop a professional relationship, this could
potentially pose a problem with treatment. A trusting relationship between client and
professional is built upon trust and respect (Crits-Christoph, et al., 2019). This bond is essential
in the treatment that is provided, unfortunately, in an emergency, the client is likely not with the
professional long enough for the bond to be made.
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Response option two has the psychological professional providing treatment to an
individual from a different ethnic background. While this is an emergency case situation, the
information was shared with the professional promptly to begin to look over the situation and the
details that have been provided by the referring professional. In a situation where care and
treatment will be provided to a client with different ethnic backgrounds, it is important to learn
and understand the culture. When providing treatment to an Asian minor child, the professional
will need to understand that the Asian community generally does not seek mental health
treatment based on the stigma that surrounds mental illness (Li & Seidman, 2010). Given that
there this community of individuals is reserved when it comes to seeking treatment, the
professional should understand the parents are skeptical of seeking treatment for fears of the
breeching patient confidentiality (Li & Seidman, 2010). General Principal A: Beneficence and
Nonmaleficence apply to response option two because the professional is respecting the rights of
the family members and providing adequate treatment to the client (APA, 2017). Even though
the family is of a different ethnic background, they deserve the same treatment that would be
provided to American families. Adequate care is essential when providing care to all individuals
regardless of ethnic background. General Principle B: Fidelity and Responsibility apply to this
response option because when preparing for a session with a new client, they are researching
treatment options according to the ethical compliance that they along with other staff members
will provide to this client (APA, 2017). The professional is taking responsibility to research
treatment options that may be provided in the client’s culture. Within the Asian community, the
Chinese culture believes that mental illness is often caused by a lack of emotions or an individual
is possessed by evil spirits (Kramer, et al., 2002). When a member of this culture is believed to
be suffering from a mental illness such as depression, they would traditionally attempt to try
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natural herbs or acupuncture for treatment options (Kramer, et al., 2002). Given the opportunity
to speak with the client, the professional should ask questions about any previous treatment that
has been conducted before coming into this office. If they do not have any previous treatments,
the professional could speak with the family about if they would like to try doing an herbal
treatment first. This will show the family the professional is being cognizant of their beliefs.
General Principal C: Integrity is being adhered to in this response option because the
psychological professional is being open and honest with the client about treatment options that
are available based on the cultural background (APA, 2017). Being honest with the client and
their family members is essential because this will open a door to adequate treatment being
provided. When a relationship is formed based on deception, it is headed in a direction that will
not benefit from any treatment. General Principal D: Justice is being followed in this response
option because the professional can recognize the client is entitled to fairness and justice
regardless of age, race, or background (APA, 2017). The professional has studied the
Asian/Chinese culture to ensure that proper treatment is being provided to the client. No matter
the ethnic background of the client, all individuals deserve the option to obtain fair treatment.
When the professionals study the culture, they are going beyond their scope of practice. General
Principle E: Respect for People’s Rights and Dignity is followed in this response option because
the professional is respecting the dignity of the client and their family based on their ethnic
background (APA, 2017). Respect for the client is being shown by the professional with the
research that has been completed to provide treatment. The professional is going beyond their
scope of practice to ensure the client is comfortable when coming in for the first session. The
psychological professional is adhering to the general principles of the code of ethics, by
following general principles E (APA, 2017). Respecting the rights of a client who is from a
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different ethnic background shows that the professional can provide treatment to all who seek
assistance. The professional would be adhering to all principles when choosing this response
option. The only time a violation would be considered is if the professional does not accept the
rights and dignity of the client or their immediate family members based on their ethnic
background. This would then lead to a situation that could jeopardize the professional career
from this point on.
When treating an individual of different ethnicity, there are potential implications that
could arise based on the type of treatment that is provided to the client. A psychological
professional who will be treating an individual of a different culture often benefits from
researching the treatments that are usually provided within their culture. In the event, this
research is not completed, and traditional treatment is provided, it could cause further emotional
damage to the client. Some individuals believe that mental health is not a concern that requires
treatment by a professional. To avoid any implications, the professional would benefit from
speaking with the parents or caregiver of the client. This will allow the family the opportunity to
express their concerns with treatment. Additionally, the treatment would be more effective due to
the input of the family members.
Response option three states the client has expressed failed attempts at suicide and the
sexual abuse at the hands of her brother, which now has the treatment heading in a different
direction. The purpose of the first session was to address the new onset of depression that the
minor is experiencing. Since the client has expressed attempts of suicide, the professional is now
obligated to possibly report the findings to the local law enforcement professionals. What started
as a meeting addressing the depression that is now plaguing this young woman, has now turned
into a situation where the professional must decide one if there is an imminent danger to the
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child, and two, reporting the alleged abuse and breaking confidentiality. General Principal A:
Beneficence and Nonmaleficence relates to this option because the professional is ensuring that
no additional harm is done to the client (APA, 2017). By reporting the information that was
provided by the client, the professional is taking the necessary steps needed to ensure that safety
is kept. General Principle B: Fidelity and Responsibility relate to this response option because
the professional is communicating with other agencies about what is occurring with their client.
By sharing this information with the proper authorities, the duty of the professional is being
adhered to according to the American Psychological Associations Code of Ethics (APA, 2017).
General Principal C: Integrity adheres to this response option because the psychological
professional is aware that their deception towards the client is going to ultimately protect them
from additional harm (APA, 2017). Reporting the abuse and the suicide attempts will alert the
proper authorities that address the claims and treat them accordingly. If the client is actively
planning a suicide attempt, there may be a need to put her in a facility where she can receive one
on one attention. Receiving this level of care is essential in the treatment process of her
depression, as it is a cause of concern. Without the professional adhering to due diligence, there
is an increased chance of harm coming to the child. General Principal D: Justice adheres to this
response option because the professional is remaining poised and not showing their biased
opinion (APA, 2017). In these situations, the professional may develop strong feelings of
aggression towards the individual(s) responsible for causing their client to suffer from this
trauma. However, by adhering to the code of ethics general principles, the professional remains
calm and does not allow their personal biases to interfere with the treatment that is being
provided to the client. While collaborating with the client, the professional does not allow their
opinion or feelings show to the client. General Principle E: Respect for People’s Rights and
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Dignity is related to this response option because the dignity of the client is being respected by
the handling of information that was provided (APA, 2017). The child was alerted to two
situations that have occurred that have the professional now questioning the safety of the client.
To ensure that the client remains stable and safe, respecting their dignity is being upheld by
allowing them to receive additional treatment or help from an outside agency. As with response
option two, when thinking about the principles that would be adhered to in this situation, with the
professional reporting the abuse, they would be adhering to all principles. However, in the event
of the family members not agreeing to additional treatment, the professional would be violating
principal E, respect for people’s rights and dignity (APA, 2017). This could pose a potential
problem for the professional because it could upset the family and the client.
Response option three is possibly one of the most common types of treatment that is
provided in the United States. Considering that each year there is the likelihood that millions of
children and their families will be investigated by Child Protective Services regarding abuse and
the neglect of a child (Gonzalez, et al., 2021). Providing psychological care in this situation can
be rewarding and upsetting at the same time. An implication that may be encountered when
providing this treatment would be breaking confidentiality. The client expresses to the
professional that they want this information to remain confidential, because of the seriousness of
the information. As a professional, maintaining confidentiality is not always easy. As soon as a
concern arises for the safety of the child, the professional must warn the proper authorities of the
state they are in. This will require pertinent information to be disclosed to the referring facility.
While the information will remain confidential for the time being, the professional is responsible
for alerting the receiving facility that there have been unsuccessful attempts to commit suicide
with scars as proof. Regarding the abuse that has been done to the child, the professional must
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report this to Child Protective Services (CPS) immediately. While details of what caused the
suicide attempts can be kept confidential, this information cannot be withheld from CPS. This
will break the confidentiality agreement that was made at the beginning of treatment; however, it
is essential in ensuring the professional is adhering to the code of ethics.
Personal Response Option
In the event of being faced with this situation as a psychological professional, my
response option would be response three; to alert proper authorities of the failed suicide attempts
and alert CPS regarding the abuse at the hands of the brother. This child is going to need
extensive therapy to overcome depression and suicidal ideations. With suicidal ideations being
common amongst those who were abused as children, immediate treatment is necessary (Bahk,
et al., 2017). No individual should be made to feel as though they are not worthy enough to live a
full life, nor should they be made to bear these actions on their own. As a psychological
professional who will be specializing in general psychology, getting this child’s treatment is of
the utmost importance. People may think that depression is only something that plagues adults
and that children are not susceptible to developing this problem. However, after a girl reaches
puberty, she is more likely to develop depression (Maughan, et al., 2013). According to Selph &
McDonagh, in 2016, approximately 5% of 12-year-olds reported having experienced a
depressive episode within the last 12 months (2019). While depression is likely to form from
family history, when there is an exposure to any type of stressful life event, this too can lead to a
robust factor for depression (Maughan, et al., 2013). Knowing this information makes it more
important for me, as a professional to ensure that proper assistance is provided to the minor,
which would be alerting the proper authorities. Providing proper counseling to this child could
change the course of a possibly negative situation if not managed properly; although, the suicide
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attempts need to be addressed first to ensure the child is in a safe place. Aside from providing a
positive environment for the minor, being the professional provides a level of active support and
sufficient monitoring of the behaviors, which is essential when providing care to a minor with
depressive episodes (Selph, & McDonagh, 2019).
Values and Beliefs
As a psychological professional, my values and beliefs will play a role in the
effectiveness of my planned treatments for potential clients. Personal beliefs are fundamental in
providing effective treatment because it shapes who the professional is and establish a sense of
familiarity. Being able to put oneself in the shoes of the client allows feeling and understanding
of what the individual is experiencing. Even if the professional has not been through the same
situation, providing empathy is what makes the treatment personal for the individual. Not
everyone can provide empathy. Even if they strive to be empathetic, there is a difference
between sympathy and empathy. When professionals, such as I have been raised to be caring and
nurturing, it is an instinct for them to want to teach others those same qualities. I was raised that
when I see someone in need, I am to help. Whether it be giving them the last dollar in my pocket,
or being a shoulder to cry on, if I can help, then do it. This is the foundation of what has driven
me to the point of wanting to work with children in the field of psychology. Being the person
that I am would have me supplying emergency treatment to this young individual in hopes that I
would be able to influence her life. I am not naïve enough to think that I will be able to help
every child that I encounter; however, I am confident enough to know that I will always provide
the best advice and treatment possible depending on the situation the individual is in. I believe
that no matter one’s race, religion, or creed should decide the type of mental health care they
receive. I was raised in a middle-class working family who did not always have the best of
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material things, but I had the love of both parents who instilled in me that ethnicity is not what
makes us who we are. Love, honor, and respect are what make an individual the type of person
they are. Living this has gone into my adult years and has been taught to my son. As a
psychological professional, I will never treat any child differently based on their religion or
ethnicity, even if it is different than mine.
Children deserve to live a life full of happiness, love, and understanding. Unfortunately,
terrible things are still going to happen to people, including children. The psychological
professional must be there when called to pick up the pieces and supply treatment. In this
situation, the client was a minor who had multiple challenges. Primarily, the most important part
that needed to be addressed first is the abuse that has occurred, causing her to feel as though
death is the only way out. Once that has been addressed, the next solution would be to address
the client’s feelings and supply cognitive therapy to help the child to overcome the feelings this
abuse has left on her. This will not be an easy task; however, it will be rewarding for both the
professional and the client. Since young girls have an increased risk of developing depression, it
is essential to begin treatment as soon as possible. Since this child has already tried suicide,
ensuring that there are no other attempts is crucial. The goal of treatment for these children is for
them to build a loving relationship with themselves, one that allows them to accept that what has
happened to them is of no fault of their own. Once that relationship is formed, encouraging the
young girl to embrace the life she has been given will allow her to be productive and continue to
find out who she is outside of the trauma. Life is free of guilt from being abused. Once
counseling has been started, the professional will continue to provide professional advice to them
and help them for as long as deemed necessary. Treatment works best when the client and the
professional can work together. Working together is easier when there is a trusting bond between
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the professional and the client. This bond is easily created when the professional adheres to the
Code of Ethics put into place by the American Psychological Association.
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