Ethical Decision-Making Process

Grace Lebrecht
Erica Emery
Allison Qualls
Ethnee Rohrer
RecTh 5350
4/6/20
Darlene provides recreational therapy to children who have been sexually abused. During a
group session of mixed gender children, a 6-year old boy, comes and sits in Darlene's lap. Even
though she was surprised and felt a little shocked, she did not ask the boy to get off of her lap.
This is because she has seen other therapist in the same situation.

1. Recognize a moral issue

a. This conflict is at the personal level. This scenario demonstrates low professional
boundaries. With any population, the therapist is working with, having a
child/patient sit on her lap could be inappropriate. The therapist should have
been more conscious of the population and boundaries.
2. Begin your decision making
a. The relevant act of the case is the six-year-old boy sitting in Darlene’s lap. The
therapist, Darlene, is involved, as well as the six-year-old boy and the six-year-old
boy’s parents that would acting as legal guardians in this situation. The other
clients are potential players, as is the therapist Darlene has seen in a similar
situation. The therapist’s obligations first and foremost is to the clients, and
making sure the kids are safe and understand boundaries. The therapist has
ultimate control over the situation, as she is running the group. The therapist is
affected by this situation, as she received mixed signals from another therapist
implying that this situation is appropriate. The six-year-old boy who sat on
Darlene’s lap is also directly affected, as he tries to understand the situation and
his professional connection to his therapist. This connection would be difficult to
explain to such a young child, but it is the responsibility of the therapist to set
this boundary. To explain this to a young child, showing what a connection with
other people besides the caregiver/guardians is important.
3. Brainstorm alternatives
a. One potential alternative is to have the child sit next to Darlene rather than on
her lap. Consequences of this alternative could include the child accepting
moving willingly. The child could also be uncomfortable being told what to do
and could react negatively which could be having an angry outburst or disrupting
the group.
b. Another alternative is could be to tell the child to return to his original seat. This
alternative would likely have the same consequences as having the child sit next
to the therapist.
4. Look at each from various points of view
a. Virtue approach—Using this approach would involve being honest with the child.
Darlene would tell the child that he simply isn’t allowed to sit on her lap during
therapy. She would explain the boundary to the child in a way he would
understand. This would help build the therapeutic relationship as the child would
develop trust in the therapist and learn boundaries.
b. Utilitarian approach—Using this approach, the therapist would follow policy
regarding boundaries with clients. For example, when the child sits on the
 therapist’s lap, it would be standard for the therapist to have the child sit next to
them instead. The therapist would explain that sitting on her lap crossed a
boundary, and that crossing boundaries has consequences. For example, sitting
on Darlene’s lap during therapy could result in potentially intimate contact,
which can be harmful for children who have experienced sexual abuse. It is
important to understand what the relationship between therapist and client is,
and how it is important to maintain that relationship in order to achieve goals.
c. Rights approach—Using this approach, Darlene would make sitting next to her
instead of on her lap the decision of the boy. She could ask “Should you be sitting
on my lap?” This allows the boy to think about what he is doing and to make a
different choice. She could give him several options, for example “you can sit
next to me or go sit back in your original seat.” This allows the child to be making
his own decisions rather than being told what to do, which is key in this
approach to ethics. Allowing the child to make his own decision about where he
sits, with some guidance from the therapist, allows him to practice his right of
choice.
d. Fairness approach—All the therapists should be following the same policy, and
the kids should be following the same rules. No child should be allowed to sit on
any therapist’s lap. This ensures that no therapist gives preferential treatment to
any child or puts any child at a disadvantage by allowing him/her to cross
boundaries. This approach could also see this scenario as ethical because
another therapist allowed a child to sit on his/her lap, it could be considered fair
for Darlene to do the same.
e. Common good approach—This approach would make it clear that all therapists
are teaching the kids the same lessons, for example appropriate boundaries. By
making sure everyone is on the same page, situations like this can be avoided.
Everyone is working toward the same common goal for the greater good of the
client population.
5. Look at each suggested alternative in view of obligations, ideals, and greatest good
a. The first alternative is to have the child sit next to Darlene rather than on her lap.
The child will benefit from this alternative because he learns boundaries. Darlene
also benefits from this alternative because should a situation arise where her
actions are questioned, she took appropriate action by not having the child sit on
her lap. Given the information provided, Darlene did not promise the child that
he could sit on her lap. Therefore, no obligation is being reneged and there are
no consequences of this. This alternative is the ideal because it allows the child
to be close to the therapist and comfortable without crossing a boundary.
Possible effects of this alternative are: the child accepts the alternative and sits
next to Darlene; the child protests the alternative and refuses to not sit on
Darlene’s lap; the child protests the alternative at first but reluctantly sits next to
Darlene instead.
b. The second alternative is to have the child return to his original seat. The child
would benefit from this situation because he would learn boundaries. The
therapist would again benefit; should a situation arise where her actions are
 being questioned, she did not allow a child to sit on her lap. Darlene reneged on
the perceived expectation of trust and safe in the group setting, should she enact
this alternative. By sending the child back to his seat, she is turning him away. He
may feel as if he cannot trust or be near Darlene anymore, and this could affect
his proximal goals in therapy but reinforce distal goals. This alternative is less
than ideal because it could have a negative effect on the child. Possible effects of
this decision include: the child doesn’t trust the therapist or feel safe to share;
the child accepts the alternative and returns to his seat without any negative
impact; the child protests the alternative and behaves accordingly, disrupting
group.
c. The first alternative, having the child sit next to Darlene rather than on her lap, is
the fairest for all parties involved.
d. The first alternative is best for all involved because it keeps the therapist safe
should her actions be questioned, while also teaching the child boundaries
without breaking trust.
e. The first alternative would make a good rule for the institution to have for all
therapists in similar situations.
f. The first alternative would lead to the best overall consequences.
6. Make your own decision
a. The first alternative is the best given the situation.
b. Yes, other people we respect would approve of our choice.
c. Yes, having the child sit next to the therapist instead of on her lap was a good
choice. It has the least negative consequences.

The ATRA Code of Ethics would be relevant in this situation. Principle One, beneficence,
would be relevant. This principle states that the therapist needs to protect her clients from
harm while also maximizing benefits. Potential harm is triggering trauma and potential
sexual contact. Benefits would be teaching the child boundaries and other options of social
interaction. By having the child sit next to her instead of on her lap, Darlene would be doing
that.
Principle Two, non-maleficence, would be relevant. Darlene would be using her best
judgement and knowledge to know that having a child sit on her lap could cause harm, and
having him sit next to her instead would prevent said harm.
Principle Three, autonomy, would be less relevant. A six-year-old child would be less
involved in making their own decisions. However, it could be important to allow the child to
choose to not sit next to Darlene by providing him with alternatives to choose from.
Principle Four, justice, would also be relevant. Darlene would need to be fair to the
children by not letting any child sit on her lap, rather than allowing specific children to do so
but not others.
Principle Five, fidelity, would be less relevant. Darlene’s first obligation is to her clients,
then to her institution. She would show that obligation by doing what is best for the child,
not letting him sit on her lap. This also reflects on the profession internally and externally.
Principle Six, veracity, would be less relevant as well. Darlene would simply need to be
honest with the child by telling him he couldn’t sit on her lap, and explaining why.
 Principle Seven, informed consent, could also be relevant. This would apply when
Darlene makes it clear to the children what the boundaries and rules of the group are. The
children would then choose to participate or not, with an understanding of the expectations
of their behavior and the potential consequences of their actions.
Principle Eight, confidentiality and privacy, is less relevant to this situation. Darlene
would need to make sure she didn’t discuss the details of this situation with anyone other
than her supervisor and treatment team, this is because she is working with minors.
Principle Nine, competence, could be relevant in this scenario. Darlene would need to
have enough knowledge about working with children, specifically those who were sexually
abused, to understand the effects that having a child sit on her lap would have.
Principle Ten, compliance with laws and regulations, would be less relevant to this
situation. As long as Darlene was following laws and regulations, which it seems she is,
there would not be an issue with this principle.