Project

Instructor: Dr. Henna Qureshi

Course Title: Professional Ethics
Contact: hennaqureshi@s3h.nust.edu.pk

Part 1:
1. Create a case study that defies maximum 10 expectations of the Ethical guidelines.

Part 2:
2. Discuss why the ethical guide was included in your study.
3. Critically analyse why it defies the ethical guidelines.
4. Attach the Project page to the assignment.

Assignment given: 13 April, 2021

Due date: 23 April, 2021
Total marks: 20
Rubric
Case study with 10 deviation (5)

State the ethical guide and why (5)

Critical Analysis the divergence (7)

Academic Language and organization (2)

Format specifications: font- Times New Roman, font size-12, 1.5/double

spaced, (0.5)
Project page Attached (0.5)

Total marks: 20

Name: Iqra Ali Mirza

INTRODUCTION:

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 The British ethical framework for counseling professions serves as a stellar source of

guidance for practitioners to provide therapeutically informed services to the masses. As a

therapist, it is of utmost importance to follow this meticulously crafted set of instructions that

consist of values, principles, and personal moral qualities. The sole aim of this framework is

to foster a practitioner's commitment to clients and augment their good practice. However, in

the case study mentioned below, the practitioner appears to violate several ethical guidelines.

CASE STUDY:

*Roxanne is a 19-year-old Biology student at the University of Edinburgh. She faces

the predicament of memory loss and reports to possess three distinct personalities within her.

Her PG diagnosed her with post-traumatic stress disorder and referred her to a

psychotherapist. After a fortnight, Roxanne visited a therapist, *Ms. Susan for her first

session. Roxanne made herself comfortable on the couch for the first few minutes while

Susan indulged in a scuffle-over video call with her husband. After some time, Susan was

finally off the call, and the two shared a glance. The client, Roxanne, initiated the

conversation by inquiring if the practitioner was a 'doctor like all other therapists.' Susan

responded with a grim yes while stating that her qualification is not a matter of concern.

However, in reality, Susan held a Master's Degree in Clinical and Counselling Psychology

rather than a Doctorate.

Moving on, Susan began the session formally by inquiring about the client's

preliminary life. Roxanne told her that she is an aboriginal rich Scottish but fails to discern

solitude. The practitioner asked if she could lend her some additional money apart from the

charged fee for the service since she is exceptionally affluent. The client politely agreed.

Roxanne continued her brief anecdote by stating how she is the only daughter of a widow and

a member of the transgender community. Upon hearing this, the practitioner's eyes popped

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wide open with disgust as she shrugged her shoulders and remarked, "Oh, I find that weird;

you are basically a boy." The client chose to stay silent.

Ms. Susan then proceeded to ask about Roxanne's intimate details. Roxanne told how

she was a victim of sexual abuse at the tender age of five, and ever since then, she would look

into the mirror and see her alters. She felt as if two other people reside within her, summing

up to three separate personalities. She was severely bullied by her peers and belittled by her

teachers for her 'poor aptitude' in their own words. Consequently, she began having cynical

thoughts like "I will never be good enough" and failed 4 th grade. The practitioner started

roaming around meanwhile but stumbled down and experienced a gruesome injury upon her

knee since she forgot to bring her glasses to the office and 'everything was a blur' to her.

Once Susan was up on her feet, Roxanne continued telling her problems with recalling things

"It was 2 pm on a bleak Tuesday, next thing I know it is 6 pm". Roxanne did not remember

her actions during this period, but others would remember them. She felt as if someone else

(her alters) would intervene during this lost time. In response to this, the practitioner asked if

the client, Roxanne, was making things up and simply faking her condition for attention. The

client said she had been accused of lying on a myriad of occasions. However, she stated that

she was not lying.

Roxanne then explained her condition by informing Ms. Susan that the two

personalities present within her are Mariah and Sophie. Mariah is a five-year-old girl from

Denver, whereas Sophie is a sixteen-year-old adolescent from Melbourne. Both of Roxanne's

personalities intervene to protect her from any danger, according to her. Ms. Susan, the

practitioner, was bewildered and figured that Roxanne had a rare condition called Multiple

Personality Disorder or, in her words, "something else, I reckon the name of this condition

has been changed, and I have not had a chance to catch up with the new name so I will need

to search it up on Wikipedia."

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 Then, the practitioner prescribed Roxanne a medicine to elevate her symptoms

referring to them as 'happy pills.' However, the therapist did not mention any side effects or

potential risks of the prescribed drug. Suddenly, without any imminent warning, with half an

hour of the agreed session time remaining, the practitioner, Ms. Susan, stated she forgot to

tell Roxanne beforehand how she needed to catch up with a friend over coffee. Thus, she

trudged outside, resulting in the session reaching an abrupt end, leaving the client disoriented

about having a second session. Later that day, the practitioner shared intricate details of the

client Roxanne's disorder with her friend at coffee, including the client's details, such as her

name, in an attempt to deride her. The practitioner went as far as labeling her client as

'delusional.'

STATE THE ETHICAL GUIDE AND WHY:

The practitioner, Ms. Susan, engaged in a quarrel with her husband over a video call

while the client was waiting for her. This action violates the principle of putting the client

first, which is essential to achieve good practice. The deviation from this ethical guideline

was included in the case study because putting the client first establishes a secure

practitioner-client relationship where the client feels recognized and worthy in the eyes of

their therapist. This could ultimately lead to the client feeling more secure during the session.

Moreover, Susan was not only discourteous, but she also lied about her qualification

by stating she had a doctorate when in reality, she had a master's degree. Here, the

practitioner evidently diverged from the ethical guideline of integrity. She failed to maintain

probity in her practice. This guideline was inculcated in the case study to stress the

significance of honesty. Uprightness sets the basis of a professional relationship. However,

when honesty is not observed in professional correspondence, it will inevitably deteriorate.

Then, the practitioner plainly asks her client, Roxanne, for money. This appears to be

an attempt at extorting the client financially and deviates from the ethical guideline of

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establishing an appropriate relationship. This ethical guideline was mentioned in the case

study because the pristine relationship between the therapist and the client should be

professional at all times. Thus, the exchange of money is not permissible. Therapists must

protect their clients instead of exploiting them or seeking advantage of them.

In addition to this, Ms. Susan reacted unpleasantly when her client revealed that she

was transgender. The practitioner, through her presumptuous remark, diverted from the

ethical guideline of respect for a client. The divergence from this ethical guideline was

incorporated in the case study to shed light on the importance of respect. In this case, the

practitioner's derogatory remarks could lead to Roxanne feeling judged due to her gender

identity. As a result, she may hold back in expressing her feelings and discussing her

condition. Hence, leaving a minimal chance for an accurate diagnosis.

The practitioner stumbled down due to the absence of her glasses and sustained an

injury. Here, she diverged from the principle of caring for herself as a practitioner. The

divergence from this ethical guideline was mentioned because it is imperative for

practitioners to monitor their own health to emerge triumphant in working with a client. Ms.

Susan failed to adopt reasonable precautions to safeguard her physical safety. If a practitioner

is unable to care for themselves, they may not be able to undertake the mammoth

responsibility of taking care of their client.

Once the client opened up about her ordeal, the practitioner paid no heed instead

scrutinized her agony by asking if Roxanne was faking her condition for mere attention. This

is not only inconsiderate of the practitioner, but it also defies the ethical principle of respect.

Ms. Susan fails to recognize Roxanne's unique situation. She not only lacks person-

centeredness but also becomes defensive. This has been included in the case study

specifically to discuss the consequences of the practitioner's invalidating statement towards

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the client. The client may feel judged and abstain from expressing herself in the future

[ CITATION Sha19 \l 1033 ].

Although the practitioner had correctly understood Roxanne's disorder and knew that

'Multiple Personality Disorder is a primitive term, she was not updated with the new

terminology for the disorder. The new DSM-5 renamed multiple personality disorder to

'Dissociative Identity Disorder'[ CITATION Smi20 \l 1033 ]. However, Ms. Susan diverged

from the ethical guideline of working to professional standards. This reflects the significance

for psychotherapists to keep their skills and knowledge at par with the changing dynamics of

the scientific world; otherwise, certain situations may be unknown. Hence, stressing the need

to acclimatize with new researches and happenings in the respective field of expertise.

Ms. Susan prescribed a medicine to Roxanne, which would aid in controlling her

symptoms, but she did not mention the potential side effects of the drug or risks if she would

miss a dose. Therefore, the practitioner diverged from the ethical guideline of good practice

that is accountability and candor. This ethical guideline has been mentioned because had the

practitioner been open with the client and discussed these possibilities; the client would have

reciprocated this. This would lead to the development of the practitioner-client relationship.

Soon after prescribing the client a medicine, the practitioner stated she forgot to

inform the client about a prior commitment. The practitioner ended the session

instantaneously, not even providing the client a chance to clarify any queries she may have

and without setting up a second session. The therapist, Ms. Susan, violated the ethical

guideline of suitable breaks and endings. She failed to inform the client in advance about any

such commitment, which may reduce the time of the agreed session. This may lead to the

development of morose emotions in the client's mind, who may believe that their practitioner

disregards their feelings. Thus, a practitioner must abide by the cardinal rule of planning to

avoid disruptions.

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 The practitioner ridiculed her client in front of her friend and breached the client’s

confidentiality by sharing personal details of her client, thereby violating her commitment to

the client and diverging from the ethical guideline of confidentiality. This ethical guideline of

deviation from confidentiality was included in the case study because confidentiality helps

establish trust between the client and practitioner. Thus, the client may willingly share private

information with the therapist.

CRITICAL ANALYSIS OF THE DIVERGENCE:

While the client sat waiting, the practitioner was engaged in a video call with her

husband. Hence, she diverged from the ethical guideline of putting the client first, thereby

failing to maintain a good practice. Clients are at the heart of what therapists do. Mindfulness

is an indispensable trait for a psychotherapist. The practitioner, Ms.Susan, should have been

present in the moment both consciously and unconsciously instead of holding back the client.

The client must be the sole center of attention to establishing a stellar practice. Practitioners

must set their priorities appropriately. Thus, Ms. Susan also deviated from the personal moral

quality of wisdom. She should have sagaciously chosen to cater to the client, Roxanne, once

she entered her office instead of staying on a video call with her husband and dealing with

her private matters. Therapists must strike a healthy balance between their personal and

professional lives instead of mixing the two. Perhaps the practitioner in this case study did

not intend to jeopardize the client's emotions, but the defining moment she had to decide

between her client and her husband, she chose the latter; possibly causing the client to feel

insignificant.

The practitioner, Susan, lies to the client about her qualification, perhaps to feel

validated and diverges from the ethical guidelines of integrity. To a multitude of individuals,

degrees hold a sense of self-worth. This may explain why the practitioner lied about

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possessing a Doctorate like most of her peers when in reality, she held a Master's Degree.

Practitioners must maintain quintessential standards of honesty in their practice. Lying about

qualifications in the workplace is illegal, and the practitioner may even find herself in a

lawsuit if the truth prevailed [ CITATION And20 \l 1033 ]. If a practitioner-client relationship

is based upon untrustworthiness, it can annihilate the client's emotions, who would feel

betrayed by her safe haven, her therapist. Moreover, it is obligatory for the practitioner to

truthfully reveal her qualifications so the client can decide if she is satisfied with receiving

her services by analyzing the practitioner's training. As a result, the practitioner violates the

principle of the client's autonomy since Roxanne cannot make an informed decision due to

Susan's fabrication of her qualifications.

When the client begins discussing her life details, she mentioned how she finds it

onerous to discover peace even though she belongs to an opulent household. In response to

this, the practitioner asked her for money. This is highly unprofessional. The practitioner

diverged from the ethical guideline of building an appropriate relationship. The practitioner

should not have tried to prey on her client Roxanne's vulnerability. Here, Susan should have

been more watchful about her actions. The client is not her friend or family member. Thus,

she cannot borrow cash from her no matter how dire her financial situation may be. In

addition to this, Susan also deviated from the ethical principle of self-respect. No self-

respecting practitioner asks her client for money in any case.

Furthermore, the client Roxanne may think she must lend money to Susan; otherwise, she

may not actively listen to her. In an attempt to feel heard by her therapist, the client may be

indirectly pressured to loan Susan money. Hence, therapists must not wish to satisfy their

own needs at the expense of the client's progress and health.

Susan's response to Roxanne telling her she is transgender yet again depicts her

divergence from an ethical guideline. The practitioner diverges from the ethical guideline of

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respect by failing to acknowledge the client's individuality. Susan instead openly expresses

her repulsiveness towards members of the transgender community. She looked down upon

the client and considered her as an inferior being solely because of her gender identity. Also,

Susan appears to be substantially critical of Roxanne and tells the client how she is 'basically

a boy.' Ms.Susan violates the personal moral quality of esteem. She does not display

appropriate respect for Roxanne's understanding of herself. LGBTQ members are more prone

to clinical depression [CITATION Men \l 1033 ]. Hence, the therapist should have been

cautious in her cruel disregard to Roxanne, who is already in a precarious state. Thus, the

practitioner violates the value of upholding the safety of the client by her statement, which

would directly put the client at substantial risk. Moreover, she also infracts the value of

appreciating the variety of human experience; instead, she disparages her client based on her

gender identification.

The practitioner, Susan, appeared to be forgetful and harmed herself due to the

absence of her glasses while the client was discussing the details about her condition. This

signifies that the therapist diverged from the ethical principle of caring for herself as a

practitioner. The physical and mental health of a client is a tremendous responsibility that lies

upon the practitioner's shoulders. Susan portrays a lack of responsibility by forgetting her

glasses, and she was unable to care for herself and lost her balance. Therefore, she may be

deemed unfit to undertake the strenuous responsibility of providing therapeutic services to

her client, Roxanne.

As the session proceeded and the client further revealed her condition, the practitioner

asked an insensitive question, whether the client was faking her symptoms to grasp attention.

Ms. Susan diverged from the ethical principle of respect. All clients deserve to be treated

with utmost dignity. Mental health professionals should know better than invalidating their

client's feelings. Unfortunately, the practitioner left no stone unturned in dismissing the

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client, Roxanne's emotions. This could result in the client doubting themselves and refusing

to accept the help they need due to the constant fear of being judged. The practitioner should

have listened to Roxanne patiently instead of blaming her for her symptoms. The cardinal

aim of a practitioner is to assist their client in ascending to the summits of success, in formal

words, a state of 'self-actualization.' This state cannot be reached if the practitioner does not

recognize the client's emotions. Ms. Susan violated the personal moral quality of empathy

here as well. She failed to sincerely and accurately feel the emotions of her client.

Later on, the practitioner was not acquainted with the changes in the DSM 5 and its

criteria. DSM 5 is the principal guiding source for mental health practitioners. The DSM 5

renamed multiple personality disorder to 'dissociative identity disorder.' The practitioner,

however, is not familiar with the new name for Roxanne's condition. Thus, the practitioner

diverged from the ethical guideline of working to professional standards. Practitioners are

required to remain cognizant of changes in their field. One way they can do so is by

consulting professional journals. However, the practitioner stated she would be reading

Wikipedia for this purpose. It is noteworthy that Wikipedia, the internet encyclopedia, had

been banned as a source in exams and professional settings since 'it symbolizes the best and

worst of the internet' [ CITATION Ric15 \l 1033 ]. Therefore, Wikipedia is not a reliable source

as it can be edited by anyone worldwide, and people may consider someone else's opinions as

misleading facts. To bolster her knowledge, the practitioner, Ms.Susan, should consult a well-

grounded resource to provide sterling services to her client. Moreover, the therapist defies the

personal moral quality of diligence because she fails to deploy top-notch knowledge to assist

the client.

Ms.Susan prescribed a particular medication to the client but failed to inform her of

any side effects or potential risks if she could not take medicine on time. The practitioner

diverged from the ethical guideline of accountability and candor. Not only this, but she also

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failed to follow the principle of beneficence. The practitioner appeared to be insincere in her

efforts to promote the client's well-being and was unable to provide the client autonomy. If

she had been open with the client about the side effects or the risks of the medication

provided, the client could choose whether or not to take medicine in the first place. Moreover,

in the occurrence of an unpleasant side effect of the drug, the practitioner could not be held

accountable if she informed the client beforehand about any associated risks and decided to

move forward with the medication. Furthermore, if Ms.Susan had been open with Roxanne, it

would have created a sense of belonging in the practitioner's mind. Thus, improving the

practitioner-client relationship as the client would open up to the therapist as well.

The practitioner failed to plan and set her commitments so that they would not disrupt

the session. Ultimately, Ms. Susan had to suddenly put an end to the session, leaving the

client baffled. Hence, the practitioner diverged from the ethical guideline of ending the

session appropriately. Susan should have ended the therapeutic session suitably, which would

have allowed both the client and the therapist to assess and process their progress of the

respective session. Appropriate endings allow the practitioner and client to reflect upon their

progress together and receive valuable feedback. Therefore, a session must never end

abruptly. Furthermore, the practitioner defies the principle of justice because adequate service

is not provided as the session is ended before the agreed time.

Lastly, the practitioner breached the ethical guideline of confidentiality by sharing

non-anonymous details of the client's case with her friend. She was also unable to fulfill her

commitment to the client. Trust is the foundation for functionality between the practitioner

and the client. If the foundation of this professional relationship is frail, it would not be easy

to achieve any progress. If Roxanne found out her therapist, Susan had betrayed her trust and

had been insensitive to her personal information; she would not be able to freely participate

in their upcoming sessions. Roxanne would be more likely to be dishonest about her true

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feelings. As a result, her progress might be hindered, and the counselling session would prove

ineffective.

CONCLUSION:

On the whole, the case study was designed solely for educational purposes. However,

it provides a comprehensive understanding of the ethical guidelines practitioners must abide

by, discussing divergences from these guidelines. It is noteworthy that the British ethical

guide is not fixed, and it can be altered according to the situation but the true essence of the

morals a practitioner must uphold essentially remains the same. Aspiring psychologists can

take this case study as a sample of the actions they should avoid to establish an ethical

practice.

*= pseudo names

Bibliography

Arabi, S. (2019, March 4th). 5 Signs of Narcissistic Therapists (The Ultimate Covert Wolves In

Sheep's Clothing). Retrieved from The Bravo Institute: https://ckbravo.com/news-

notes/2019/3/5/5-signs-of-narcissistic-therapists-the-ultimate-covert-wolves-in-

sheeps-clothing

Arkley, A. (2020, May 3). Lying About Your Degree. Retrieved from Purple CV:

https://purplecv.co.uk/blog/little-white-lies-are-they-ever-ok-on-your-cv#:~:text=In

%20short%2C%20yes.,maximum%2010%2Dyear%20jail%20sentence.&text=And

%20you%20can't%20claim%20ignorance%20of%20lying%20either.

Bhandari, S. (2020, January 22). Dissociative Identity Disorder (Multiple Personality

Disorder). Retrieved from Web MD: https://www.webmd.com/mental-

health/dissociative-identity-disorder-multiple-personality-disorder

Campbell, R. (2015). New Skills For A New World. In R. Campbell.

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Mental Health America. (n.d.). LGBTQ+ Communities And Mental Health. Retrieved from

Mental Health America: https://www.mhanational.org/issues/lgbtq-communities-

and-mental-health

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