Case 2. Cultural Values and Competent Mental Health Services to Minors
Irina, a 13-year-old girl of Arabic cultural heritage living in Boston, Massachusetts, was brought by her parents to a hospital emergency room after an assault by a stranger. Based on her injuries, the hospital staff suspected that the attacker had also sexually assaulted the girl, but she and her parents refused medical Assessments for rape. The family received a referral to see Janet Matthews, a clinical psychologist specializing in adolescent trauma. During their initial meeting with Dr. Matthews, the parents asked the psychologist not to discuss any sexual aspects of the assault with their daughter but to treat the psychological trauma from the assault in general. They told the psychologist that admitting a rape had taken place would cast a stigma on their daughter and make her ineligible to be married to men in their closely knit ethnic community. When asked in private, the girl also requested that sexual issues not be discussed for the same reason.
Ethical Dilemma
Dr. Matthews does not know whether she should agree to the parents’ and child’s request.
Suggested Readings
American Psychological Association. (2003). Guidelines on multicultural education, training, research, practice, and organizational change for psychologists. American Psychologist, 58, 377–402.
American Psychological Association. (2007). Guidelines for psychological practice with girls and women. American Psychologist, 62, 949–979.
Arredondo, P., & Toporek, R. (2004). Multicultural counseling competencies = ethical practice. Journal of Mental Health Counseling, 26(1), 44–55.
Gallardo, M. E., Johnson, J., Parham, T. A., & Carter, J. A. (2009). Ethics and multiculturalism: Advancing cultural and clinical responsiveness. Professional Psychology: Research and Practice, 40, 425–435.
Vasquez, M. (2012). Social justice and civic virtue. In S. Knapp, M. Gottlieb, M. Handelsman, & L. VandeCreek (Eds.), Handbook of ethics in psychology (Vol. 1, pp. 75–98). Washington, DC: American Psychological Association.
Zerr, A., & Pina, A. (2014). Predictors of initial engagement in child anxiety mental health specialty services. Child & Youth Care Forum, 2, 151–164.
Case Study Two Worksheet
1. Why is this an ethical dilemma? Which APA Ethical Principles help frame the nature of the dilemma?
2. How might Irina’s age and parents’ involvement in the referral affect how Dr. Matthews can resolve the dilemma? How might the state law on treatment of minors and HIPAA rule on access of guardians to a minor’s health care record influence Dr. Matthews’ decision?
3. How are APA Ethical Standards 2.01a b, and c; 2.04; 3.04; 3.06; 4.01; 4.02; and 10.10a relevant to this case? Which other standards might apply?
4. What are Dr. Matthews’ ethical alternatives for resolving this dilemma? Which alternative best reflects the Ethics Code aspirational principle and enforceable standard, as well as legal standards and Dr. Matthews’ obligations to stakeholders?
5. What steps should Dr. Matthews take to ethically implement her decision and monitor its effects?
Reference
Fisher, C. B. (2013). Decoding the ethics code: A practical guide for psychologists. Thousand Oaks, CA: Sage.
