Slide 1: Promoting Wellbeing Through Ethical School Counseling: A Case Study
Charlene Wheeler
Psychology Capstone PSYC-FPX4900
Capella University
Instructor: Ruhama Hazout
Speaker Notes:
Hello everyone, and welcome to this presentation. My name is Charlene Wheeler, and today I’ll be discussing a critical topic in the field of psychology—Promoting Wellbeing Through Ethical School Counseling.
This is my capstone project for the Psychology program at Capella University. I’m excited to share my insights and research findings with you.
Slide 2: Presentation Overview
- Case Study
- Cultural Issues
- Best Practices
- Theoretical Perspectives
- Cultural Competencies
- Research
In this presentation, we’ll start by examining a case study that serves as the cornerstone for our discussion. This case study helps us explore the complexities and challenges that school counselors often face, especially when working with culturally diverse and at-risk youth. The story of Hannah, a school counselor, and Adara, a Muslim-American high school student, illuminates various cultural and ethical issues.
Next, we’ll focus on the cultural aspects that are essential for understanding the dynamics of the case. This will include a discussion on best practices for working with cultural differences, an exploration of relevant theoretical perspectives, a look at cultural competencies, and a review of related research findings. Each of these components will contribute to a comprehensive understanding of the cultural factors involved, which is crucial for any effective intervention.
Slide 3: Presentation Overview (continued)
- Ethical Dilemma
- APA Standards
- Recommended Course of Action
- Research
- Conclusion
Speaker Notes:
Moving on, we’ll shift our attention to the ethical dilemma presented in the case study. This part of the presentation will explore the American Psychological Association’s standards and how they relate to the situation. I will discuss the ethical responsibilities of the counselor and the rights of the student, and how these can sometimes conflict.
I will then suggest a course of action that takes into account both ethical considerations and cultural sensitivities. This recommendation will be supported by research to ensure its credibility and effectiveness. I will summarize the key points and their implications for the field of psychology and school counseling.
Slide 4: Hannah and Adara
- Hannah, 36-year-old African American school woman
- •School counselor at Cargill Academy with 10 years of experience
- Faces ethical dilemma concerning Adara’s suicidal ideation and confidentiality
- Adara, 15-year-old Muslim-American female
- Experiencing depression, bullying, and suicidal ideation
- Feels betrayed by Hannah’s breach of confidentiality
Speaker Notes:
Hannah is a 36-year-old African American woman who has dedicated a decade of her life to the community of Riverbend City through her role as a school counselor at Cargill Academy. She’s highly respected by the principal and teachers for her hard work and long hours spent attending to the students. Although she doesn’t have children of her own, she often says, ‘children are my life.’ Currently, she finds herself in a complex ethical dilemma involving the confidentiality of her student, Adara, which has implications at individual, family, societal, and cultural levels.
Adara is a 15-year-old Muslim-American girl, born to Iraqi immigrants who settled in Detroit, Michigan. She moved to Riverbend City at the age of 11 and has been navigating the challenges of feeling ‘different’ from her peers ever since. She’s been experiencing depression, has been bullied both in school and on social media, and has recently expressed suicidal ideation. Her trust in Hannah was shattered when Hannah, concerned for her safety, informed her parents about her condition. This breach of confidentiality has added another layer of complexity to Adara’s already challenging situation.
Slide 5: Hay’s ADDRESSING Model
- Hays’ ADDRESSING Model
- A Age – Adara’s adolescence
- R Religion – Adara’s Muslim Faith
- E Ethnicity – Adara’s Iraqi descent
- G Gender – Adara being a female
The ADDRESSING model, developed by Dr. Pamela Hays, provides a comprehensive framework for understanding the complex interplay of cultural and social factors in an individual’s life. This acronym stands for Age, Religion, Ethnicity, Nationality, Gender, and other social factors. In the field of mental health, this model is a valuable tool for professionals like Hannah, guiding them toward a more culturally sensitive approach. In the case of Adara, this model is particularly insightful.
Adara is 15 years old, an age often marked by identity formation and emotional development. Her adolescence adds a unique layer to her situation. She’s not just navigating the typical challenges of teenage life but also grappling with her own cultural and religious identity, which adds complexity to her mental health needs.
Adara’s Muslim faith is a significant aspect of her life, affecting her experiences in school and her community. Her religious beliefs intersect with her emotional struggles, contributing to her feelings of isolation. Being the only Muslim-American in her social circle amplifies this sense of isolation, making her faith an important factor in her overall well-being.
Being of Iraqi descent, Adara faces specific cultural challenges that affect her mental health. Her ethnicity has made her a target for bullying and contributes to her feelings of being an outsider. These experiences are not just isolated incidents but form a pattern that impacts her mental health and sense of belonging.
As a female within the Muslim faith, Adara wears a headscarf, a visible marker of her cultural and religious identity. This not only subjects her to gender-specific societal expectations but also amplifies her sense of difference. The headscarf serves as both a symbol of her faith and a point of divergence from mainstream culture, potentially contributing to her emotional struggles and experiences with bullying.
By understanding these factors through the lens of the ADDRESSING model, Hannah can tailor her counseling methods to be more culturally sensitive and effective. This is crucial for building a therapeutic relationship that respects and understands the multifaceted cultural background that Adara comes from.
Slide 6: Best Practices for Working With Cultural Differences — Age
- •Promote Adolescent Autonomy in Decision-Making (Alderman et al., 2019)
- •Importance of Open Communication Between Adara and Parents
- •Enhance Positive Youth Development and Resilience
- •Advocate for a Collaborative Approach Involving Professionals and Families
- •Employ Shared Decision-Making Principles
Speaker Notes:
As we explore the ADDRESSING model further, the first factor we’ll focus on is Age. The 2019 article ‘Unique Needs of the Adolescent’ by Alderman et al. serves as a policy statement by the American Academy of Pediatrics. It outlines the unique health challenges adolescents face and offers recommendations for caregivers, making it highly relevant to our discussion on Adara’s situation.
The article emphasizes the importance of promoting adolescent autonomy in decision-making. This is particularly aligned with Adara’s developmental stage and the challenges she’s navigating. Another key point is the necessity of open communication between adolescents and their parents. In Adara’s case, open dialogue is crucial for her emotional well-being.
Positive youth development and resilience are also highlighted in the article. Implementing these developmentally appropriate interventions could be transformative for Adara. The article further advocates for a collaborative approach involving professionals and families, which is particularly relevant for Adara’s complex needs.
Finally, the article discusses the concept of Shared Decision-Making. This approach respects Adara’s growing autonomy and actively involves her parents, creating a balanced and respectful environment for addressing her unique needs.
Slide 7: Best Practices for Working With Cultural Differences — Religion
- •Recognize Diversity in Muslim Youth Identity (Tindongan, 2011)
- •Create a Safe and Supportive Environment
- •Address Stereotypes and Biases
Speaker Notes:
In the 2011 article ‘Negotiating Youth Identity in a Post-9/11 World’ by Tindongan, the focus is on the unique challenges and opportunities that Muslim youth face, particularly in the U.S. public school system. The article explores the historical and current implications of colonialism, postcolonialism, and transnationalism for Muslim immigrants. These factors significantly influence their identity formation, cultural adaptation, and social integration. Understanding these elements is crucial when working with Adara, who is navigating her identity as a Muslim-American teenager in a predominantly Christian society.
The article also discusses the impact of 9/11 on the perceptions, attitudes, and behaviors of Muslim youth and their non-Muslim peers, teachers, and counselors. This has far-reaching consequences on their academic achievement, mental health, and overall well-being. In Adara’s case, her Muslim faith and the wearing of a headscarf have made her a target for derogatory remarks, intensifying her feelings of isolation. Being sensitive to these challenges is essential for professionals like Hannah to provide effective support.
The importance of cultural competence, multiculturalism, and social justice in psychology is emphasized. These principles are especially relevant when working with Muslim youth. Adara’s faith is a significant part of her identity, and any interventions must be culturally sensitive and responsive to be effective.
The article also outlines various strategies for enhancing the effectiveness of psychological interventions for Muslim youth. These include modifying existing therapies and collaborating with families and communities. Implementing such strategies could be particularly beneficial in Adara’s case, as they would not only address her unique needs but also involve her family and community in her healing process.
Slide 8: Best Practices for Working With Cultural Differences — Ethnicity
- Counter Stereotyping and Bullying (Tindongan, 2011)
- Promote Inclusion and Mental Well-being
- Importance of Professional Vigilance (Khan & Ecklund, 2013)
- Family and Community Involvement
Speaker Notes:
The importance of employing culturally sensitive and anti-bias interventions in Adara’s case is multi-faceted and deeply rooted in the challenges she faces due to her Iraqi descent. One of the primary goals of these interventions is to counter the harmful stereotyping and bullying that Adara has been subjected to, especially the derogatory labels like “terrorist.” According to Tindongan’s 2011 paper, “Negotiating Muslim youth identity in a post-9/11 world,” by actively addressing these issues within the therapeutic setting, we’re not only providing emotional support to Adara but also contributing to a safer, more inclusive environment for her to thrive in.
Adara already feels excluded and isolated due to her ethnicity, so creating an inclusive atmosphere is crucial for her mental well-being. This goes beyond just the therapy room; it extends to her social circles, school environment, and even online spaces where she has been subjected to bullying. The aim is to make her feel valued and included, which can have a significant positive impact on her mental health.
Another critical aspect is the need for professional vigilance. In a predominantly Euro-American environment, therapists and counselors must be acutely aware of any societal stereotypes or biases that could inadvertently influence their professional decisions. As highlighted in Khan and Ecklund’s 2013 paper, “Attitudes toward Muslim Americans post-9/11,” this is about ensuring that Adara receives the unbiased, effective care she deserves. Professionals must be trained and committed to recognizing these biases, both in themselves and in the broader environment in which they operate.
Finally, the role of Adara’s family and community in her therapeutic process is invaluable. Their involvement adds an additional layer of support and understanding, making the interventions more comprehensive and effective. It also provides a more holistic view of Adara’s challenges and assets, allowing for a more nuanced approach to her care. By involving her family and community, we’re not just treating Adara; we’re engaging with a network of relationships that are integral to her well-being.
Slide 9: Best Practices for Working With Cultural Differences — Gender
- •Gender-Sensitive Support
- •Creating Gender-Sensitive Atmospheres
- •Challenging Gender Stereotypes
- •Boosting Self-Efficacy and Confidence
- •Encouraging Conversations on Gender Practices
Speaker Notes:
Empowering Adara through gender-sensitive support is important, particularly given her identity as a young Muslim female who wears a headscarf. Tailoring support to her specific gender-related needs provides a more nuanced and effective form of assistance.
Creating a gender-sensitive atmosphere where Adara can express herself is crucial. Such an environment is particularly important for her as she grapples with gender-specific issues that may be challenging to discuss elsewhere.
Addressing societal and cultural stereotypes about Muslim women is important. This involves educating peers and authority figures to challenge preconceived notions and biases, thereby fostering a more inclusive environment.”
Enhancing Adara’s self-efficacy and confidence is another focus. Given the societal pressures and gender stereotypes she faces, empowering her to make her own choices can positively impact her mental well-being.
Encouraging conversations about gender roles, particularly the significance of wearing a headscarf, can lead to a deeper understanding of her unique challenges. This dialogue can help demystify cultural practices tied to gender and reduce the sense of “otherness” she may experience.
Slide 10: Theoretical Perspectives
- Erik Erikson’s Psychosocial Development Theory
- Bronfenbrenner’s Ecological Systems Theory
After exploring the various cultural factors that shape Adara’s experiences, it’s crucial to understand the theoretical frameworks that can help us make sense of these complexities. Theoretical perspectives offer us lenses through which we can examine Adara’s situation more holistically. They provide the scaffolding for interpreting her behaviors, emotions, and the influences acting upon her. In the next part of this presentation, we’ll focus on two key theories: Erik Erikson’s Psychosocial Development Theory and Bronfenbrenner’s Ecological Systems Theory. These theories not only enrich our understanding but also guide professionals in crafting more effective, individualized interventions.
The value of incorporating theoretical perspectives cannot be overstated. They allow us to move beyond surface-level observations to explore the underlying mechanisms that contribute to Adara’s mental health struggles. By integrating these theories into our analysis, we can develop a more nuanced understanding of Adara’s unique challenges and strengths. This, in turn, enables mental health professionals to design interventions that are not only culturally sensitive but also grounded in proven psychological theories.
Slide 11: Erik Erikson’s Psychosocial Development Theory
- Identity vs. Role Confusion in Adolescence (Sufah et al., 2023)
- Impact of Cultural and Religious Background
- Challenges to Personal Identity Formation
- Role of Supportive Environment (Juroszek, 2023)
- Importance of Nurturing Care
- Shared Decision-Making in Therapy
Erik Erikson’s Psychosocial Development Theory offers a valuable framework for understanding Adara’s current life stage, specifically the “Identity vs. Role Confusion” stage. According to a 2023 study titled “Early Adult Psychosocial: Synthesizing Erick Erikson’s Theory” by Sufah, et al., this stage is pivotal for adolescents like Adara in developing a strong sense of self and personal identity.
Adara faces challenges that can hinder her identity formation, including feeling “different” due to her cultural and religious background as well as experiencing bullying. These obstacles are consistent with Erikson’s theory, which suggests that failing to successfully navigate this stage can result in role confusion and a weakened sense of self.
The 2023 article titled “Witold Pilecki as a caring parent model from the Erik Erikson’s theory perspective” by Juroszek explores the life and personality of Witold Pilecki, a Polish soldier and resistance fighter. The article uses Erikson’s theory of psychosocial development to analyze Pilecki as a model of a caring parent. It emphasizes how Pilecki demonstrated the virtue of care in various aspects of his life, from his relationships with his family to his actions in Auschwitz. While the article’s primary focus is on the demonstration of care by Pilecki, it also underscores the importance of nurturing care in psychosocial development.
In Adara’s case, the emphasis shifts to the need for her to receive nurturing care, especially as she navigates the challenges associated with the “Identity vs. Role Confusion” stage. Receiving this type of nurturing care can be a pivotal factor in helping her successfully navigate the complexities of identity formation. This aligns well with Erikson’s theory, suggesting that the presence of nurturing care can aid in resolving the crisis of this stage, thereby contributing to a stronger sense of self and identity.
Creating a supportive environment is crucial for Adara’s successful navigation through this complex stage. This support can be further enhanced by incorporating shared decision-making in therapy. Shared decision-making is a collaborative process where Adara and her therapist work together to make choices about her treatment plan. This approach not only empowers Adara but also aligns well with Erikson’s principles of psychosocial development, which emphasize the importance of agency and choice in shaping one’s identity.
Slide 12: Bronfenbrenner’s Ecological Systems
- •Microsystem: Immediate Environments (Amali, et al., 2023)
- •Mesosystem: Interactions Between Immediate Environments
- •Exosystem: Parents’ Backgrounds and Community Factors (Chong, et al., 2023)
- •Macrosystem: Societal Beliefs and Cultural Norms
Bronfenbrenner’s Ecological Systems Theory provides a nuanced framework for examining the multiple environmental factors that shape Adara’s experiences. This makes it an invaluable tool for understanding the complexities Adara faces, from her immediate surroundings to broader societal influences.
In the microsystem, Adara’s immediate environment, including her school and family, plays a significant role. Ideally, a nurturing microsystem should offer emotional and psychological safety. However, in Adara’s case, her microsystem is far from nurturing; she faces bullying at school and complex interactions with Hannah, making her environment challenging to navigate.
The mesosystem involves the connections between Adara’s immediate environments, such as her school and family. These relationships become particularly important when considering the dynamics that change after Hannah’s disclosure to Adara’s parents. According to Amali et al., a supportive mesosystem should encourage positive social interactions and foster individual autonomy. In Adara’s case, Hannah’s decision to disclose sensitive information to her parents took away her choice and autonomy, highlighting the need for a mesosystem that respects individual agency.
In the exosystem, factors like her parents’ background as immigrants from Iraq indirectly influence Adara. A 2023 study by Chong et al. supports the idea that such external factors can significantly impact an individual’s social context. In Adara’s situation, her parents’ immigrant status could contribute to how she is perceived in her community, especially given the post-9/11 context that adds another layer of complexity.
At the macrosystem level, broader societal beliefs and cultural norms are considered. Stereotypes about Muslim-Americans, for instance, are part of this layer. Chong et al. elaborate that the macrosystem should aim to promote understanding rather than perpetuating stereotypes. For Adara, this means that societal beliefs can either hinder or help her development, depending on whether they are based on understanding or prejudice.
Incorporating Bronfenbrenner’s theory into our analysis offers a comprehensive perspective on the multiple environmental influences affecting Adara. It emphasizes the importance of considering both her individual developmental stages and the broader societal context. This dual focus is crucial for addressing her unique challenges effectively and holistically.
Slide 13: Cultural Competencies
- Cultural Humility
- Active Listening and Open-Mindedness
- Ongoing Education and Training
- Self-Awareness
- Adaptability
- Advocacy Skills
Speaker’s Notes:
Cultural competencies are essential for delivering holistic mental health care. They offer a comprehensive approach that goes beyond surface-level interactions. These competencies are particularly important for this case study, as they provide the tools needed to understand and assist Adara in her unique situation.
One of these key competencies is cultural humility, which involves acknowledging the diverse backgrounds of each client. Therapists should engage in ongoing education to better understand a range of cultural perspectives. This mindset helps to establish a therapeutic relationship that is both respectful and open. For someone like Adara, who comes from a complex cultural background, this aspect of therapy is vital for building trust.
Active listening involves fully engaging with the client to understand not only what is being said but also the emotional and cultural nuances that accompany the words. This skill is vital in therapy, as it allows for a deeper understanding of the client’s needs and concerns. In the context of Adara’s case, active listening can help the therapist pick up on subtle cues that may indicate deeper issues, enhancing the effectiveness of the therapeutic process.
Being open-minded as a therapist means creating an environment where clients feel validated and heard. An open-minded approach involves understanding the client’s worldview, beliefs, and values without judgment. For Hannah, adopting this mindset can lead to a deeper understanding of the complexities in Adara’s life. This enhanced understanding not only strengthens the therapeutic relationship but also allows for more targeted and effective interventions. To cultivate open-mindedness, Hannah could engage in ongoing cultural competence training and seek supervision or peer feedback, especially when dealing with culturally complex cases like Adara’s.
Ongoing education and training are essential for therapists to stay current on the complexities of cultural diversity. These can range from academic research to community outreach programs. Staying updated is particularly important for providing Adara with the most effective and respectful care. For instance, understanding the latest research on the mental health challenges faced by young Muslim-American girls can offer Hannah valuable insights into Adara’s unique situation.
Self-awareness requires therapists like Hannah to engage in ongoing self-examination and reflection to identify any biases or privileges they may hold. This is often facilitated through supervision, peer feedback, and mindfulness practices. Being aware of one’s own biases is particularly crucial when treating Adara, as any preconceived notions could negatively impact the therapeutic relationship. For example, if Hannah holds biases about Muslim-American families, those biases could cloud her judgment and hinder Adara’s progress in therapy.
Adaptability in therapy means being flexible enough to tailor approaches and techniques to fit the unique needs and cultural contexts of each client. This could involve modifying language, incorporating cultural rituals, or even adjusting the pacing of therapy sessions. For Adara, this level of adaptability is essential. Given her Muslim-American background and the complexities she faces, a one-size-fits-all approach won’t work. Hannah’s ability to adapt her therapeutic techniques can make a significant difference in how effectively Adara engages with the therapy process.
Advocacy skills empower therapists to take action beyond the confines of the therapy room. These skills can range from advocating for policy changes at institutional levels to engaging in community outreach and education. In Adara’s situation, advocacy could mean pushing for anti-bullying programs at her school or working to combat harmful stereotypes and prejudices within her community. Hannah’s role as an advocate can extend to liaising with other professionals or institutions, amplifying Adara’s voice in spaces where she might not be heard.
By honing these specific competencies, therapists are better equipped to provide care that is not only effective but also respectful and culturally sensitive. This comprehensive approach is crucial for addressing the unique challenges faced by clients like Adara, who are navigating complex cultural and societal landscapes.
Slide 14: Research Findings:
- Therapeutic Relationship with Minors
- Experience of Muslim-Americans in Post 9/11 America
- Mental Health Stigma in Muslim Cultures
Speaker’s Notes
Without scientific research to support the claims made about the cultural complexities in Adara’s case, the analysis would lack credibility. Empirical evidence in the form of research findings adds a layer of validation to the observations and recommendations made. Specifically, we have research studies focusing on the therapeutic relationship with minors, the experience of Muslim-Americans in post-9/11 America, and mental health stigma in Muslim cultures. These topics are highly relevant to Adara’s situation and provide a robust foundation for the case analysis.
Slide 15: Therapeutic Relationships With Minors
- Maintaining confidentiality with minors: Dilemmas of School Counselors (Lazovsky, 2008)
- Challenges around confidentiality
- Importance of clear communication
- Influence of Physician Confidentiality Assurances on Adolescents’ Willingness… (Ford, 1997)
- Effect on teen openness due to confidentiality assurances
Speaker’s Notes
A 2008 study by Lazovsky sheds light on the challenges school counselors face in maintaining confidentiality with minors. The study used a questionnaire survey to examine the attitudes of 195 school counselors in Israel. They were presented with 18 ethical dilemmas in three domains: dangerous behaviors or situations, unlawful behaviors, and personal and family information. The counselors’ decisions were influenced by the type of dilemma and the perceived level of danger or harm. This study emphasizes the importance of clear communication about the boundaries of confidentiality, a point particularly relevant for Adara, who misunderstood the limits of confidentiality.
In another study, from 1997, Ford investigates the impact of confidentiality assurances on adolescents’ willingness to disclose information. Conducted in three suburban public high schools in California, the study involved a randomized controlled trial with 562 students. They were randomly assigned to one of three groups that received different types of confidentiality assurances through a standardized audiotape. The outcome measures included the students’ willingness to disclose general and sensitive information, intended honesty, and likelihood of return visits to the physician. The study suggests that teens are more likely to open up when assured of confidentiality, an important insight for Hannah given the serious nature of Adara’s disclosures.
Both studies underscore the need for transparent and age-appropriate communication about confidentiality to build a trusting and effective therapeutic relationship. The insights from these studies are vital for Hannah to understand, as they directly impact her ability to help Adara effectively.
Slide 16: Experience of Muslim-Americans in Post 9/11 America
- Negotiating Muslim Youth Identity in a Post-9/11 World” (Tindongan, 2011)
- Marginalization and discrimination faced by Muslim youth
- Pressure to assimilate and hide religious identity
- Attitudes Toward Muslim Americans Post-9/11 (Khan and Ecklund, 2013)
- Specific and situational negative attitudes toward Muslim Americans
- Anxiety due to unpredictable negative sentiment
Speaker’s Notes:
The study “Negotiating Muslim Youth Identity in a Post-9/11 World” by Tindongan in 2011 used narrative inquiry with six Muslim immigrant high school students. The research methods included semi-structured interviews, observations, and document analysis. The findings reveal that Muslim youth often feel marginalized, discriminated against, and pressured to assimilate. These findings help us understand the social pressures and discrimination that Adara faces, particularly at school where she has been bullied and called names.
In “Attitudes Toward Muslim Americans Post-9/11” by Khan and Ecklund in 2013, 208 subjects were surveyed to explore situational attitudes toward Muslim Americans. The study found that negative attitudes are often specific and situational rather than global. This helps us understand the heightened scrutiny and prejudice Adara faces, especially in her school environment. The study also suggests that Muslim Americans may experience anxiety due to unpredictable negative sentiment, which could be contributing to Adara’s mental health challenges.
Both studies not only emphasize the need for cultural sensitivity but also offer insights that can guide therapeutic interventions. For instance, understanding the specific challenges Muslim youth face can help Hannah tailor her approach to better meet Adara’s unique needs, thereby enhancing the effectiveness of the therapy.
Slide 17: Mental Health Stigma in Muslim Culture
- Mental Health Help-Seeking Behaviors of Muslim Immigrants (Amri & Bemak, 2013)
- Role of social stigma and cultural mistrust
- Influence of cultural factors and religious beliefs
- Mental Health Stigma in the Muslim Community (Ciftci, Jones, & Corrigan, 2013)
- Role of traditional and religious beliefs
- Preference for traditional healing methods
Speaker’s Notes
In the study “Mental Health Help-Seeking Behaviors of Muslim Immigrants” by Amri and Bemak (2013), the research highlights the role of social stigma and cultural mistrust in deterring Muslim immigrants from seeking mental health services. Understanding this can help us better grasp why Adara might be reluctant to discuss her mental health issues with her parents. It suggests that her hesitancy may be rooted in cultural norms and expectations, which is information Hannah needs to consider when developing a treatment plan.
The literature review “Mental Health Stigma in the Muslim Community” by Ciftci, Jones, and Corrigan (2013) is informative for our case study as it outlines the cultural and religious beliefs that often lead to mental health stigma within Muslim communities. Given this context, Adara might fear that her parents would view her need for mental health care as a sign of spiritual weakness or as a family disgrace. This concern could be a significant barrier for her in seeking and continuing therapy, which is essential for Hannah to understand when planning her therapeutic approach.
Both studies offer valuable perspectives that can inform the approach of mental health professionals when working with clients like Adara. They provide context that can help in customizing therapeutic strategies to be both effective and culturally sensitive.
Slide 18: Ethical Dilemma
- Hannah’s Duty to Report vs Adara’s Right to Confidentiality
- Adara’s Trust vs Her Safety
- Adolescent Autonomy vs Parental Oversight
- Cultural Factors
Speaker’s Notes:
We now come to the ethical dilemma that Hannah is confronted with in the case study. After Adara tells Hannah of her suicidal thoughts, Hannah tells her parents. Adara is upset by this, as she assumed her discussions with Hannah would remain private.
Trust is a foundational element in any therapeutic relationship. Adara disclosed her thoughts and fears to Hannah, believing they would be kept confidential. She now feels Hannah has broken that trust. However, Adara is unaware of the ethical and legal responsibilities that come with Hannah’s role, specifically the “duty to warn” parents or guardians if a minor is at risk of harm. This complicates the expectation of privacy.
While Adara is still a minor, she is old enough to have her own opinions and want to make her own decisions, particularly around who is told about her mental health status. By telling her parents, Hannah took away her autonomy. Since she’s a minor, in many states her parents legally have a right to be told, but Hannah also has to consider if that is the most ethical decision, when Adara has voiced concern about how receptive her parents would be to the news.
The cultural factors we’ve discussed are also relevant to this ethical dilemma. Adara’s age is a cultural consideration, adding to her misunderstanding of the expectations of privacy, made clear when she said, “Doesn’t she have to keep what I say to herself?” Additionally, Adara has expressed that her parents would not be supportive of her seeing a therapist, possibly due to the stigma surrounding mental health in the Muslim community, another cultural factor. These cultural nuances add depth to the ethical choices Hannah must make.
Slide 19: APA Ethical Standards
- Standard 4.05: Disclosures (APA, 2017)
- Standard 4.02: Discussing the Limits of Confidentiality
- Principle E: Respect for People’s Rights and Dignity
- Principle A: Beneficence and Nonmaleficence
- Principle B: Fidelity and Responsibility
- Principle D: Justice and Standard 3.04: Avoiding Harm
Speaker’s Notes
Hannah’s ethical dilemma is further complicated by APA standards and principles, which seem, at times, to contradict each other. Examining the relevant APA standards and principles reveals the intricate challenges Hannah faces. Standard 4.05, known as ‘Avoiding Harm,’ advises discussing confidentiality limits before receiving sensitive information. In Hannah’s case, the emergent nature of the counseling session may have prevented this discussion, leading to Adara misunderstanding the limits of her privacy.
Standard 4.02, referred to as ‘Discussing the Limits of Confidentiality,’ allows for breaching confidentiality if there’s an immediate risk of harm. However, Principle E, known as ‘Respect for People’s Rights and Dignity,’ focuses on respecting Adara’s autonomy by maintaining confidentiality unless immediate danger is present. The conflict between these two is known as a dual loyalty conflict. Then there is Principle A, called ‘Beneficence and Nonmaleficence,’ which prioritizes client welfare and requires Hannah to use her best judgment to determine if the criteria for immediate danger are met.
Principle B, known as ‘Fidelity and Responsibility,’ emphasizes the duty to warn if danger is clear, even if it goes against Adara’s wishes, while Principle D, called ‘Justice,’ and Standard 3.04, known as ‘Avoiding Harm,’ obligate Hannah to minimize harm from any disclosure and ensure ongoing care for Adara. Possible harm could include issues with her family or emotional distress from the perceived breach of trust. Hannah must weigh these factors to make an ethically responsible decision regarding Adara’s situation.
Slide 20: Suggested Course of Action
- Alternate Supportive Adult
- Explain Hannah’s Responsibility
- Collaborate With Adara on Trusted Adult Choice
- Joint Discussion With Chosen Person
- Ongoing Check-ins
- Upholds APA’s Principle E (APA 2017)
Speaker’s Notes:
Building on the APA guidelines, the next step is to outline our recommended course of action, which is to involve an alternative supportive adult in Adara’s life. The initial action calls for Hannah to clarify her legal and ethical responsibilities to Adara, including the necessity to disclose imminent risks to parents or guardians. Establishing this clarity is foundational for trust and transparency between Hannah and Adara. Supporting this approach is a 2019 study by Fish and colleagues, which indicates that having even one trusted adult can significantly reduce suicidal thoughts.
The first step involves Hannah clearly explaining her legal and ethical responsibilities to Adara, which includes the obligation to disclose any imminent risks to parents or guardians. This is essential for building a foundation of trust and transparency between them. A 2019 study by Fish and colleagues supports this strategy, showing that having even one trusted adult can significantly lower suicidal thoughts.
Once this foundation is established, Hannah and Adara can work together to identify an alternative supportive adult within her trusted circle. This person serves multiple roles: they’re not acting in loco parentis but rather a supportive figure who can help with practical matters like transportation to therapy sessions and possibly even financial assistance for treatment. Adara herself will choose this individual, as she knows best who she would feel comfortable confiding in.
After Adara has approached the chosen adult and received a supportive response, a joint discussion involving Hannah, Adara, and the selected adult can be organized. This meeting aims to create a safe space where Adara can openly share her experiences and concerns. Hannah contributes essential clinical observations related to risk factors but does so without overshadowing Adara’s voice, thereby respecting her autonomy.
Regular check-ins between Hannah and Adara serve as a tangible commitment to Adara’s well-being, further solidifying the trust between them.
The entire process is designed to uphold APA’s Principle E, focusing on respecting Adara’s rights, dignity, and autonomy. By making an ethically responsible decision, Hannah not only adheres to professional standards but also establishes a strong and respectful support system for Adara.
Slide 21: Research Findings
- Adult Mentors for Adolescents
- Functions and Longitudinal Outcomes of Adolescents’ Naturally Occurring Mentorships (Miranda-Chan, et al., 2016)
- Trends in volunteering in the United States: 2002–2015 (Raposa, et al., 2017)
- Adolescent Autonomy and Support
- Development of Perceived Familial and Non-familial Support in Adolescence (Spitz, et al., 2020)
Speaker’s Notes
Having outlined the recommended course of action, the next step is to validate this approach with empirical evidence. The focus now shifts to key research studies that underscore the significance of adult mentors for adolescents and adolescent autonomy and support; topics which are both key to our recommended course of action.
Slide 22: Adult Mentoring
- Functions and Longitudinal Outcomes of Adolescents’ Naturally Occurring Mentorships (Miranda-Chan, et al., 2016)
- Reported Greater Well-Being
- Emotion Support as a Key Factor
- Trends in volunteering in the United States: 2002–2015 (Raposa, et al., 2017)
- Relationships With Caring Non-Parental Adults are Vital for Well-Being
- Naturally Occurring Mentorships are More Enduring
Speaker’s Notes:
The first study for discussion, ‘The Functions and Longitudinal Outcomes of Adolescents’ Naturally Occurring Mentorships’ by Miranda-Chan, Fruiht, Dubon, and Wray-Lake, was published in 2016. This large-scale longitudinal survey analyzed data from over 4,800 U.S. adolescents, initially surveyed between ages 12 and 18 and followed up 15 years later. Both quantitative and qualitative methods assessed the long-term impacts of having a natural mentor on various life outcomes, including wellbeing, relationships, education, employment, and crime.
Quantitative results revealed that individuals with mentors during adolescence reported greater wellbeing in adulthood compared to those without mentors. Qualitative analysis further categorized the functions of these mentors, emphasizing emotional support as a key factor in mentored individuals’ wellbeing.
The study’s longitudinal design lends credibility to these findings, allowing for the assessment of long-term impacts. Despite limitations like retrospective self-reports, the large national sample enhances the generalizability of the results.
In relation to the case study, these findings offer empirical backing for the recommended course of action involving a trusted adult in Adara’s life. The research aligns with APA ethics of promoting autonomy and beneficence, providing a strong empirical foundation for the positive impact that such a relationship could have on Adara’s wellbeing and growth.
A second study titled “Trends in Volunteer Mentoring in the United States: Analysis of a Decade of Census Survey Data” by Raposa et al. (2017) analyzed a decade’s worth of U.S. Census Survey data on adults who volunteered as mentors. According to the authors, naturally occurring relationships with caring non-parental adults are vital for youth development and well-being. These natural mentoring relationships are often more enduring and culturally aligned than formal mentoring programs. The authors also emphasized that mentoring can improve children’s and adolescents’ perceptions of their relationships with parents, peers, and teachers, which in turn positively affects various developmental outcomes.
In the context of Adara’s situation, these insights strongly support the recommended course of action to involve a trusted adult mentor. This aligns well with APA ethics, particularly in promoting Adara’s autonomy and beneficence.
Slide 23: Adolescent Support and Autonomy
- Development of Perceived Familial and Non-familial Support in Adolescence (Spitz, et al., 2020)
- Family Support Continues to Play a Role
- Respect of Adolescent Autonomy Through Privacy and Consent
Speaker’s Notes
Development of Perceived Familial and Non-familial Support in Adolescence’ by Spitz, Winkler Metzke, and Steinhausen, was published in 2020. This longitudinal study analyzed survey data from 857 Swiss adolescents at ages 11, 13, and 18, focusing on their perceived social support from various sources. The study’s design allowed for the capture of developmental shifts in social support among youth, and its large community-based sample enhances the generalizability of the findings.
The study revealed that while consultation with parents and grandparents for support declined over time, these sources remained highly satisfying. This indicates that family continues to play an integral role in support systems, even as peer roles expand during adolescence.
In terms of its relevance to the case study, this research emphasizes the importance of family involvement in youth mental healthcare. It also supports the idea of respecting adolescent autonomy needs through privacy and consent. Therefore, incorporating a trusted adult as an additional support aligns well with these developmental support priorities.