Promoting Wellbeing Through Ethical School Counseling — Presentation Outline

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Title Slide

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 Charli Wheeler, and today I’ll be discussing a critical topic in the field of psychology—Promoting Wellbeing Through Ethical School Counseling, a subject that has far-reaching implications for the mental health of our youth. This is my capstone project for the Psychology program at Capella University. I’m excited to share my insights and research findings with you

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Hannah and Adara

• Hannah, 36-year-old African American 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. Briefly mention the cultural issues and the ethical dilemma at play in this case study

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Cultural Issues

• Hays’ ADDRESSING Model
  • A Age – Adara’s adolescence
  • R Religion – Adara’s Muslim Faith
  • E Ethnicity – Adara’s Iraqi descent
  • N Nationality – Adara’s family’s immigrant background
  • G Gender – Adara being a female

Speaker Notes:

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 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.

Adara’s family’s immigrant background from Iraq presents its own set of challenges. Immigrants often grapple with the dual pressures of assimilation and preserving their cultural heritage. For Adara, being of Iraqi descent in post-9/11 America adds an additional layer of complexity, affecting how she is perceived and treated by others.

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.

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Erik Erikson’s Psychosocial Development Theory

• Identity vs. Role Confusion in Adolescence
• Impact of Cultural and Religious Background
• Challenges to Personal Identity Formation
• Role of Supportive Environment
• Importance of Nurturing Care
• Shared Decision-Making in Therapy

Speaker Notes:
Erik Erikson’s Psychosocial Development Theory offers a valuable framework for understanding Adara’s current life stage, the “Identity vs. Role Confusion” stage. According to a 2023 study by Sufah, Latipah, and Izzah, this stage is crucial for adolescents like Adara to develop a strong sense of self and personal identity.

Adara’s unique challenges, such as feeling “different” due to her cultural and religious background and experiencing bullying, can significantly impede her identity formation. These challenges align with Erikson’s theory, as failure to navigate this stage successfully can lead to role confusion and a weakened sense of self.

The 2023 article by Juroszek provides an interesting angle on Erikson’s ‘virtue of care.’ It focuses on Witold Pilecki, a Polish soldier who volunteered to infiltrate Auschwitz and later became a model of a caring parent. The article emphasizes how Pilecki demonstrated this virtue 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 demonstrating care, in Adara’s case, the emphasis shifts to the need for her to receive nurturing care.

A supportive environment, both at home and in therapy, is essential for Adara to navigate the complexities of this stage successfully. Shared decision-making in therapy can further empower her, aligning with Erikson’s principles of psychosocial development.

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Bronfenbrenner’s Ecological Systems Theory

• Microsystem: Adara’s Immediate Environments (School, Family) (Amali, et al., 2023)
• Mesosystem: Interactions Between Immediate Environments (School-Family Dynamics)
• Exosystem: Parents’ Backgrounds and Community Factors
• Macrosystem: Societal Beliefs and Cultural Norms

Speaker Notes:
Bronfenbrenner’s Ecological Systems Theory serves as a robust framework for understanding an individual within multiple environmental contexts. According to a 2023 study by Amali et al., the theory is effective in identifying preferred learning environments at different systemic levels, making it highly relevant for dissecting the complexities in Adara’s life.

In the microsystem, the immediate environment involving Adara’s school and family is crucial. Amali et al. found that a nurturing microsystem should offer clear language and ample resources. In Adara’s case, experiences like bullying and interactions with Hannah are pivotal at this level.

Shifting the focus to the mesosystem, the connections between Adara’s school and family come into play. This becomes particularly significant when considering the dynamics that change after Hannah’s disclosure to Adara’s parents. Amali et al. emphasized the importance of a mesosystem that encourages positive social interactions and fosters individual autonomy.

In the exosystem, factors that indirectly influence Adara are introduced. For example, her parents’ background as immigrants from Iraq can shape community perceptions, especially in a post-9/11 context. A study by Chong et al. in 2023 also supports the notion that external factors like these can have a substantial impact on an individual’s environment.

At the macrosystem level, broader societal beliefs and customs come into focus. Stereotypes about Muslim-Americans, for instance, fall into this category. Chong et al. further elaborate that the macrosystem should aim to promote understanding rather than perpetuating stereotypes.

Incorporating Bronfenbrenner’s theory provides a thorough perspective on the multiple environmental influences affecting Adara’s life. It highlights the necessity of considering both her individual developmental stages and the broader societal context when addressing her unique challenges.

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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

When it comes to therapeutic relationships with minors, the balance between trust, confidentiality, and ethical responsibility is delicate. Two key studies shed light on this complexity. The first, by Lazovsky from 2008, focuses on the challenges counselors face in maintaining confidentiality with minors. The study underscores the importance of clear communication about the boundaries of confidentiality right from the start of therapy. This is particularly relevant to Adara’s situation, where she felt her trust was compromised when Hannah informed her parents about her suicidal thoughts.

The second study, conducted by Ford in 1997, examines the effect of confidentiality assurances on adolescents’ willingness to open up. The research suggests that when teens are assured their conversations will remain confidential, they are more likely to disclose sensitive information. This is important for Hannah to understand, especially given the serious nature of Adara’s disclosures.

Both studies emphasize the need for transparent and age-appropriate communication about confidentiality to foster a trusting and effective therapeutic relationship.

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Experience of Muslim-Americans in Post 9/11 America

• Identity Negotiation of Muslim Youth in Post-9/11 U.S. (Tindongan, 2011)
  • Struggle with dual identities
  • Feelings of isolation due to prejudice
• Attitudes Toward Muslim Americans Post-9/11 (Khan and Ecklund, 2013)
  • Heightened prejudice against visibly identifiable Muslims
  • Labeling as “terrorists”

Speaker’s Note:
The post-9/11 era has been challenging for Muslim-Americans, marked by increased scrutiny and discrimination. Two studies provide valuable insights into this experience. Tindongan’s 2011 study explores how Muslim youth often struggle with dual identities, trying to navigate both their American surroundings and their religious and cultural heritage. This struggle can result in feelings of isolation, particularly when they encounter prejudice or discrimination.

Khan and Ecklund’s 2013 study takes a closer look at the attitudes toward Muslim-Americans in this period. The research indicates that those who are visibly identifiable as Muslims, like Adara with her headscarf, face even more intense prejudice. They are sometimes even labeled as “terrorists,” which resonates with Adara’s own experiences of bullying and feeling “different.”

These studies highlight the complex social landscape that Adara is navigating, and they underscore the importance of cultural sensitivity in mental health care.

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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

Mental health stigma varies widely across different cultures and can be a significant barrier to seeking help. Amri and Bemak’s 2013 study focuses on the mental health help-seeking behaviors of Muslim immigrants in the U.S. The study points out that social stigma and cultural mistrust often deter individuals from seeking help. Cultural factors, religious beliefs, and a general lack of mental health knowledge contribute to negative views about mental disorders and treatments.

On a similar note, Ciftci, Jones, and Corrigan’s 2013 study explores the mental health stigma within the Muslim community. The study highlights how traditional and religious beliefs shape perceptions about mental health. In many Muslim communities, mental health issues are often attributed to supernatural causes, and there’s a tendency to opt for traditional healing methods over Western psychiatric treatments.

Both studies offer valuable insights into why Adara might be hesitant to discuss therapy with her parents and why she felt betrayed by Hannah. Understanding this cultural context is crucial for mental health professionals to navigate the complexities involved in treating individuals from diverse backgrounds.

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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 Sensitivity in the Muslim Culture

Speaker Notes:
In the counselor-student relationship between Hannah and Adara, ethical dilemmas challenge standard practices. Hannah has a professional obligation to report signs of self-harm or danger to a student’s well-being. This is a fundamental aspect of her role. Adara, on the other hand, entered the counseling relationship with a mistaken assumption of complete confidentiality. The tension between maintaining confidentiality, especially for minors, and ensuring safety is a key aspect of this dilemma.

The issue of trust is also at play. Adara confided in Hannah, revealing her deepest fears and thoughts. Hannah must balance this trust against the immediate need to ensure Adara’s safety. This balance is essential for maintaining the integrity of their relationship as counselor and student.

Another ethical consideration is the balance between adolescent autonomy and parental oversight. Adara is a minor but still has her own thoughts and a degree of agency. Hannah must consider how much autonomy should be granted to Adara, particularly when it conflicts with the parents’ right to know and act for their child’s safety.

Cultural considerations are integral to ethical decision-making. Given Adara’s background in a culture where mental health is often stigmatized, it’s essential for Hannah to approach the situation with heightened sensitivity. This isn’t just about understanding Adara’s individual needs; it’s also about being aware of the cultural context that shapes her experiences. This makes cultural competence a necessity in resolving the ethical dilemma.

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APA Ethical Standards

• Standard 4.05: Discussing Confidentiality Limits (APA, 2020)
• Standard 4.02: Breaching Confidentiality
• Principle E: Respecting Autonomy
• Principle A: Prioritizing Client Welfare
• Principle B: Duty to Warn
• Principle D and Standard 3.04: Minimizing Harm

Speaker’s Notes

Hannah faces a complex ethical situation with regards to informing Adara’s parents of her concerns. What makes it more complex is that multiple APA standards and principles appear to contradict each other.

Standard 4.05, known as “Disclosures,” 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 a possible ethical pitfall for Hannah.

Standard 4.02, referred to as “Privacy and Confidentiality,” allows for breaching confidentiality if there’s an acute risk of harm. For Hannah, this means she must carefully assess whether Adara is in immediate danger and consider the impact this breach could have on their trust and Adara’s willingness to continue the therapeutic relationship.

Principle E, known as “Respect for People’s Rights and Dignity,” focuses on respecting Adara’s autonomy by maintaining confidentiality unless there’s immediate danger. Principle A, called “Beneficence and Nonmaleficence,” prioritizes client welfare. In this case, Hannah has to judge whether or not the standard for immediate danger is met.

Principle B, known as “Fidelity and Responsibility,” emphasizes the duty to warn if danger is clear, even against Adara’s wishes. 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. Again, it is up to Hannah to judge if the standard for clear danger is met, and if it is to minimize harm caused to Adara. This could be problems with her family or emotional distress from the perceived breach of trust.

Hannah has to weigh Adara’s welfare, safety, autonomy, and dignity against each other to make the most ethically responsible decision.

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Suggested Course of Action

• Alternate Supportive Adult
• Explain Hannah’s Responsibility
• Collaborate With Adara on Trusted Adult Choice
• Joint Discussion With Chosen Person
• Ongoing Checkins
• Upholds APA’s Principle E (APA 2017)

Speaker’s Notes:
The suggested course of action begins with Hannah transparently explaining her legal and ethical responsibilities to Adara, including the obligation to disclose any imminent risks to parents or guardians. This initial step is crucial for establishing a foundation of trust and transparency between Hannah and Adara. From there, they collaborate to identify an alternate supportive adult within Adara’s family circle. This strategy is not only ethically responsible but is also supported by a 2019 study by Fish and colleagues, indicating that having even one trusted adult can significantly lower suicidal thoughts.

After establishing a transparent and honest relationship with Adara, Hannah collaborates with her to identify a trusted adult family member to serve as an additional source of support. This adult’s role is multifaceted: they are not acting in loco parentis, but rather serve as a supportive figure who can assist with practical matters like transportation to therapy sessions and possibly even financial assistance for treatment. At the same time, they offer emotional support and a listening ear for Adara. Adara’s perspective is invaluable in selecting this individual, as she has the most intimate understanding of her family dynamics and 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 is intended to be a safe space where Adara feels empowered to openly share her experiences and concerns. Hannah’s role in this setting is to provide essential clinical observations related to risk factors. She does so without overshadowing Adara’s voice, thereby respecting her autonomy and self-determination.

Regular check-ins between Hannah and Adara serve as a tangible expression of Hannah’s ongoing commitment to Adara’s well-being.

The entire process is consciously designed to uphold APA’s Principle E. From the outset, where a transparent conversation sets the stage, to the collaborative identification of a supportive adult, and all the way through to the regular check-ins, the overarching focus is 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 robust and respectful support system for Adara.