EPPP: Part 2, Skills Quiz: Ethical Resolution

Dr. Shah works in a pediatric specialty clinic. She provides therapy to Lila (12) for chronic illness adjustment. Lila's parents request access to Lila's patient portal messages, stating they manage all medical care. Lila uses the portal to message Dr. Shah about body image and bullying and asks that her parents not read the messages. The clinic's portal policy is unclear for minors, and IT staff say they can grant proxy access to parents by default. Dr. Shah must decide how to structure communication, consent, and confidentiality to protect Lila while involving caregivers appropriately. Relevant APA standards include 4.02 (Discussing Limits of Confidentiality), 4.01 (Maintaining Confidentiality), 3.04 (Avoiding Harm), and 10.01 (Informed Consent) (APA, 2017). How can Dr. Shah ensure compliance with ethical standards in this situation?

Dr. Morgan provides therapy to Kai (17) in a hospital adolescent program. Kai's parents consented to treatment but demand that Dr. Morgan disclose whether Kai is sexually active and using contraception. Kai states they will stop therapy if this information is shared and reports a history of punitive responses at home. Kai is not suicidal, but has escalating anxiety and occasional binge drinking. The hospital's policy allows limited confidentiality for adolescents, but it requires clinicians to inform guardians of "significant health risks," a term not clearly defined. Dr. Morgan must navigate informed consent, confidentiality limits, and family engagement while minimizing harm. Relevant APA standards include 4.02 (Discussing Limits of Confidentiality), 4.05 (Disclosures), 3.04 (Avoiding Harm), and 10.01 (Informed Consent) (APA, 2017). What is the most ethical action for the psychologist to take in this scenario?

Dr. Hart conducts telepsychology from her home office. After a platform update, she discovers that session recordings were automatically enabled and stored in a cloud folder accessible to administrative staff. Two staff members inadvertently listened to portions of a couple's session while troubleshooting audio. The couple, Rae and Kim, are in high-conflict therapy and have discussed sensitive legal issues related to custody. Dr. Hart immediately disables recording but is unsure whether to inform the couple, fearing escalation and complaints. The clinic director suggests quietly deleting the files and moving on. Relevant APA standards include 4.01 (Maintaining Confidentiality), 4.04 (Minimizing Intrusions on Privacy), 6.02 (Maintenance of Records), and 3.04 (Avoiding Harm) (APA, 2017). What are the potential consequences of violating this ethical principle?

Dr. Okafor, a psychologist at a university counseling center, is treating Aisha (20), an international student experiencing acculturative stress and family pressure. Aisha requests that therapy incorporate her religious practices and asks Dr. Okafor to avoid "Western labels" like depression. Dr. Okafor believes CBT with diagnostic framing is essential and worries that adapting too much could reduce treatment fidelity. Meanwhile, the center requires DSM diagnoses for session authorization, and Aisha fears documentation could affect her visa status if disclosed. Dr. Okafor is aware of cultural stigma and language nuances; Aisha's English is fluent but she uses culturally specific idioms of distress. Relevant APA standards include 2.01 (Boundaries of Competence), 2.03 (Maintaining Competence), 3.01 (Unfair Discrimination), 3.04 (Avoiding Harm), 10.01 (Informed Consent), and Principle E (Respect for People's Rights and Dignity) (APA, 2017). Dr. Okafor must decide how to adapt treatment while meeting institutional requirements and protecting confidentiality. What is the most ethical action for the psychologist to take in this scenario?

Dr. Barnes, a psychologist in a small town, begins treating Hannah (27) for OCD. After two sessions, Hannah invites Dr. Barnes to join a volunteer board at the local animal shelter, noting "everyone important is on it." Dr. Barnes already serves on the board and would see Hannah monthly in meetings. Hannah says she would feel "rejected" if Dr. Barnes declines and hints she might stop therapy. There are few alternative providers nearby, and Hannah's symptoms are impairing. Dr. Barnes must evaluate multiple relationship risks, client welfare, and community realities. Relevant APA standards include 3.05 (Multiple Relationships), 3.04 (Avoiding Harm), 10.01 (Informed Consent), and 2.01 (Boundaries of Competence) (APA, 2017). What is the most ethical action for the psychologist to take in this scenario?

Dr. Foster treats Malik (24) for social anxiety. After several months, Malik offers Dr. Foster discounted web-design services for the practice website, stating he cannot afford full fees and wants to "trade" services. Dr. Foster is considering a fee increase and worries Malik will drop out. Malik's work quality is strong, and Dr. Foster feels appreciative and excited about the offer. Dr. Foster must consider potential exploitation, boundary issues, and whether bartering is appropriate in their community. Relevant APA standards include 3.05 (Multiple Relationships), 3.08 (Exploitative Relationships), 6.04 (Fees and Financial Arrangements), and 10.01 (Informed Consent) (APA, 2017). What is the most ethical action for the psychologist to take in this scenario?

After a clinic-wide data breach, Dr. Kim drafts a client notification letter. The clinic administrator wants the letter to be vague, stating only "a technical issue occurred," and to omit mention that psychotherapy notes may have been exposed. Dr. Kim believes clients need enough information to take protective steps and make informed decisions about continuing treatment. Several clients are high-profile community members, and leadership fears media attention. Relevant APA standards include 3.04 (Avoiding Harm), 4.01 (Maintaining Confidentiality), 4.04 (Minimizing Intrusions on Privacy), and 6.02 (Maintenance of Records) (APA, 2017). Which ethical principle is most relevant to resolving this dilemma?

In a school-based clinic, Dr. Thompson provides therapy to Diego (13) for anxiety. Diego's grandmother is his primary caregiver and speaks limited English; Diego is bilingual and often interprets at medical appointments. The school requests that Dr. Thompson use Diego to interpret during therapy check-ins with the grandmother to "save time." Diego reports that when he interprets, he filters information to avoid upsetting his grandmother, and he feels responsible for her emotions. Dr. Thompson believes involving the grandmother is important for treatment but worries about role strain, confidentiality, and accuracy. The district provides professional interpreters, but scheduling can take two weeks. Relevant APA standards include 3.04 (Avoiding Harm), 3.10 (Informed Consent), 4.01 (Maintaining Confidentiality), and Principle E (Respect for People's Rights and Dignity) (APA, 2017). How can Dr. Thompson ensure compliance with ethical standards in this situation?

Dr. Jensen provides therapy to Omar (16), whose parents request that Dr. Jensen share session-by-session updates. Omar agrees to general updates but wants details about his sexual orientation kept private. Omar's parents also ask Dr. Jensen to sign a school form stating Omar has "no mental health concerns" so he can join a competitive program. Omar has moderate depression symptoms but is functioning academically. Dr. Jensen must manage informed consent, truthful documentation, and confidentiality with a minor. Relevant APA standards include 4.02 (Discussing Limits of Confidentiality), 4.05 (Disclosures), 10.01 (Informed Consent), and 6.01 (Documentation of Professional and Scientific Work) (APA, 2017). Which course of action best adheres to the ethical code?

At a hospital-based pain clinic, Dr. Chen is asked to provide EMDR for a patient, Luis (46), who has complex PTSD and opioid use disorder. Dr. Chen's training includes general trauma-focused therapy but not EMDR; the medical director insists EMDR is "evidence-based and quick" and wants Dr. Chen to start next week to reduce length of stay. Luis is eager for EMDR after seeing social media testimonials. There is no EMDR-trained psychologist on staff, and referral options exist but would delay care and require travel. Dr. Chen worries about competence, informed consent, and potential destabilization given Luis's substance use and medical comorbidities. Relevant APA standards include 2.01 (Boundaries of Competence), 2.03 (Maintaining Competence), 3.04 (Avoiding Harm), and 10.01 (Informed Consent) (APA, 2017). Dr. Chen must decide whether to seek training/supervision, provide alternative interventions, or refer. Which course of action best adheres to the ethical code?

Dr. Alvarez provides couples therapy to Priya and Mark. Mid-treatment, Mark requests individual sessions "just to vent" and reveals he has been having an affair and intends to continue, but he wants Dr. Alvarez to keep it secret from Priya to avoid divorce. Priya, in joint sessions, has asked repeatedly whether there are any "secrets" undermining trust. Dr. Alvarez's informed consent paperwork briefly mentions that the therapist may not keep secrets in couples therapy, but it was not discussed in detail. The clinic supervisor advises Dr. Alvarez to "use clinical judgment" and keep Mark engaged. Dr. Alvarez must manage conflicting obligations, clarify informed consent, and avoid harm to both partners while maintaining professional integrity. Relevant APA standards include 10.01 (Informed Consent), 3.04 (Avoiding Harm), 3.07 (Third-Party Requests for Services), and 4.01 (Maintaining Confidentiality) (APA, 2017). What is the most ethical action for the psychologist to take in this scenario?

Dr. Yamada supervises a postdoctoral fellow, Dr. Singh, at a forensic clinic. Dr. Singh reports that a former therapy client has started dating Dr. Singh's sibling, and the client has begun texting Dr. Singh socially. The client is no longer in treatment but requests "advice" about the relationship and hints they may seek to restart therapy. Dr. Singh feels uncomfortable but worries about appearing rude and damaging the client's progress. The clinic has strict boundary policies due to court-involved cases, and any appearance of impropriety could affect credibility. Relevant APA standards include 3.05 (Multiple Relationships), 3.06 (Conflict of Interest), 2.05 (Delegation of Work to Others), and 4.01 (Maintaining Confidentiality) (APA, 2017). Dr. Yamada must guide Dr. Singh on boundary management and documentation. What steps should the psychologist take to address this ethical issue?

A hospital psychology service experiences a phishing incident. Dr. Lopez learns that an intern clicked a malicious link, exposing shared drive folders containing psychological testing reports. The risk management team plans to notify only current patients, not former patients whose reports remain stored. Dr. Lopez notes that some former patients may face ongoing risks (e.g., employment background checks) if reports are leaked. The department chair is concerned about workload and suggests limiting notification to reduce calls. Relevant APA standards include 6.02 (Maintenance of Records), 4.01 (Maintaining Confidentiality), 3.04 (Avoiding Harm), and 4.04 (Minimizing Intrusions on Privacy) (APA, 2017). What is the most ethical action for the psychologist to take in this scenario?

A group practice discovers a data breach affecting several clients, including Noor (38), who is in therapy with Dr. Stein for intimate partner violence. Noor uses a shared family computer and fears her partner may monitor email. The practice's standard notification method is email with a templated message. Dr. Stein worries that emailing could increase danger, but delaying notification could violate state reporting timelines. The practice manager wants uniform communication for efficiency. Dr. Stein considers alternative contact methods, documentation, and safety planning. Relevant APA standards include 3.04 (Avoiding Harm), 4.01 (Maintaining Confidentiality), 4.04 (Minimizing Intrusions on Privacy), and 6.02 (Maintenance of Records) (APA, 2017). How should the psychologist balance the interests of all parties involved?

Dr. Price is asked by a community agency to provide dialectical behavior therapy (DBT) groups for clients with borderline personality disorder. Dr. Price has experience with CBT groups but no formal DBT training. The agency offers a small stipend and says, "You can learn as you go," because funding is expiring. Clients have high acuity, frequent self-harm histories, and limited crisis resources. Dr. Price worries about competence and potential harm if the intervention is delivered incorrectly, but also recognizes the community's lack of services. Relevant APA standards include 2.01 (Boundaries of Competence), 2.03 (Maintaining Competence), 3.04 (Avoiding Harm), and 10.01 (Informed Consent) (APA, 2017). What is the most ethical action for the psychologist to take in this scenario?

Dr. Allen treats Sasha (30) for eating disorder recovery. Dr. Allen later learns Sasha has started a romantic relationship with Dr. Allen's clinical supervisor's adult child. The supervisor is involved in Dr. Allen's performance evaluation and licensure hours documentation. Sasha asks Dr. Allen whether this connection could "mess up therapy" and requests reassurance that nothing will change. Dr. Allen worries about conflicts of interest, confidentiality, and whether the supervisor might infer Sasha's client status. Relevant APA standards include 3.06 (Conflict of Interest), 3.05 (Multiple Relationships), 4.01 (Maintaining Confidentiality), and 2.06 (Personal Problems and Conflicts) (APA, 2017). What steps should Dr. Allen take to address this ethical issue?

Dr. Green, a psychologist at a multidisciplinary clinic, receives a request from a physician colleague to share detailed psychotherapy notes about a mutual patient, Elena (52), to support a disability claim. Elena signed a general release for "medical records" but did not discuss psychotherapy notes specifically and is ambivalent about disclosing trauma details. The physician insists the claim will fail without specifics and asks Dr. Green to send notes today. Dr. Green must decide what to disclose, how to interpret the release, and how to protect Elena's privacy while supporting her goals. Relevant APA standards include 4.01 (Maintaining Confidentiality), 4.05 (Disclosures), 4.04 (Minimizing Intrusions on Privacy), and 10.01 (Informed Consent) (APA, 2017). What steps should Dr. Green take to address this ethical issue?

In a university clinic, Dr. Rossi supervises trainees providing therapy to students. A trainee reports they recognized a current client, Ben (19), as a new roommate in their graduate housing. Ben does not know the trainee's role at the clinic yet, and the trainee fears housing tension if they request a move. The clinic director suggests the trainee can continue treatment "as long as boundaries are clear," citing staffing shortages. Ben is being treated for paranoia and has expressed mistrust of others' intentions. Relevant APA standards include 3.05 (Multiple Relationships), 3.06 (Conflict of Interest), 3.04 (Avoiding Harm), and 2.05 (Delegation of Work to Others) (APA, 2017). What is the most ethical action for the psychologist to take in this scenario?

A private practice experiences a cyberattack. Dr. Ibrahim learns that the attacker posted a sample of stolen documents online, including a de-identified but recognizable progress note referencing a local newsworthy event and a client's job title. The client, Marisol (39), could be identified by community members. Dr. Ibrahim considers whether this constitutes a confidentiality breach requiring notification and remediation, and whether to contact law enforcement, the board, and affected clients. The practice's insurer recommends minimizing admissions until the investigation finishes. Relevant APA standards include 4.01 (Maintaining Confidentiality), 4.04 (Minimizing Intrusions on Privacy), 6.02 (Maintenance of Records), and 3.04 (Avoiding Harm) (APA, 2017). What is the most ethical action for the psychologist to take in this scenario?

During outpatient therapy, Dr. Nguyen learns her group practice's EHR vendor suffered a ransomware breach. A former client, Jordan (29), had ended treatment 6 months ago after trauma-focused CBT. The practice's IT consultant reports that exported backup files containing names, dates of service, diagnoses, session notes, and insurance IDs were accessed for at least 48 hours; it is unknown whether files were copied. The practice owner urges staff to "wait for legal to advise" and avoid contacting clients to prevent reputational harm. Jordan's employer is a local police department; Jordan previously expressed fear that disclosure of PTSD treatment could affect promotion. The state has a health-data breach notification statute with a 30-day reporting deadline; the insurer contract also requires prompt notice. Dr. Nguyen is not the privacy officer but is Jordan's treating psychologist of record in the chart. She worries about potential harm, her duty of confidentiality, and coordinating with the institution. Relevant APA Ethical Principles and Code of Conduct include Standard 4.01 (Maintaining Confidentiality), 4.04 (Minimizing Intrusions on Privacy), 4.05 (Disclosures), 6.02 (Maintenance, Dissemination, and Disposal of Confidential Records), and 3.04 (Avoiding Harm) (APA, 2017). Dr. Nguyen must decide how to respond internally, whether and how to notify Jordan, and what steps to prevent recurrence while respecting institutional roles. What steps should Dr. Nguyen take to address this ethical issue?