
Name
Capella University
NURS-FPX4000 Developing a Nursing Perspective
Prof. Name
Date
Alex Turner is a 35-year-old software engineer who communicates to his psychologist, Dr. Laura Simmons, that he has plans to harm a colleague in a session. Dr. Simmons faces the ethical dilemma of maintaining Alex’s confidentiality over the protection of potential victims, which is incidentally aligned with the principles of beneficence and non-maleficence (Capella University, 2023). In this paper, the ethical options will be applied to address the moral dilemma of Alex’s case.
In the case study of Alex Turner, the stakeholders include Alex himself, his coworker whom Alex intended to harm, and Dr. Laura Simmons, a psychologist to whom Alex is reporting. The disclosure of the very detailed plans of inflicting harm by Alex on his coworker, which are apparently triggered by some personal and professional conflicts, lays a huge challenge on the ethics of Dr. Simmons. Considering the case study analysis that led to this ethical dilemma, the following have been facts gathered:
The trust Alex gained toward Dr. Simmons, developed over months of therapy, forms the basis of their relationship. It would be essential that confidentiality reinforces this source of trust so the patient opens up more in therapy because open communication is guaranteed to be respected. Studies emphasize the need to respect confidentiality in psychotherapy to ensure such treatment results (Grover et al., 2022). This empirical analysis provides additional valid background for the analysis above in grounding the ethical dilemma Dr. Simmons has in balancing confidentiality toward Alex with her duty toward others.
Alex has made explicit threats to harm a colleague, thus compromising the commitment to the principle of non-maleficence because it is making people vulnerable to direct harm. With regard to threats of violence, psychologists are faced with a dilemma between the responsibility of rescuing others from potential damage and the violation of confidentiality that such an act would entail (Miller, 2021). The given study confirmed the reasoning that this presents an ethical dilemma wherein the safety and well-being of a patient and others become at stake.
Dr. Simmons has legal and ethical duties, such as the duty to warn and disclose confidential information so that no people get harmed. Studies in moral decision-making in mental health practice indicate that professionals in the field face particular challenges in terms of confidentiality and responsibility to protect others from harm (Bar et al., 2020). This testimony, therefore, serves as evidence to support the analysis as it supports the presentation showing that Dr. Simmons should balance her legal and ethical obligations as she decides what is right for Alex.
In the situation concerning Alex Turner, Dr. Laura Simmons is required to manage a sensitive ethical and therapeutic equilibrium following Alex’s disclosure of his intent to inflict harm upon a coworker. The rapport they have established over several months of therapy is jeopardized, necessitating that Dr. Simmons conveys her message with precision to uphold the therapeutic alliance while simultaneously acknowledging her ethical responsibility to safeguard others. Her method of communication should be marked by thoughtfulness, supportiveness, and clarity as she moves through the seriousness of the situation so that Alex doesn’t withdraw emotionally or intensify his intentions.
Rather than acting like a mere recipient of information, Dr. Simmons should ask intuitive, open-ended questions that will help Alex deliberate on the more fundamental forces that create his thoughts. This process can lead to deeper thinking and help Alex realize his grave situation on his own (Cohen et al., 2020). Dr. Simmons should direct Alex to assess the implications of his actions, not only for himself but also for others. Encouraging Alex to think about the impact may help him see the damage he intended to do, even though Dr. Simmons did not say anything specifically. Dr. Simmons will give him alternative approaches based on cognitive-behavioral methods or stress reduction exercises, thus providing Alex with practical resources to deal with his emotions nonviolently (Gruber et al., 2020).
Demonstrating excessive shock or worry may lead Alex to perceive judgment or a lack of understanding, which could result in his retreat from therapeutic engagement (Perricone et al., 2023). Instructing Alex with precise directions regarding his actions while neglecting to allow him the opportunity to reflect on his emotions and arrive at his own conclusions could result in resistance or opposition (Markowitz et al., 2022). Their execution allows Dr. Simmons to maintain a productive and respectful dialogue that facilitates Alex’s deeper engagement with his thoughts and prospective solutions. This approach encourages self-efficacy and offers Alex more constructive coping skills. However, if she responds with overwrought intensity or provides an excess of detailed instructions, Alex may feel powerless or criticized, which could exacerbate his anger or distrust. An ideal balance between support and understanding is necessary to meet this challenge at the ethical and therapeutic levels.
Moral Awareness: Dr. Simmons demonstrates strong moral awareness in recognizing the ethical dilemma presented by Alex’s disclosure of his violent thoughts. She understands the tension between maintaining confidentiality—a core principle in therapy—and the obligation to protect others from potential harm. This awareness positions her to move toward making a moral judgment about how to handle the situation.
Moral Judgment: In exercising moral judgment, Dr. Simmons evaluates the situation by weighing the risks of potential harm against the importance of maintaining the therapeutic relationship. She carefully considers ethical guidelines that mandate breaking confidentiality if there is a credible threat of harm while also acknowledging Alex’s need for trust and support in addressing his emotional struggles.
Ethical Behavior: Dr. Simmons’ moral behavior is evident in her efforts to engage Alex in deeper conversation, encouraging him to explore the underlying causes of his anger and consider non-violent alternatives. She strives to maintain trust by showing empathy and non-judgment but also understands that her responsibility may require reporting the threat if she believes there is an imminent risk to others. Her ethical decision, however, is not yet resolved, as she seeks the most appropriate course of action.
The consequences of practical and ineffective ethical approaches in this scenario could be significant. By incorporating empathetic dialogue and encouraging Alex to reflect on the consequences of his actions, Dr. Simmons could help de-escalate the situation while preserving trust in their therapeutic relationship. On the other hand, if she acts too quickly without fully exploring Alex’s intentions or fails to address the risk of harm, the situation could escalate, potentially leading to real-world consequences and damaging the therapeutic bond (Markowitz et al., 2022). Therefore, Dr. Simmons must carefully balance emotional intelligence with ethical obligations to protect both Alex and others as she works through the dilemma.
A potential solution to the ethical dilemma in Alex Turner’s case could involve arranging a structured therapeutic intervention where Dr. Simmons, Alex, and potentially another mental health professional collaboratively explore his harmful thoughts and develop strategies for managing them (Malat et al., 2024). In this setting, Alex would be encouraged to express his emotions and underlying frustrations further, while Dr. Simmons could provide a safe space for him to process these thoughts and offer non-violent alternatives. During this session, Dr. Simmons could also introduce Cognitive Behavioral Therapy (CBT) techniques, focusing on helping Alex challenge and reframe his aggressive thoughts (Nakao et al., 2021). By emphasizing Alex’s control over his actions and offering practical coping mechanisms, Dr. Simmons would be honoring her duty of care while actively working to prevent harm. This solution reflects the ethical principles of beneficence and non-maleficence, aiming to prevent harm to both Alex and his colleague.
Additionally, Dr. Simmons can explore whether involving a colleague in the process, such as a forensic psychologist or legal consultant, would be appropriate if the risk of harm increases. By doing so, she could ensure that Alex receives specialized care while protecting his confidentiality until a direct threat emerges. This approach maintains the therapeutic alliance by avoiding a premature breach of trust and ensures that any necessary actions, such as alerting authorities, are taken only when necessary.
Bar, M., Fish, E., & Mendlovic, S. (2020). Mental-health care under threat: A pragmatic approach for ethical decision-making for practitioners in COVID-19. Counselling Psychology Quarterly, 1–13. https://doi.org/10.1080/09515070.2020.1777939
Cohen, J., Wright-Berryman, J., Rohlfs, L., Wright, D., Campbell, M., Gingrich, D., Santel, D., & Pestian, J. (2020). A feasibility study using a machine learning suicide risk prediction model based on open-ended interview language in adolescent therapy sessions. International Journal of Environmental Research and Public Health, 17(21), 8187. https://doi.org/10.3390/ijerph17218187
Grover, S., Avasthi, A., & Nischal, A. (2022). Ethical and legal issues in psychotherapy. Indian Journal of Psychiatry, 64(7), 47–61. https://doi.org/10.4103/indianjpsychiatry.indianjpsychiatry_50_21
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Malat, J., Eng, S., & Teck, A. (2024). Group psychotherapy. Springer EBooks, 3835–3870. https://doi.org/10.1007/978-3-030-51366-5_37
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Miller, D. (2021). Responsibility and the duty of rescue. Journal of Applied Philosophy. https://doi.org/10.1111/japp.12560
Nakao, M., Shirotsuki, K., & Sugaya, N. (2021). Cognitive–behavioral therapy for management of mental health and stress-related disorders: Recent advances in techniques and technologies. BioPsychoSocial Medicine, 15(1), 1–4. https://doi.org/10.1186/s13030-021-00219-w
Perricone, A., Bitran, A., & Ahn, W. (2023). Explaining how psychotherapy affects the brain can increase the perceived effectiveness of psychotherapy: A randomized controlled trial. Behavior Therapy. https://doi.org/10.1016/j.beth.2023.10.003
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