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1 Case 9-3: A Young Asian Woman Case Study 9-3: “A Young Asian Woman” Allison Cormier Southern New Hampshire University PSY-570: Ethical Practice in Psychology Dr. Donato November 14, 2023

2 Case 9-3: A Young Asian Woman Case Study 9-3: “A Young Asian Woman” Summary The Case Study 9-3: “A Young Asian Woman” pertains to a situation between a therapist, Dr. Letme Fixit, and his client, a young Asian woman who is struggling with low self- esteem and lack of confidence. Dr. Fixit, in an attempt to make his client feel better and improve her confidence, made several inappropriate comments regarding the woman’s appearance and race. While striving to boost her self-esteem, Dr. Fixit made remarks to the woman telling her she had beautiful eyes and commenting on the type of man she deserves, saying he could imagine her in a relationship with a “white man” like himself, continuing on to say that he wished he could be that man for her (Koocher & Keith-Spiegel, 2016). When going before the licensing board, he attempted to rationalize his behavior by admitting he may have gone over the top but only in an attempt to boost her self-esteem by trying to make her feel more attractive, however the board was not convinced. The case raises serious ethical concerns regarding cultural biases, multiple-role relationships, and the mandate to maintain self-awareness. Culture Culture and social orientation both have an influential effect on ethical behavior and the existing codes of conduct. A psychology professional’s perception and values have a significant impact on how the individual behaves, and often influences whether that behavior is ethical or not (Chmielewski, 2004). The relationship between a therapist and their client can be easily disrupted if the professional is placing any biases on their client in relation to personal factors such as race, age, income, gender, etc. (Koocher & Keith-Spiegel, 2016). Allowing these biases and prejudices to cloud one’s judgment can increase risks of unethical behavior and unwanted

3 Case 9-3: A Young Asian Woman consequences. To help mitigate these risks the APA Code of Conduct provides two principles that discuss the importance of eliminating any biases, the principles being Principle D: Justice and Principle E: Respect for People’s Rights and Dignity (American Psychological Association, 2017). Principle D emphasizes psychology professionals taking cautious measures beforehand to ensure their potential biases are not impacting their judgement, and Principle E discusses awareness and respect for other’s cultural and individual differences including age, ethnicity, socioeconomic status along with several other personal factors (American Psychological Association, 2017). Culture and social orientation have such a significant influence on ethical behavior that the APA Code of Conduct provides additional standards, besides the principles, in regard to Human Relations (Section 3) which outlines Unfair Discrimination (3.01) and Avoiding Harm (3.04), both emphasizing dismissing personal and cultural judgements in order to promote ethical behavior (American Psychological Association, 2017). A professional’s personal values and biases could lead to unfair treatment which would cause harm to the individual they are working with. This would then violate additional ethical codes such as Principle A: Beneficence and Maleficence, where the policy for doing harm to the client is discussed (American Psychological Association, 2017). Any type of microinequities between the therapist and client has the potential to cause the client to feel less confident or less productive (Koocher & Keith-Spiegel, 2016). The influences of culture and social orientation are seen within the Case 9-3 as Dr. Fixit displayed cultural biases and prejudices which led to him having to appear in front of the licensing board for consequences. The Doctor must recognize that his personal opinions of the woman’s appearance and of the Asian culture may not align with others. Implementation of cultural and social awareness is very important when dealing with contemporary problems. Psychology professionals are located all around the world and need to

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4 Case 9-3: A Young Asian Woman be able to communicate and work with each other effectively, which includes having an understanding and respect for the cultural differences. While professionals in a place like Japan view the exchanging of gifts during business a normal event, professionals within the Western culture may portray this as a bribe and that it is a negative thing (Donaldson, 2016). From either perspective it is important for the individual to understand that the variations are only differences based on their personal cultures and that it does not mean either way is wrong. If a professional disregards culture and social orientation and the ethical codes surrounding these factors and their feelings, emotions, and biases, which is a major part of self-awareness, it can negatively impact their role and behavior. Interactions Throughout interactions between important roles in psychology, such as a therapist and their client like in Case 9-3: “A Young Asian Woman,” culture and social orientation are quite influential. The effect social orientation and culture has on these interactions then continues on to inform ethical conduct in the psychology field. The way that we perceive ourselves as well as those around us and our environment has a significant impact on the way that we behave. In order to adequately promote ethical behavior, an individual must take into account how their own values impact our social environment (Chmielewski, 2004). In Case 9-3: “A Young Woman,” Dr. Fixit broke the APA Code of Conduct by demonstrating cultural biases when commenting that Asian woman “look good” with white men. These types of comments can cause the client to feel uncomfortable or offended, either way causing harm to the client and leading to ineffective treatment. Additionally, comments such as the one made on her personal features could lead the client to believe that there is a possibility or that it is acceptable for a romantic relationship to happen with their therapist, thus why defining the unacceptance of multiple-role

5 Case 9-3: A Young Asian Woman relationships is needed. When there is a lack of respect for culture and social orientation in interactions between the important roles in psychology it can cause harm to others, which is breaching the APA Code of Conduct as it relates to Principle A: Beneficence and Maleficence (American Psychological Association, 2017). Within a therapeutic practice, the professional should never place any biases in relation to personal factors such as race, age, income, etc. as it can disrupt the therapeutic relationship between the roles (Koocher & Keith-Spiegel, 2016). Any degree of microinequities between the important roles could lead the client to feel less productive and confident as well as excluded (Koocher & Keith-Spiegel, 2016). Therefore, the therapist should avoid situations where they believe the microinequities could cause any type of bias or problem at all costs. Both ensuring that harm is not done and promoting an effective therapeutic relationship are two of the key aspects within the psychology field, and therefore any conduct that attempts to defy these principles assist in influencing what conduct is ethical or not. Supported or Unsupported Within the field of Forensic Psychology, in order to determine if an ethical strategy is supported or unsupported, not only should the APA Code of Conduct be referred to, but also the judicial systems and their set of policies and standards as well. Behavior that might be regarded as unethical by the APA Code of Conduct could also be determined by the judicial system to be civilly or criminally actionable (Koocher & Keith-Spiegel, 2016). Depending on the environment that the professional is working in, the criteria for making ethical decisions can vary. Supported strategies in Forensic Psychology involve the inclusion of all guidelines, standards, and policies that applies to the professional, not just including those that apply to the field of psychology specifically. A common setting that a professional in this area of concentration may work within would be a prison, and whilst doing so the professional is to follow the policies and rules that the

6 Case 9-3: A Young Asian Woman prison system currently has in effect, but also must consider the APA Code of Conduct at the same time (Adams & Ferrandino, 2008). There are instances in which certain standards may counteract each other, and in these scenarios, it is important to reach out to other resources, such as other professionals in the Forensic Psychology field, so that various perspectives on the situation can be taken into consideration. Unsupported strategies would lack the reference to APA principles and standards and would not account for the work setting’s set of policies. Contemporary Problems Psychology itself is a developmental study, meaning that as humans continue to develop through the years, the information that we learn about humans also continues to expand (Behnke, 2009). As these new developments are discovered, the APA Code of Conduct, which are highly regarded and supported opinions on ethics, need to be revised and updated so that the principles and standards are still applicable to the current research and methods used. In doing so, any potential strengths and weaknesses that the professional presents as they continue to advance in the psychology field, has the opportunity to be exposed (Behnke, 2009). In the Forensic Psychology field specifically, contemporary problems can have a substantial impact on the necessity of reconsidering supported opinions. This was seen significantly when COVID-19 hit as rules and policies within the prison system, a popular work setting for forensic psychologists, were altered to better suit the present situation. It is considered ethical practice, meaning there are opinions supporting this matter, that prisoners, under certain circumstances that depend upon one’s sentencing or other personal factors, have a right to have visitors at the prison. However, when the new contemporary issue of COVID-19 was introduced, this supported ethical practice had to be reconsidered as it was reported by the CDC that quarantining was in effect and that being in close proximities with others was a dangerous health risk, (Schuchat, 2020). Therefore,

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7 Case 9-3: A Young Asian Woman the previously established ethical practices had to be reconsidered and altered, and visitation had to be temporarily suspended until further notice. Another contemporary issue that arose with COVID-19 as a result of the mandated quarantine that affected forensic psychologists was the necessity for different treatment formats that would not violate CDC guidelines (Winter, et al., 2023). Previously supported ethical opinions of in-person therapeutic treatment was halted, and the uprise of online therapy began. Contemporary issues are created every day and therefore professionals in the psychology field are continuously reevaluating and reconsidering what is supported in regard to ethics. Ethical Analysis Ethical Issues The Case 9-3: “A Young Woman” presents several ethical issues and highlights the importance of psychology professionals need to maintain self-awareness so that they do not participate in rationalizations used to justify their unethical behavior (Koocher & Keith-Spiegel, 2016). Dr. Fixit exhibited an inability to maintain appropriate and professional boundaries with his client when he made personal comments on her appearance and projected cultural biases. When telling his client that he could imagine her with a “white man” he made an implication that Asian people hold less value than white people, such as himself, demonstrating cultural prejudice and an insensitivity towards the client. A psychology professional needs to maintain the ability to recognize their own values, beliefs, and prejudices so that they may gain a better understanding of their biases which will reduce risks of ethical issues and unethical behavior (Koocher & Keith-Spiegel, 2016). The professionals that do practice self-reflection often make more ethical decisions that are more effective than those who don’t (Prasco, et al., 2023). When questioned by the licensing board for his behavior, Dr. Fixit attempts to rationalize his behavior using self-

8 Case 9-3: A Young Asian Woman deception. Self-deception usually occurs unconsciously and allows oneself to believe that they are acting morally when in fact they are actually acting out of self-interest (Koocher & Keith- Spiegel, 2016). These ethical issues present a major conflict for the therapeutic relationship between Dr. Fixit and the young woman. Ethical Strategy To address the ethical issues in this case, an ethical strategy must be developed to ensure that supported ethical guidelines are being followed. As Dr. Fixit was generating a possible solution to approach his client’s struggles with self-esteem and confidence, the assistance of an Eight-Step analysis could prove to be most beneficial. The Eight-Step analysis allows decisions to be made that are based off of current theories and evidence and also adheres to the APA Code of Conduct all while reducing any risks of biases or outside variables that may influence the decision. The ethical issues in this case are that the therapist was unable to maintain self- awareness and engaged in rationalizations in an attempt to justify his unethical behavior (Koocher & Keith-Spiegel, 2016). The Eight-Step model will help the therapist to maintain his self-awareness, including his cultural biases and personal emotions, so that his client is not harmed. Defining the ethical issue is important in the analysis as it allows Dr. Fixit to refer to the APA Code of Conduct to see which standards and guidelines apply to his particular issue. This strategy is informed by several of the ethical principles and standards that are described in the APA Code of Conduct, most importantly the key principle to do no harm to the individuals that the professionals work with (American Psychological Association, 2017). Additionally, this strategy would lead him to consult with Section 3: Human Relations, of the APA Code of Conduct to gain information on the policies surrounding unfair discrimination and to ensure fair treatment, as well as Principle E which highlights the awareness and respect of other cultures and

9 Case 9-3: A Young Asian Woman individual differences (American Psychological Association, 2017). Understanding the ethical principles and standards that inform the strategy will allow Dr. Fixit to alter his behavior so that there are not ethical violations. Dr. Fixits implementation of this Eight-Step decision-making analysis will ensure the APA Code of Conduct is being followed and reduce his risk of consequences, like being seen by the licensing board. Continuing on in the model, Principle D: Justice of the APA Code of Conduct informs the next steps as Dr. Fixit would engage in self- reflection to make sure that self-awareness is being maintained so that his cultural biases about Asian culture and his client’s personal appearance does not lead to unjust behavior and practices (American Psychological Association, 2017). This step also continues works towards ensuring the client is not harmed in any way. Professionals often times have a difficult time viewing situations objectively as their own personal needs, lack of competency, or personal prejudices influence their judgement (Koocher & Keith-Spiegel, 2016). Therefore, following along the Eight-Step model and consulting with other colleagues allows other perspectives and opinions to be given which can generate alternative solutions and reduce risks. This step will certify that the APA Code of Ethics is being adhered to in that it’s not causing any harm to his client and eliminating the influence of Dr. Fixit’s personal biases. Dr. Fixit should ask his colleagues how to go about boosting a client’s self-esteem while also not committing any ethical violations. Next would be to assess the rights and vulnerabilities of all the parties affected, in this case the young woman would be the affected party. The APA Code of Conduct’s Principle E: Respect for People’s Rights and Dignity, outlines the necessity of protection for the person’s rights and welfare and supports this step of the Eight-Step analysis (American Psychological Association, 2017). When completing this step, Dr. Fixit will observe that the comments about her appearance and race are not respectful of the woman’s rights to treatment with bias or prejudice and will

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10 Case 9-3: A Young Asian Woman alter them to be more appropriate. Using the assistance from colleagues as well as personal competencies will drive the next step in the analysis where any and all possible solutions are generated. This would allow Dr. Fixit to weigh out the pros and cons of each and whether or not they adhere to the APA code of ethics so the best decision can be made about how to boost her self-esteem. Possible alternative solutions in this case might include learning positive affirmations, journaling, physical activity, or engaging in a self-care routine (Martinez, 2023). All of these solutions would adhere to the APA Code of Conduct as therapist would not be causing any harm to the client or making inappropriate and discriminatory comments, and the Eight-Step model would require Dr. Fixit to observe any potential consequences that each solution may create. After going through the steps in the Eight-Step model, the final act would be to actually make the decision. If Dr. Fixit follows all of the steps noted, then the solution he generates for boosting his client’s self-esteem and confidence will be well-informed and adheres to the APA Code of Conduct. Opposing Ethical Strategy Following similar steps as the Eight-Step model is the PLUS ethical decision-making model. Unlike the Eight-Step model, the PLUS model only includes seven steps, and they are based on current theories. Ethical strategies that stray from the Eight-Step model often tend to lack the support of ethical guidelines and principles, create more risk for counterarguments and unwanted consequences to arise (ECI, n.d.). Both models include defining the problem within the first step, however the PLUS strategy does not specify that the problem has to be one related to ethics. Therefore, the problem could actually be one that is associated with poor professional etiquette instead of an ethical violation or problem. Both the Eight-Step and the PLUS strategies include the consultation of outside colleagues as an important step as it allows the professional to gather

11 Case 9-3: A Young Asian Woman support, solidify their priorities, and gain other’s perspectives on the situation (ECI, n.d.). A major aspect that the PLUS strategy is lacking in comparison to the Eight-Step is allotting time in the decision-making process for the professional to look internally and recognize any personal factors or biases that are affecting their decision, which is especially important to the current case study. Without this step, the opportunity for counterarguments increases as other professionals will question if the decision was determined ethically or with bias. Similarly to the Eight-Step strategy, the PLUS strategy also includes creating and determining any and all alternative solutions to the current problem, this would ensure that the decision you are making has the maximum benefits and the most minimal risks in comparison to other decisions. Another important step that the Eight-Step strategy includes but is missing in the PLUS model is the reviewal of the patient’s rights and vulnerabilities, which is important in making sure no boundaries are crossed, as what has happened in the current case study. Both strategies include making the decision as one of their steps, but whereas the Eight-Step strategy ends their process there, the PLUS strategy continues on to explore the implementation of the decision as well as an evaluation of the effectiveness of that solution (ECI, n.d.). This allows for the professional to receive feedback which is beneficial in improving one’s decision-making skills in the future. Overall, the PLUS decision-making strategy lacks the extensive reviewal and comparison of the decision to ethical principles and standards as well as the assessment of one’s personal judgement and biases, thus increasing the risk of counterarguments which can prove difficult to refute and unwanted consequences. Multiple Role Relationship Issues When dealing with ethical issues related to multiple-role relationships, the Eight-Step decision-making strategy assists the professional in addressing them. Within the strategy there is

12 Case 9-3: A Young Asian Woman time provided to the professional to review their own personal judgements, biases, and prejudices as well as the effects that those factors have on their decision-making abilities. There are several reasons why professionals end up making unethical decisions, and one of the most frequently seen is the professional’s inability to view a situation objectively due to the interference of those personal biases and prejudices (Koocher & Keith-Spiegel, 2016). This issue has led to an increase in multiple-role relationships within the psychology field and a necessity to review the APA Code of Conduct prior to making a final decision, which is included in the Eight-Step strategy. When consulting the APA guidelines and principles during one of the steps, the professional will notice the APA Standard 3.05 which discusses multiple-role relationships and the importance of avoiding those situations at all costs (American Psychological Association, 2017). In Case 9-3: “A Young Asian Woman,” Dr. Fixit clearly allowed his personal judgement and cultural biases to affect his ethical decision-making ability in attempting to boost the woman’s self-esteem and confidence. When telling her that he would like to be in a relationship with her, he created the opportunity for a multiple-role relationship to form, or at least gave the client that implication. With assistance from the Eight-Step decision-making strategy, Dr. Fixit, and other professionals, will be able to view the situation thoroughly and determine risks and benefits of each solution to ensure a multiple-role relationship does not occur or is even insinuated. Multicultural Competence Issues The proposed strategy addresses ethical problems associated with multicultural competence issues by considering issues with diversity and culture as it pertains to the main ethical problem. The ethical issue that is seen in Case 9-3 involves the therapist’s lack of self- awareness, specifically how it pertains to his personal judgements and cultural biases. Dr. Fixit,

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13 Case 9-3: A Young Asian Woman in commenting on his client’s race, insinuated that the Asian culture was inferior to the white culture as he suggested she be with a “white man” (Koocher & Keith-Spiegel). Because the strategy devised follows the Eight-Step model, it will adhere to the APA Code of Conduct which includes standards surrounding respect for cultural differences and acceptance of diversity. When Dr. Fixit is carrying out his strategy, he will consider any issues in regard to diversity and culture, as well as gain other’s perspectives on problems related to this matter which will decrease multicultural competence issues. The strategy takes into account the young woman’s cultural background and her social orientation, which may influence how she perceives Dr. Fixit’s comments. Therefore, the strategy emphasized the necessity of cultural sensitivity and an understanding of individual differences in regard to handling the situation. Codes Psychology is a developmental study meaning it evolves as we evolve. Therefore, current ethical codes need to also evolve and adapt to better fit the current theories and research. Within the past couple of years alone, especially since COVID-19 emerged, significant alterations have had to be made in regard to ethics as the widespread illness led to a change in treatment formats (Hamlett, et al., 2023). Instead of in-person treatment, majority of therapeutic treatments had to be performed through online platforms, and thus the APA Code of Conduct had to reflect that change and update their standards relating to privacy and confidentiality to apply to online treatment. Additionally, psychology professionals also had to ensure that there was still no harm being done to their clients during these changes as it applies to the APA principles. The current proposed strategy for Case 9-3 aligns with both current and emerging ethical codes in psychology. In regard to the APA’s Principles, the current case violates Principle A as Dr. Fixit allowed his personal judgements to influence the situation and in doing so he violated the client’s

14 Case 9-3: A Young Asian Woman rights and caused the client harm which is key in this principle. The comments the Doctor made also violated Principle B as he crossed boundaries and did not maintain his professional role by making the inappropriate comments towards his client. Principles D and E were also breached as they both discuss the need to maintain self-awareness, specifically in regard to any biases or personal prejudices, as Dr. Fixit allowed his feelings for his client and his cultural biases to negatively impact his role as her therapist, ultimately showing a lack of respect for the cultural and role differences between him and his client. The proposed strategy will adhere to all APA principles, by using the Eight-Step analysis, as it eliminates any harm done to the client, ensures the therapist is maintaining self-awareness and boundaries, and diminishes cultural biases. Dr. Fixit’s case also violates numerous APA standards, primarily those involved in Section 3 of the APA Code of Conduct. Section 3 involves policies pertaining to Unfair Discrimination (Standard 3.01), Sexual Harassment (Standard 3.02), Avoiding Harm (Standard 3.04), and Multiple Relationships (Standard 3.05), all of which were disregarded by Dr. Fixit (American Psychological Association, 2017). Dr. Fixit displayed discrimination when he projected cultural biases on his client and also devalued her Asian culture and favored his own. The comments Dr. Fixit made regarding the woman’s appearance could be perceived by the woman as sexual harassment if she observes the comments to have a sexual undertone or is offended. He also told her that he wished he could be in a relationship with her, which will be violating the Multiple- Role Relationship Standard (3.05), as it is not allowed for a therapist to enter into another relationship, whether romantic or not, with a client of theirs. The comments Dr. Fixit made were his personal opinions and therefore weren’t built upon any scientific evidence or knowledge, thus violating the Standard 2.04 Bases for Scientific and Professional Judgements (American Psychological Association, 2017). The Eight-Step model assisted strategy discussed previously

15 Case 9-3: A Young Asian Woman will also eliminate any ethical violations as it relates to the APA Standards as the model follows all APA Codes of Conduct and would eliminate the risk of Dr. Fixit making inappropriate comments. Overall, the proposed strategy addresses the ethical issues noted in the original strategy that Dr. Fixit displayed, and better aligns with current and emerging ethical codes as listed by the American Psychological Association. Conclusion Culture and Social Orientation When developing the proposed ethical strategy, culture and social orientation has a significant influence, and different cultural implications need to be considered in the process. Due to the fact that Dr. Fixit projected cultural and social biases on his client, the strategy needed to ensure that this did not happen. This is why the strategy includes the self-reflection of Dr. Fixit’s self- awareness and personal biases as well as gaining colleagues input on any biases they see in effect. The comment Dr. Fixit made regarding his client’s Asian culture implied that it holds less value than his own white culture, displaying racial microaggressions. Therefore, this cultural implication needed to be considered when developing the strategy and is similarly addressed in the self-reflection and consultation with colleagues’ steps. The young woman’s perception of the cultural “compliment” may not be the same as the therapists, as different cultures around the world have varying factors of cultural judgements, and in-turn could leave the client feeling offended or irritated (Yu, 2019). Considerations must be made for the cultural and social differences between the therapist and his client, and these are addressed within the model as it adheres to the APA Code of Conduct which identifies respect for these differences as a key principle. Compliments in different cultures can be perceived very differently. Whereas in English cultures it is acceptable for a male to compliment both male and females, it is considered

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16 Case 9-3: A Young Asian Woman rude in Chinese culture for a male to compliment a female on her appearance (Yu, 2019). Cultural differences such as those can also be seen between the English and Asian cultures and the proposed strategy eliminates the risk of misperception by eliminating the compliments altogether. The strategy allows Dr. Fixit to maintain self-awareness, so he is able to devise a solution for increasing his client’s confidence and self-esteem that is influenced by cultural and social considerations. Diversity and Equality Throughout the development of the ethical strategy that incorporates the use of the Eight- Step model, the concepts of diversity and equality were quite influential to the thought process and decisions in the creation of the strategy. In order for the strategy to follow the Eight-Step model it must adhere to all APA Codes of Conduct, which includes standards and guidelines surrounding diversity and equality. Two of the key principles of the APA codes is to do no harm and to treat all persons equally and fairly, both applicable to diversity and equality (American Psychological Association, 2017). Diversity discusses the exercise of including individuals from a variety of different social, ethnic, and cultural backgrounds, as seen in the case study as the therapist is a white male, and his client is an Asian female. Practicing diversity is an important factor to the strategy, as without it, unfair discrimination can take place which is a violation of APA standards. Additionally, diversity allows the professional to create a more selfless viewpoint and consider the other person’s view, and also how it relates to that individual’s personal factors such as their culture or gender, as every person in the world sees things differently (Moleiro, et al., 2018). Understanding the differences in diverse populations will allow the therapist to promote a higher equality of care where his clients are treated equally despite their cultural background or other personal factors. In developing the strategy,

17 Case 9-3: A Young Asian Woman consideration had to be taken to ensure that Dr. Fixit is including diversity and equality in his practices instead of making potentially offensive comments regarding the woman’s culture without even recognizing it. The self-reflection process of the Eight-Step strategy will also provide the therapist with the opportunity to observe and diminish any of his own prejudices and biases that may cause an inability to function with diverse and equal care. The therapist’s incorporation of diversity and equality principles into his strategy will ensure that all APA codes are being followed while simultaneously reducing risks and unwanted consequences. Controversial Issues Controversial issues in ethics are those that present some sort of moral conflict that needs to be addressed. Emerging ideas in ethics are usually generated, altered, and developed due to historical events that made a significant impact, such as the Nuremberg Trials in 1945, as well as ethical failures that drove researchers to develop new precautions, such as the Milgram Experiment (Weinbaum, et al., 2019). These changes in ethical ideas are also caused by scientific growth that expanded upon or created new research, for example the emergence of technology in psychology practices, and could occur in response to alterations in societal norms and cultural values that develop throughout the years (Weinbaum, et al., 2019). Psychology professionals, in the recent years have grown substantially more worrisome about Potentially Harmful Treatments (PHT), thus becoming a controversial issue in ethics as to what type of treatment qualifies as potentially harmful for the client/patient (Wendt, 2015). The development of the proposed strategy was influenced by this controversial issue as the whole purpose of the strategy is to eliminate the ethical issues and avoid cause the young woman in the case study any harm. The strategy uses a traditional Eight-Step model decision-making process to ensure APA code of

18 Case 9-3: A Young Asian Woman ethics is being adhered to, that any biases or prejudices are not impacting treatment, and that the client is not being harmed. Issues of Multiple-Role Relationships The proposed strategy does have the potential to be altered to further address issues related to multiple-role relationships. In the current strategy, Dr. Fixit is to engage in self- reflection to assess his personal opinions and judgements and how to not let them influence the ability to effectively provide care, as he did in the case study when he commented on the women’s appearance and her “beautiful eyes” and told her he wished to be in a relationship with her (Koocher & Keith-Spiegel, 2016). While this is extremely beneficial in reducing the chances of multiple role relationships occurring, there are additional ways that the strategy lacks to mention that can manage risks in regard to these types of relationships. Without setting boundaries, the behavior Dr. Fixit presents can encourage relationships that may be harmful to his clients. If Dr. Fixit believes that these feelings of attraction towards his client would interfere with his therapist role, to address this issue he could provide a referral to another therapist who may be better suited for the woman (Amaglo, 2022). If the issue of Dr. Fixit’s personal attraction to his client is not resolved, it could cause serious damages to the clients in the future. The strategy could also be changed or developed upon if Dr. Fixit were to consult with his colleagues about his feelings towards his client instead of only or just speaking with them about methods to boost his client’s self-esteem. When consulting ethical guidelines, the APA Code of Conduct discusses Multiple Relationships (Standard 3.05) and the negative impacts it has on the therapist’s ability to provide objectively effective treatment (American Psychological Association, 2017). If making changes to the strategy to further address these relationships, this standard should be heavily referred to, which the original strategy failed to focus upon. A

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19 Case 9-3: A Young Asian Woman multiple-role relationship between a therapist and their client should never occur as the treatment is supposed allow the client a safe place to receive clear feedback and allows them to focus on themselves, thus maximizing benefits and reducing risks and harm. Issue of Multicultural Competence To further address the issues of multicultural competence within the case, changes may be made to the Eight-Step model assisted strategy. Ethical violations can easily occur when professionals lack the education or willingness to learn. Through the process, when self- reflection occurs, the competencies of the professional are to be scrutinized to review any cultural prejudices or biases that may be influencing their ability to perform their job. The APA Code of Conduct discusses Boundaries of Competence (Standard 2.01) and how effective treatment cannot be provided unless the therapist has the adequate knowledge and experience to understand the components that are applicable to things such as race, culture, and religion (American Psychological Association, 2017). The current proposed strategy emphasizes the consultation to the APA code of ethics to eliminate ethical violations. In changing this to include consultation of the cultural knowledge and cultural standards, multicultural competency issues can be further addressed. For a therapist to be culturally competent, they should be aware of the beliefs and values that their own culture holds as well as the cultural beliefs and values of the clients they work with (Nair, 2019). The strategy could also be revised to add the potential alternative solution of Dr. Fixit taking classes or attending seminars to learn about other cultures besides his own so he can understand the harm his client is feeling in regard to his cultural biases. Conclusion

20 Case 9-3: A Young Asian Woman The primary ethical issues that presented themselves in Case 9-3 “A Young Woman” involved the therapist’s inability to maintain self-awareness as he used rationalizations to try and justify his unethical behavior. Additionally, Dr. Fixit made ethical violations when he made culturally prejudicial comments towards his client and made inappropriate comments about her appearance. When implementing a strategy to solve this situation, it is beneficial to refer to the assistance of the Eight-Step model analysis. This strategy will reduce the risk of harm done to the client by eliminating Dr. Fixit’s cultural biases and prejudices through the practice of self- awareness and consultation with other colleagues. The Eight-Step analysis adheres to all of the APA’s Code of Conduct and these standards will be referred to when proposing alternative solutions and making a decision. Gathering alternative solutions, either through outside resources or personal research, such as referring the client to another therapist or using different activities like positive affirmations for the client to learn rather than give inappropriate compliments allows for the best decision to be made where benefits are maximized, and risks are minimal for the client. This process also allows for issues regarding culture and social orientation, multiple- role relationships, and multicultural competence to be addressed, ultimately reducing possibilities of ethical violations

21 Case 9-3: A Young Asian Woman References Adams, K., & Ferrandino, J. (2008). Managing mentally ill Inmates in prisons. Criminal justice and behavior. SageJournals, 35(8), 913–927. https://doi-org.ezproxy.snhu.edu/10.1177/0093854808318624 Amaglo, E. (2022). Managing boundaries and multiple relationships in counselling and psychotherapy. Global Journal of Psychology. 2. 1-11. https://doi.org/10.51594/gjp.v2i1.361 American Psychological Association. (2017). Ethical principles of psychologists and code of conduct (2002, amended effective June 1, 2010, and January 1, 2017). http://www.apa.org/ethics/code/index.html Behnke, S. (2009, January 1). Ethics from a developmental perspective. Monitor on Psychology , 40(1). https://www.apa.org/monitor/2009/01/ethics Chmielewski, C. (2012, November). The importance of values and culture in ethical decision making . NACADA > Home. https://nacada.ksu.edu/Resources/Clearinghouse/View- Articles/Values-and-culture-in-ethical-decision-making.aspx Donaldson, T. (2016). Values in tension: Ethics away from home . Harvard Business Review. https://hbr.org/1996/09/values-in-tension-ethics-away-from-home ECI. (n.d.). The plus ethical decision-making model - Ethics & compliance toolkit. Ethics & Compliance Initiative . https://www.ethics.org/resources/free-toolkit/decision-making- model/ Hamlett, G. E., Tyler, J., Bredemeier, K., Ballentine, E., & Brown, L. A. (2023). The impact of COVID-19 on treatment seeking and interest in internet-based therapy for anxiety-related disorders: An interrupted time-series analysis. Psychiatry Research . 320, 5044. https://doi- org.ezproxy.snhu.edu/10.1016/j.psychres.2022.115044

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22 Case 9-3: A Young Asian Woman Koocher, G. P. & Keith-Spiegel, P. (2016). Ethics in psychology and the mental health professions: Standards and cases (4th ed.). Oxford University Press. https://mbsdirect.vitalsource.com/reader/books/9780199957705/pageid/3 Martinez, A. (2023). 14 therapy activities for self esteem to boost your confidence today. Crystal Mind Counseling . https://www.crystalmindcounseling.com/blog/therapy-activities-for-self- esteem Moleiro, C., Freire, J., Pinto, N., & Roberto, S. (2018). Integrating diversity into therapy processes: The role of individual and cultural diversity competences in promoting equality of care. Counselling & Psychotherapy Research , 18(2), 190–198. https://doi- org.ezproxy.snhu.edu/10.1002/capr.12157 Nair, L., & Adetayo, O. A. (2019). Cultural competence and ethnic diversity in healthcare. plastic and reconstructive surgery. Global open , 7(5), e2219. https://doi- org.ezproxy.snhu.edu/10.1097/GOX.0000000000002219 Prasko, J., Ociskova, M., Abeltina, M., Krone, I., Kantor, K., Vanek, J., Slepecky, M., Minarikova, K., Mozny, P., Piliarova, M., & Bite, I. (2023). The importance of self- experience and self-reflection in training of cognitive behavioral therapy. Neuro endocrinology letters, 44(3), 152–163 https://pubmed.ncbi.nlm.nih.gov/37392442/#:~:text=Practising%20the%20CBT %20approach%20and,confidence%20and%20sense%20of%20competence. Schuchat, A., & CDC COVID-19 Response Team (2020). Public health response to the initiation and spread of pandemic COVID-19 in the united states, February 24-April 21, 2020.

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23 Case 9-3: A Young Asian Woman MMWR. Morbidity and mortality weekly report , 69(18), 551–556. https://doi.org/10.15585/mmwr.mm6918e2 Weinbaum, C., Landree, E., Blumenthal, M., Piquado, T., Gutierrez, C. (2019). Ethics in scientific research: An examination of ethical principles and emerging topics. RAND Corporation . https://doi.org/10.7249/RR2912 Wendt, D. C., Gone, J. P., & Nagata, D. K. (2015). Potentially Harmful Therapy and Multicultural Counseling: Bridging Two Disciplinary Discourses. The Counseling psychologist, 43(3), 334–358. https://doi-org.ezproxy.snhu.edu/10.1177/0011000014548280 Winter, S., Jesser, A., Probst, T., Schaffler, Y., Kisler, I. M., Haid, B., Pieh, C., & Humer, E. (2023). How the COVID-19 pandemic affects the provision of psychotherapy: Results from three online surveys on austrian psychotherapists. International journal of environmental research and public health , 20(3), 1961. https://doi-org.ezproxy.snhu.edu/10.3390/ijerph20031961 Yu, Rongmei. (2019). A comparison of chinese and english compliments. Journal of Language Teaching and Research. 10. 1257. http://dx.doi.org/10.17507/jltr.1006.14

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