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American Annals of the Deaf

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Ethics in Mental Health and Deafness

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Perhaps because of Bradís postdivorce vulnerability and loneliness, he became very close to a 24-year-old, cocaine-addicted, deaf female client named Eileen. He often ran into Eileen at social events in the local Deaf community. Through their dream analysis and projective testing work during therapy, Eileen discovered what she thought to be repressed memories of sexual abuse by her hearing, widowed, non-signing, alcoholic father. Perhaps as a result of his own difficult childhood with non-signing hearing parents, Bradís face flushed with anger at the thought of Eileenís abuse experience.

Because he had not explained his legal and ethical duties to report child abuse at the beginning of the counseling relationship, Brad had to backtrack quickly to help his naive client understand his responsibilities.

Eileen begged Brad not to report the memories of sexual abuse. She said she never would have brought up her repressed memories had she known it would cause problems for her elderly, frail father recently diagnosed with Alzheimerís disease.

Concerned that Eileen would terminate therapy in a community where there were no other signing therapists, Brad agreed not to report Eileenís abuse memories. He thought the hearing police might not understand. Perhaps his dream analysis and projective testing work with Eileen evoked false memories of abuse. What was the impact of Eileenís long-term addiction and depression on her dreams and her memories? Were Bradís sympathy for, affection for, and personal identification with Eileen clouding his ability to spot organic or psychotic markers?

As Eileen left her meeting with Brad one evening, they hugged and kissed. Brad made nothing of this, thinking that physical affection was part of Deaf culture. But Brad also recognized that he was very attracted to Eileen, her vulnerability, and her adoration for him. Since it was the end of his day, Brad decided to postpone writing his case notes until the next day.

He never got to it.

That same night, Eileen committed the details of her session with Brad to her diary. In rough notes, she worried that she was wrong about her repressed memories of abuse. Was she simply trying to please Brad, a therapist who had a special commitment to projective techniques? She was found dead of a drug overdose the next morning.

After the police handed over Eileenís diary to her family members, the family retained a skilled attorney to sue Brad for malpractice. They alleged that Bradís ethical violations were the cause of Eileenís death.

Letís go through the elements of a negligence/malpractice suit and the malpractice jury question to determine where Brad stands. How might you have advised Brad if you were his supervisor?

Duty of Reasonable Care

A lawyer representing Eileenís family would have little difficulty showing that Brad and Eileen had an implicit therapist-client relationship. An exchange of expectations occurred. The lawyer for Eileenís family would also have little trouble finding ethical code language, starting with the preamble of the American Psychological Associationís (APA) ďEthical Principles of Psychologists and Code of ConductĒ (1992).

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