Case study

Marcelle lives in a small regional town in Victoria. She recently resigned from her part-time job as a consultant psychologist to schools in the region. Her children are staying with her parents for a fortnight so she can take her first real (stay-at-home) break since becoming a single parent two and a half years ago.

She plans to take over her best friend Sunita's small practice of private clients when Sunita moves back to Western Australia to be closer to her family next year. Marcelle is looking forward to this professional challenge but she is also nervous. Sunita's departure will mean Marcelle is once again the only psychologist in her town. Sunita also works with a diverse cross-section of the community, including with people experiencing comorbid substance use issues and syndromes commonly experienced in older adults (e.g., dementia). Marcelle hasn't practised in these areas since completing her postgraduate training a decade ago. To prepare for the challenges of private practice, she plans to complete some targeted professional development over the coming months.

Yesterday, however, a distraught Sunita phones Marcelle and says that she is on her way to Western Australia because her father has died suddenly. During the call, Sunita explains that she has already contacted her clients who have all expressed a willingness to continue therapy with Marcelle. Sunita explains that two of her clients require therapy the next day: Sophie and David, who have both agreed to see Marcelle via telehealth. Sunita expresses relief about this, explaining that they both require ongoing therapy - Sophie because she is embroiled in a toxic relationship and David because he has a long history of substance use issues and relies on Sunita's support to stay sober. Sunita emails Marcelle the telehealth log-in details for the sessions with Sophie and David and says that she will also send through login details to her client management database, including client case notes, once she arrives in Western Australia.

Then this morning, as Marcelle's telehealth session with Sophie is drawing to a close, an adolescent comes into the room that Sophie is sitting in, sees Marcelle's face on the screen, appears momentarily stunned, and then runs out of the room. Sophie apologises for the interruption, explaining that it was her sixteen-year-old son, Connor, and then promptly says "Thanks again. It's such a relief knowing I've still got support. See you next week" and ends the telehealth session. Marcelle had immediately recognised Connor as her mature minor client with whom she worked for several months earlier in the year in her school job. She recalls that Connor only engaged in the therapeutic relationship once he was reassured that he could do so without his parents' permission. As Marcelle sits there in the aftermath of the session wondering what to do next, she receives an email from Sunita with the client database log-in details and a message that reads "Here are the clients' contact details and appointment schedule. I know it's terrible but I'm a few months behind with case notes. Sorry and thanks!". Marcelle takes a deep breath and looks at the clock. She has four hours before the scheduled session with David.

• What ethical principle(s) are involved?
• Clarify the available facts
• Consult the relevant codes and guidelines.
• Consider everything that might influence your decision.
• Consult a trusted colleague (for this step please state whether or not the psychologist should consult a colleague and whom).
• Evaluate the rights, responsibilities and vulnerability of all affected parties.
• Generate alternative decisions.
• What are the consequences of making each decision?
• Make the decision.
• Implement the decision.