Ethics Vignettes
Dr. Bruce started dating a former client just one month after terminating therapy. During their sessions, the therapist had also borrowed money from the client, promising to pay it back but never did. The therapist disclosed the client’s personal issues to their mutual friends at a party.
What are Standard 3.05: Multiple Relationships, Standard 10.08: Sexual Intimacies with Former Clients, Standard 6.04: Fees and Financial Arrangements, Standard 4.01: Maintaining Confidentiality?
This individual struggles to understand the basic concepts of their trial, often confusing the roles of the judge and the attorney, leading to questions about their competency to participate in legal proceedings.
Dusky v. United States
A 32-year-old woman has been feeling extremely sad and hopeless for the past year. She reports difficulty sleeping, constant fatigue, and frequent crying spells. She feels guilty about past events and has lost interest in daily activities. Her thinking is slower, and she struggles to concentrate.
On the MMPI-3, scales likely to be high: RCd (Demoralization), RC2 (Low Positive Emotions), Negative Emotions
On the WAIS, Processing Speed and Working Memory are likely to be low due to cognitive slowing and concentration difficulties.
Jessica, a 25-year-old graphic designer, has always been passionate about her work. However, her creativity comes with a price; she experiences periods of intense energy and productivity, followed by episodes of deep despair and fatigue. During her manic phases, she impulsively takes on numerous projects, often overspending and neglecting her responsibilities. Recently, she has also started to experience overwhelming anxiety and panic attacks, leading her to avoid social situations altogether. This has left her feeling isolated and struggling to maintain her professional relationships.
Becca is a 26-year-old graphic designer who shares an apartment with her roommate, Lily, a vivacious and attention-seeking individual known for her dramatic flair. Lily often dominates conversations and finds ways to be the center of attention, whether it's through her elaborate stories or her constant need for validation. While Becca appreciates Lily's creativity, she often feels overwhelmed by the intensity of her roommate's emotions and the demands for attention.
One evening, Becca returns home from a long day at work, eager to unwind and catch up on her favorite TV show. As she walks into the apartment, she is greeted by an explosion of colorful decorations and loud music. Lily has decided to throw an impromptu "welcome back" party, inviting several friends over without consulting Becca first.
As the night progresses, Lily performs for her guests, recounting exaggerated stories about her latest escapades and showcasing her dramatic personality. Becca, feeling sidelined and frustrated, tries to engage in the conversation but finds it difficult to get a word in. When she finally expresses her feelings about wanting some quiet time, Lily reacts with exaggerated distress, claiming Becca is unsupportive and that she doesn't appreciate Lily's efforts to bring joy to their home.
The tension escalates as Becca, feeling pushed to her limits, snaps at Lily for her selfishness and lack of consideration. The confrontation leaves both women upset, and Becca finds herself questioning the compatibility of their living situation. The incident underscores the emotional turmoil that can arise when living with someone who has this type of traits, leading Becca to consider finding a new roommate.
Diagnosis: Histrionic Personality Disorder
Theories: Attachment Theory (Insecure), Social Learning Theory, General Strain
V-Codes: Problematic social relationships, Relational distress
MMPI-3
High Scales: Psychoticism, Disconstraint, Low Positive Emotions and Hypomania
WAIS Probable Scores for Lily
High Verbal Comprehension
Low Processing Speed
Dr. Lopez starts a private practice offering counseling while also teaching at a university, where they promote their practice to students. They offer discounted therapy to students who sign up for their course and use student information for a research project without de-identifying data. The psychologist fails to maintain accurate clinical records and doesn't inform clients about their right to refuse research participation.
What are Standard 3.05: Multiple Relationships, Standard 6.01: Documentation of Professional and Scientific Work, Standard 8.02: Informed Consent for Research, Standard 5.01: Avoidance of False or Deceptive Statements, 6.02, Maintenance, Dissemination, and Disposal of Confidential Records.
This person committed an act of violence but was suffering from a severe mental illness at the time, leading them to be unaware of the nature and consequences of their actions.
McNaughton Rule
A 24-year-old man has been experiencing racing thoughts, high energy, and impulsive decisions for weeks. He starts numerous projects, talks rapidly, and feels overly confident but also irritable. His focus is scattered, and he can’t stay on task.
On the MMPI-3, scales likely to be high: RC9 (Hypomanic Activation) and EID (Emotional/Internalizing Dysfunction).
On the WAIS, Processing Speed might be high during hypomanic episodes, while Working Memory and Attentionmay be low due to impulsivity and lack of focus.
Emma, a 27-year-old aspiring author, has always been celebrated for her creativity and intelligence. However, her upbringing in a household where only perfection was acceptable instilled in her a relentless pursuit of flawlessness. This pressure has led to a pervasive sense of inadequacy and a fear of failure, complicating her creative process and leading to feelings of chronic sadness.
As Emma approaches the deadline for her first novel, she becomes paralyzed by self-doubt. Despite having a detailed outline, she cannot bring herself to write a single page, convinced that her work will never meet her high standards. In social situations, she avoids discussing her writing, fearing that others will judge her harshly if she reveals her struggles. This cycle of avoidance leads to deep frustration and disappointment, further stifling her creativity and contributing to her ongoing sense of hopelessness.
edit
A young woman named Maria, 22, becomes obsessed with the idea that she is pregnant with the child of a famous pop star, Justin Bieber. She has no real connection to him but believes their brief encounter at a concert last year was significant. Maria struggles with issues due to a previous abusive relationship, which has affected her self-esteem and judgment. As time passes, she grows increasingly convinced that this supposed pregnancy will change her life and give her the fame and attention she desires.
Feeling desperate to validate her claims, Maria begins stalking Justin and even manages to secure a meeting with him through a friend who works in the industry. When she confronts him, she insists that he is the father of her child. Justin, bewildered and clearly uncomfortable, denies any connection and expresses concern for her well-being.
In her obsession, Maria becomes erratic, and when she learns that Justin is planning to perform at an upcoming festival, she decides to take drastic action. She sneaks backstage with the intention of confronting him again, but when security tries to escort her out, she panics and lashes out, injuring a security guard in the process.
Maria is arrested and charged with assault and trespassing. During her evaluation, her behavior and mental state are brought into question as her lawyer seeks to argue for a reduced sentence based on her mental health issues.
Diagnosis: Delusional Disorder Erotomanic Type
Theories: Attachment Theory (Anxious Attachment), General Strain Theory, Social Control
V-Codes: Personal history (past history) of spouse or partner neglect, Current Legal Issues
MMPI: High on Thought Dysfunction, Ideas of Persecution, Low Validity on K scale
WAIS: Low PSI & VCI, Average WMI & PRI
Dr. Wolff is supervising a new therapist does not provide appropriate guidance or feedback, leading to poor client outcomes. The psychologist also fails to maintain confidentiality in supervision meetings, and when asked about these cases by colleagues, gives misleading information about the clients' progress.
What are Standard 7.06: Assessing Student and Supervisee Performance, Standard 4.01: Maintaining Confidentiality, Standard 3.04: Avoiding Harm, Standard 5.01: Avoidance of False or Deceptive Statements?
This individual engaged in reckless behavior due to a mental health condition but claims they believed their actions were justified as part of a larger mission.
Brawner v. United States
A 29-year-old woman is undergoing evaluation for her involvement in a workplace incident where she was accused of stealing. During the assessment, she claims to experience intense paranoia and believes her colleagues are constantly watching and plotting against her. However, her claims seem exaggerated and inconsistent with her behavior, raising concerns about her reliability.
On the MMPI-3, scales likely to be high: F (Infrequent Responses) (indicating exaggerated or unusual responses) and RC6 (Ideas of Persecution) (reflecting paranoia, possibly exaggerated). RC7 (Dysfunctional Negative Emotions) and FNE (Fear of Negative Evaluation).
On the WAIS, Verbal Comprehension may be low due to disorganized thoughts and distorted perceptions, while Processing Speed could also be low as her paranoia interferes with her ability to think clearly.
Clara, a 32-year-old management consultant, is exceptionally talented in her field. Despite her expertise, she has always felt like an outsider in professional settings. Growing up in a critical household, she developed deep-seated fears of inadequacy and rejection. As a result, she avoids situations where she might be evaluated, leading to significant anxiety and distress in her career.
During a crucial presentation to a potential client, Clara's anxiety peaks. Although she has prepared extensively, she struggles to make eye contact with the audience and fumbles over her words. After the meeting, she beats herself up for not being more confident, withdrawing from her colleagues to avoid further scrutiny. This pattern of avoidance leads to missed opportunities for advancement and deepens her feelings of loneliness.
Patrick is a 27-year-old investment banker in Manhattan, leading a seemingly perfect life filled with wealth and privilege. However, beneath his polished exterior lies a deeply disturbed individual plagued by his cockiness, superficiality, and a lack of empathy for others.
In recent months, Patrick’s behavior has become increasingly violent. He fixates on a colleague, Paul Allen, whom he views as a rival. Driven by a need to assert dominance, Patrick lures Paul to his apartment under the guise of a casual dinner. After a brutal confrontation, he kills Paul with an axe, dismembers the body, and disposes of it in a nearby river, convinced he can evade capture.
As he navigates the aftermath of the crime, Patrick’s paranoia and delusions intensify, leading him to believe he is untouchable. His detachment from reality deepens, and he continues to socialize as if nothing has happened. Eventually, his behavior catches the attention of authorities, prompting an investigation into his mental state.
Diagnosis: Antisocial Personality Disorder (Or Narcissistic Personality Disorder), Potentially Delusional Disorder
Theories: General Strain Theory, Attachment Theory (Disorganized)
V-Codes: Problematic social relationships, Current Legal Problems, Childhood history of neglect?
MMPI-3:
High on Antisocial Behavior, Compulsive Personality, Hypomanic Activation, Aberrant Experiences, Low Positive Emotions
WAIS:
High in Verbal Comprehension, but average to low in Working Memory, possibly low in Processing Speed
Forensic Psychologist Ricke conducts an evaluation for a court case but doesn’t explain the limits of confidentiality to the defendant. The psychologist uses the same report for a different case without making the necessary adjustments, leading to inaccurate results. When questioned about their credentials in court, the psychologist exaggerates their qualifications.
What are Standard 4.02: Discussing the Limits of Confidentiality, Standard 9.09: Test Scoring and Interpretation Services, Standard 9.01: Bases for Assessments, Standard 5.01: Avoidance of False or Deceptive Statements?
This person exhibits erratic behavior during legal proceedings, raising concerns about their ability to understand the charges against them, leading to a psychological evaluation.
Drope v. Missouri
A 35-year-old man is being evaluated for competency to stand trial. He is accused of a violent crime but claims that the police are framing him. He refuses to cooperate with his lawyer, saying that the court is part of a conspiracy against him. His thought processes appear disorganized, and he has difficulty focusing on the questions during the evaluation.
On the MMPI-3, scales likely to be high: RC6 (Ideas of Persecution), THD (Thought Dysfunction), and AGGR (Aggression)
On the WAIS, Processing Speed and Working Memory are likely to be low due to disorganized thinking and difficulty concentrating.
Lily, a 28-year-old event planner, is known for her infectious energy and ability to light up a room. However, beneath her outgoing personality lies a series of insecurities, stemming from a fear of rejection and abandonment due to past tumultuous relationships. While she thrives on social interactions, they often leave her feeling drained and anxious.
While organizing a major corporate event, Lily becomes consumed by anxiety about how others perceive her. Despite her success, self-doubt creeps in, causing her to avoid social gatherings. When she does attend events, she turns to alcohol to cope, leading to regrettable confrontations with colleagues. This cycle of embarrassment and fear only deepens her emotional turmoil.
Hattie is a 24-year-old graduate student living in a small apartment near her university. Over the past few weeks, she has started experiencing increasing feelings of loneliness and anxiety, particularly due to her upcoming exam when her roommate, Tracy, is out of the house with her situationship. Hattie feels isolated and left out, as she often prefers spending time alone or engaging in solitary hobbies like reading or painting.
One evening, while Tracy is at her the boy's place, Hattie sits in the living room, feeling the weight of the silence in their apartment. As she scrolls through social media, she starts to imagine a conversation with Tracy, replaying their past discussions and even anticipating her responses. This daydreaming begins to intensify; she can hear Tracy's laughter and see her reactions vividly.
As the night goes on, Hattie becomes convinced that Tracy is actually in the apartment with her, chatting and laughing as if nothing has changed. She pours herself a glass of wine and engages in an animated discussion, sharing her thoughts about an upcoming exam and expressing her frustrations about feeling neglected. Hattie talks to "Tracy" as if she is there, responding to her own comments with laughter and agreement.
Eventually, Hattie realizes that she has been speaking to herself, and the loneliness crashes back over her. The conversation leaves her feeling more isolated than before, and she struggles to separate her vivid imagination from reality. Hattie's behavior begins to concern her friends, who notice her increasingly erratic comments about her interactions with Tracy. When Hattie gets arrested for stealing cigarettes, she knows it is time for a change.
Diagnosis: Brief Psychotic Disorder, Adjustment Disorder with Anxiety
Theories: Attachment Theory, Social Control Theory, General Strain?
V-Codes: Problematic social relationships, Relational distress, Current issues with the law
MMPI-3
High Scales of Negative Emotions, Thought Dysfunction, Aberrant Experiences, Low Positive Emotions
WAIS
Dr. Mosky begins therapy with a client but neglects to explain the therapy process, the client’s right to refuse treatment, or potential risks. The psychologist also keeps poor documentation and uses outdated diagnostic tools, leading to inaccurate assessments.
What are Standard 10.01: Informed Consent to Therapy, Standard 6.01: Documentation of Professional and Scientific Work, Standard 9.08: Obsolete Tests and Outdated Test Results, Standard 9.01: Bases for Assessments?
This individual committed a crime but believed their actions were justified due to the product of a severe mental illness, prompting discussions about their criminal responsibility.
Durham v. United States
A 30-year-old woman is on trial for fraud. During her psychological evaluation, she displays charm and charisma but admits to manipulating people to get what she wants. She has a history of exploiting others for personal gain and seems indifferent to the consequences of her actions. However, during the evaluation, she attempts to present herself in an overly favorable light, minimizing her issues and denying any emotional difficulties.
On the MMPI-3, scales likely to be high: RC4 (Antisocial Behavior) and AGGR-r (Aggression-Revised) (reflecting callousness and manipulative traits). Both L-r (Uncommon Virtues) and the K scale (Correction) are likely to be elevated, as she tries to "fake good" and present herself as more adjusted and virtuous than she actually is.
On the WAIS, Working Memory might be high due to her strategic thinking and manipulation skills, but Verbal Comprehension may reflect superficial charm, with deeper issues in ethical reasoning.
Daniel, a 32-year-old software developer, recently experienced a traumatic event when he witnessed a violent car accident. In the days following the incident, he began to have unusual thoughts and perceptual disturbances, believing that he was receiving messages through his electronic devices. He often felt disconnected from reality and would occasionally speak to people who weren't there. Despite this, he maintained a semblance of normalcy in his work life, but his friends noticed increasing odd behavior and a tendency to withdraw from social interactions. The episode lasts for less than a month before he begins to regain his usual demeanor.
Luna is a 21-year-old graduate student studying magical creatures at Hogwarts University. Known for her and her family's eccentricities, she often sees the world through a unique lens, frequently discussing her belief in fantastical creatures that most people dismiss as mere myths. Luna's peculiar behavior, combined with her disorganized thoughts and odd beliefs, makes her a target for teasing, but she remains unfazed.
One day, while researching for her thesis, Luna becomes convinced that a rare and powerful magical creature, the Snorkack, is hiding in a nearby forest. She believes that capturing this creature will not only prove her theories but also elevate her status among her peers. Driven by her obsession and a distorted sense of reality, Luna embarks on a mission to find the Snorkack.
In her quest, she stumbles upon a local pet shop that has been rumored to deal in rare magical creatures. Misunderstanding the store's activities, Luna believes that the shop owner is hiding a Snorkack in the back. In a moment of impulsivity, she breaks into the shop under the cover of night, intending to rescue the creature. Unfortunately, her actions lead to a confrontation with the owner, who is startled and calls the authorities. Luna is arrested for breaking and entering.
As she awaits trial, Luna insists that she was on a noble mission and expresses little understanding of the seriousness of her actions. Her quirky demeanor and lack of remorse further reinforce her personality traits, characterized by eccentric behavior, odd beliefs, and difficulty forming close relationships.
Diagnosis: Schizotypal Personality Disorder, Possible Adjustment Disorder with Anxiety, Possible Delusional Disorder
Theories: Social Learning Theory, Social Control Theory, General Strain
V-Codes: Problematic social relationships, Childhood abuse or neglect
MMPI-3
High in Dysfunctional Negative Emotions & Thought Dysfunction, Low in Positive Emotions
WAIS