Ethical Dilemmas of Confidentiality With Adolescent Clients: Case Studies From Psychologists

Navigating limits to confidentiality with adolescent clients can be ethically and professionally challenging. This study follows on from a previous quantitative survey of psychologists about confidentiality dilemmas with adolescents. The current study used qualitative methods to explore such dilemmas in greater depth. Twenty Australian psychologists were interviewed and asked to describe an ethically challenging past case. Cases were then used to facilitate discussion about the decision-making process and outcomes. Interviews were transcribed and analyzed using interpretive content and thematic analysis. Three key findings are discussed. First, it is of little use to perceive confidentiality dilemmas as binary choices (breach/don’t breach) because psychologists described 5 distinct options. These can be conceptualized on a spectrum of varying degrees of client autonomy, ranging from “no disclosure” (highest client autonomy) to “disclosure without the client’s knowledge or consent” (lowest client autonomy). Second, confidentiality dilemmas often involve balancing multiple and conflicting risks regarding both immediate and future harm. Third, a range of strategies are employed by psychologists to minimize potential harms when disclosing information. These are primarily aimed at maintaining the therapeutic relationship and empowering clients. These findings and the case studies described provide a valuable resource for teaching and professional development.     

The changes in psychological characteristics and reactions of elite athletes from injury onset until full recovery

Abstract

The purpose of this investigation was to describe the psychological characteristics and reactions of injured athletes and to examine the changes in these reactions throughout their rehabilitation. This study examined 136 elite injured athletes from 25 sports at four phases: upon injury, partial recovery, semi-recovery, and full recovery. Injury appraisal, athlete's demographics, and emotional and psychological variables were measured. Duration of injuries ranged from 4 to 99 weeks (M = 19 weeks). Changes were examined through a series of repeated measure MAN-OVAs with polynomial contrasts. Findings were typically as expected: increased confidence and vigor and decreased negative emotional responses over the recovery period. The changes over the recovery period were not always at a constant rate. Confidence of adhering to rehabilitation, passive, and emotion-focused coping, remained stable over time. The initial injury appraisal, regarding anticipated loss of time and the psychological impact of this, needs to be examined further. The psychological state of the athlete at the various stages of recovery has important implications for those diagnosing injuries and implementing rehabilitation programs.     

Older Adolescents’ Self-Determined Motivations to Disclose Their HIV Status

Disclosure of HIV status is an important topic for youth living with HIV/AIDS, yet theoretical frameworks for understanding HIV disclosure motivations have been poorly applied. Self-determination theory (SDT) proposes that people are at optimal functioning when they are engaging in activities that are interesting and enlivening. This study utilized SDT to understand young adults’ motivations to disclose their HIV status. Interviews and observations were conducted with nine youth aged 17–19 and two adult staff. Results indicate that SDT is useful for understanding types of motivation (i.e., amotivation, controlled, and autonomous motivation) to disclose. Amotivation was the most common type of motivation, and came from two recursive sources: fear of stigma and previous experiences of others disclosing without their consent. Controlled motivation to disclose occurred when participants were motivated to disclose because of reasons related to other people, rather than internal or personal reasons, and included the reasons of wanting to gain a closer relationship, reciprocate a shared secret, for psychological or emotional relief, and for attention. Autonomous motivation included two themes: the life perspective that “Having HIV is just part of who I am,” and valuing educating others because education was perceived as important and beneficial to others. This study extends SDT into the domain of HIV disclosure in older adolescents. People providing guidance and support to older adolescents with HIV/AIDS can use SDT to understand different motivations to disclose.     

Interpersonal Violence,Depression, and Executive Function

This study considers links between the number of types of violence to which women have been exposed, depression, and executive functions (EFs). Substantial research has established EF deficits among depressed individuals as well as individuals exposed to trauma. Studies have also indicated a relationship between trauma exposure and depressive symptoms across a range of traumatic events, such as combat exposure, motor vehicle accidents, natural disasters, and assaults. This study examines this relationship in an ethnically diverse community sample of 93 women exposed to interpersonal violence who completed a battery of EF tasks that assessed processing speed, working memory, response inhibition, and set shifting. Women reported an average of 5.8 types of interpersonal violence events. The number of types of interpersonal violence events was significantly related to depressive symptoms, although not EF performance. Specific EFs, such as working memory and response inhibition, were positively related to depressive symptoms.     

A Longitudinal Analysis of Loneliness Among Older People in Great Britain

Longitudinal studies of loneliness among older people are comparatively rare. At 8 years after the initial survey in 1999–2000, we followed up on the 999 people aged 65+ years who were living in the community in the United Kingdom. We found that 583 participants were still alive, and 287 (58%) participated in the follow-up survey. The overall prevalence of loneliness at both time points was very similar, with 9% reporting severe loneliness; 30% reporting that they were sometimes lonely, and 61% reporting that they were never lonely. We developed a 12-category typology to describe changes in loneliness across the follow-up period and report that 60% of participants had a stable loneliness rating, with 40–50% rating themselves as never lonely, and 20–25% rating themselves as persistently lonely; 25% demonstrated decreased loneliness, and approximately 15% demonstrated worse loneliness. Changes in loneliness were linked with changes in marital status, living arrangements, social networks, and physical health. Importantly improvements in physical health and improved social relationships were linked to reduced levels of loneliness. This result suggests that strategies to combat loneliness are not confined to the arena of social interventions such as befriending services, which aim to build and support social embeddedness, but may also result from the treatment of chronic and long-term health conditions.     

Age Differences in Adolescent Body Satisfaction

The purpose of this study was to explore differences in body satisfaction among female adolescents 14 to 18 years of age. Principal components analysis of a body cathexis measure completed by 751 high school cheerleaders indicated that six factors defined the adolescents' attitudes toward their bodies: satisfaction with the midsection and overall appearance, peripheral body parts, hair and face, mouth, hands, and height. An Age x Body Satisfaction multivariate analysis of variance (MANOVA) was conducted; a Bonferroni adjusted alpha of .007 was established for subsequent ANOVAs. Satisfaction with the mouth increased significantly as age increased, and a similar but nonsignificant trend was found for peripheral body parts. The findings contradict previous research reporting no age differences in the body satisfaction of adolescents. Role demands and physical maturation of the cheerleaders may explain differences based on age.