Reference no: EM133304938

Background:
Frederich is a 66-year-old Afrikaans speaking man. His wife scheduled a session for him at their local psychiatric hospital to seek treatment. At the hospital they have a waiting list and clients see the next available psychologist. Frederich is assigned to Mandla, a recently qualified
Clinical Psychologist who is 29 years old. Mandla received the intake form that Frederich and his wife completed before the appointment. On the intake form, Frederich indicated he has never been in therapy before and has no history of depression or anxiety. However, his alcohol
use has recently been getting in the way of his marriage and interfering with his newly retired life. He wrote down that he is drinking increasing amounts over the last year, currently consuming approximately a six-pack of beer per day. He notes that this amount "doesn't give me the same buzz as it used to." The wife indicated that he gets argumentative and irritable when he drinks, though he does not always remember these incidents. He has also fallen while intoxicated twice, causing bruises both times and hitting his head on one of the occasions.

The first session:
Frederich walked into Mandla's office and froze when he saw him. After inviting Frederich to sit down he asked Frederich if everything is okay since he looked startled when he walked in. Frederich crossed his arms and looked away while saying that he doesn't like that Mandla is so young, he doesn't need therapy, his wife is being over dramatic and that there is nothing wrong with his alcohol problem that he has. He also doesn't think someone so young can help him with his problems because how can they have the life experience that is needed to help someone who is really struggling. Mandla immediately took offense to these comments and was upset that Frederich accused him of not being good enough to be a psychologist. Mandla also thought back to his own struggles and how he had to overcome having an alcoholic father who was abusive when intoxicated.

Mandla crossed his arms and then firmly said its not right to make those kinds of accusations about someone, especially if you just met them and do not know their own background. Frederich then went on to tell him how he can make them because when he was in the army a
young medic had to help him but was not trained well enough and as a result, he has permanent back pain that could have been avoided. Mandla realised he had misinterpreted Frederich's initial reaction and misunderstood what Frederich was trying to say. Mandla apologised and indicated he was unaware of Frederich's bad experience with a health worker, and he would genuinely like to help Frederich. Frederich was hesitant but agreed to a follow up session with Mandla.

Second session:

Frederich started the session with a rigid body posture of crossed arms and legs, Mandla however sat squarely with the client, leaned forward and maintained good eye contact with Frederich. Mandla, who often gets bored and easily distracted in sessions was actually very
interested in what Frederich was saying. He listened to Frederich complain about the medic who mistreated him, about how he has nothing to keep him busy at home and how his wife keeps nagging him to do something useful with his life instead of sitting and drinking all day long. Frederich said his wife does not understand that his back gets too painful if he is too active and that drinking helps take the pain away. Mandla, calmly leaned forward, looked Frederich in the eye and said, "It sounds to me like you are frustrated at how limited you are in life due to the constant pain from your back and that your wife does not understand what you are going through at this moment. I might be making an assumption here, and please correct me if I am wrong, but I get the sense that your drinking is not the problem you are struggling the most with, it is the constant pain in you back and you only use the drinking as a method to help soothe both your physical pain and your mental pain." Frederich sat forward in his chair, uncrossed his arms and buried his face in his hands. He told Mandla that no one had ever understood his current struggles so well and he thinks that he was even lying to himself about his drinking habits, saying he told himself he only drinks to irritate his wife because she constantly nags him.

After a few sessions:
During the most recent session, Frederich entered Mandla's office in a wheelchair. Frederich was extremely angry and upset and whenever Mandla tried to probe what was wrong Frederich would just look at the floor, start crying and then get upset and keep to himself. Mandla
consulted with Frederich's wife during the session to gain more information on what happened. She informed Mandla that Frederich was driving while intoxicated and crashed their car into the neighbours' wall. Now Frederich has severe back pain (stemming from his old injury) and, according to her, he is throwing emotional tantrums. When Mandla returned to his office to continue the session, Frederich told Mandla there is no point in continuing therapy as he is a failure, and he deserves to be punished for his stupidity

Question

Indicate what the appropriate ethical guidelines would be and how these ethical dilemmas would be solved according to Egan's Skilled Helper Model