Ethical and Legal Analysis: Teenage Intersex Client's Substance Use and Family Challenges

Case Study Analysis

You work as a psychologist at a progressive independent school in Victoria. Students are either referred to you by a teacher, welfare officer or they can sign up to be on your waiting list themselves. You see students during school hours and their sessions replace normal school classes.

You have seen Lexi, a 15-year-old who has recently identified as intersex, six times over the last 3 months. Lexi was referred by the school welfare office because of recent changes (last 6-12 months) in their demeanour, falling grades, some behavioural issues and to discuss her gender ambivalence. The welfare officer notes that Lexi may be on their last chance at the school after a range of minor infractions, as Lexi is seen by some teachers as a ‘negative influence’ on others.

Lexi presented with a disengaged and somewhat disaffected manner, and took a few conversations to say much at all.Their most common response to queries from you in session is ‘I don’t know’. When booking a time for the next appointment at the end of a session, Lexi is occasionally noted to be scheduling appointments on specific days / times in order to avoid certain classes. You’re not sure if this is Lexi’s way of minimising the role of therapy in front of you, or if they are just trying to get out of class. At this stage, you feel the alliance is tenuous. 

Lexireports beinga regular consumer of edibles for a year and has recently increased their use (but are vague about milligrams, numbers etc). They also report vaping cannabis ‘when they can get it’ because they ‘need it to get through all the school and family stuff’. Lexi reports not feeling any different with this use (‘well maybe a little vibey sometimes’), but ‘feels like crap’ if they don’t‘have something’ every day now. You feel that Lexi has started to look more tired, unkempt,and agitated over the course of your sessions.They report occasionally taking a few of their mother’s diazepine tablets in the past, but that their mother ‘must have sussed it’ because she now hides the bottle.

Lexi’s parents split for the second time about a year ago and Lexi’s mother has recently started seeing a new man. He has two children of his own (12 and 14) who Lexi describes as ‘private school prats’. As the parental divorce looms, Lexi reports increasing levels of conflict between their parents, but no violence or threatening behaviour. Colleagues report that ‘Lexi’s Mum is Greek, a bit all over the placeand runs a small business’ but that ‘Dad seems more with it, but it harder to pin down’ as he is rarely seen. Lexi has been obtaining their cannabis / edibles from someone theyknow ‘around the traps’. Lexihas recently been spending more time with a social group who are comprised of older youth from the area. Lexi reports that a few members of this group often engage in illegal activity such as shoplifting and drug dealing, but Lexi says‘don’t freak out, I’m not into that, I’ve got enough sXXt to deal with already’.

You briefed Lexi about their right to confidentiality and told that them thattheirparents would only be informed of any session content if Lexi agreed for them to be so, and/or if you felt there was an imminent risk to Lexi or other people. The school has a policy that ‘appropriate school staff (unspecified) should be informed of session content if there is an issue that raises significant concern’ though, and you did discuss this challenge at the outset with Lexi also. When you asked Lexi(during session 6) if theymight agree to a parent or the school being informed about what was going on for Lexi, Lexi became upset and said ‘I only told you this stuff because you said it’d be kept private’, that there was ‘no point’ telling their mother as theywas‘too busy with hernew guy, her new family, work and the divorce stuff’ and that, if you told anyone you’d be ‘just like everyone else’. Lexi also said they’d stop coming to sessions and ‘probably get kicked out of home and school anyway, so nice work doc’.

Apply the DA-MAP (Boyle & Gamble, 2014)to this scenario.

In doing so, be sure to:

(1) identify any legal, ethical and /or practice issues this client situation raises. 

(2) Identify any relevant law, Code/s and/or Guidelines that speak on the above issues, and detail what they say that is relevant to your identified issues.

(3) Discuss the pros and cons of your chosen action/s and those of at least one alternative approach.

Last, write no more than a paragraph on the personal values / beliefs that you feel may have influenced your process or response, and how they may have done so.

No abstract required

Use APA format where possible

Don’t cite class material as a source, but feel free to cite the prescribed text and/or any additional sources

Be sure to correctly cite the relevant Law, Codes, and /or Guidelines, and feel free to use other sources (but make sure they’re up to date and correct for Victoria).

Do NOT overquote from sources such as Law, Codes etc, but by all means use short extracts (no, we’re not going to define what ‘short’ means). Those extracts and references are not included in your word count.

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