Question by Dr. Overtree
I have a client referral who is requesting, via an anonymous email message, to be screened by me as a possible patient anonymously. Although he states he is not suicidal or homicidal, nor does he meet any of the criteria for possible involuntary hospitalization (by his own report), he remains extremely concerned about allowing this judgment to be made by someone (e.g. me) other than himself. He wants to talk about his concerns, learn more about treatment, and then “walk away” if that is what he decides. Do I have any ethical or professional considerations to make if I accept his terms?
Response by Dr. Barnett
Hi Chris. This is a very interesting situation. In addition to risk management and ethics issues and concerns, I suggest you also consider your personal comfort with this situation. If you are not comfortable with this arrangement you are under no obligation to participate in it. You may decide that it is not in you or this individual’s best interests to participate in such an arrangement of an anonymous e-mail screening.
I understand that you are describing a screening process to see if the individual might be an appropriate patient for you, or even if treatment is indicated. But, what happens if/when this individual shares about some significant issues, concerns, or risk factors? Your ability to respond appropriately has been severely restricted by the ‘rules’ imposed on you by this individual. While I understand he says he is not suicidal or homicidal, I also know that things are often not as simple as they first seem. I have to wonder why he is seeking treatment (and why he feels compelled to do it in this way!). It certainly doesn’t seem like a good start for a relationship built on trust. Also, if he is “extremely concerned about allowing this judgment to be made by someone… other than himself” then what is your role in the screening process? Are you screening him or is he just seeking information about you and the services you provide? I would also wonder why he couldn’t just walk away if he decided to after an in-person screening in which he shares about who he is and responds to all your questions.
While this may only be a ’screening’ I can see the potential for significant difficulties arising. Even though this is being termed a screening one must ask if you incur a professional obligation to this individual once you begin asking questions about his history, presenting problems, etc. I also wonder how open and honest he will be about all this and as a result, what kind of job you can do with the screening.
When faced with an ethical dilemma where we must decide between two possible courses of action, Choices A or B, I often find that the best course of action is Choice C, some other option (not one of the two initially presented to us). So, I suggest you consider the options and alternatives available to you, decide what your level of comfort is with this arrangement, clarify his goals and expectations and decide if this is something appropriate for you to offer, consider what unanticipated things might occur and if you want to be in that situation, and if proceeding as asked will be in this other individual’s best interest.
You may wish to explain to him why you are not able to participate in the process as he is requesting and explain to him what you are able to offer. While you may never hear from him again, you may also be surprised and find that he agrees to this alternative plan. If you do decide to proceed with this arrangement I suggest being very clear about the parameters of the relationship, what a ’screening’ is and that this does not constitute the establishment of a professional relationship, but that this is intended to help each of you decide if you want to enter a professional relationship.
If you do decide to proceed you should be able to articulate for yourself why you are doing this. Perhaps you sense how scared this person is and that you may be able to do some good for him with how you handle this screening process. But again, it is important to be very clear about what this is and isn’t, what the goals are, what your role is, and what the potential outcomes are. I would also keep in mind the potential risks for you should you participate as he dictates.
Cite This Article
Barnett, J. E. (2009, December). Ask the ethicist: A request for an anonymous consultation. [Web article]. Retrieved from https://societyforpsychotherapy.org/ask-ethicist-req…ous-consultation/