A counselor has been treating a client, Jay, who was recently in a bad accident that left him bedridden and partially paralyzed. With sustained physiotherapy and medication, the paralytic effect has gone, but motor movements are still affected.
Jay's steady girlfriend left him when she could not cope with the demands of a paralytic partner. Jay lost his job too. These left a heavy dent on his self-esteem, and he was slowly letting his life slip past. He began attending therapy at the insistence of friends.
One day, he discloses to his counselor that he is contemplating suicide because there is nothing he looks forward to in life. He announces that he has had enough of living and plans to shoot himself that evening. The counselor knows he has access to an old hunting rifle and that he has attempted suicide in the past. He has been under treatment for major clinical depression for the past three months.
Discuss the ethical issues presented in this scenario; identify the ethical code number and definition.
Describe the limits of confidentiality that must be considered.
Justify whether or not the counselor would need to break confidentiality.
Describe the steps the counselor should follow if he or she finds it necessary to break confidentiality.
Compare the ethical issues presented in this scenario to the APA's ethical standards and describe the similarities or differences in the ethical codes using the following website: http://www.apa.org/ethics/code/index.aspx.
Grading Criteria
1. Initial Response
2. Writing Craftsmanship and Ethical Scholarship
3. Wrote in a clear, concise, and organized manner; demonstrated ethical scholarship in accurate representation and attribution of sources; and displayed accurate spelling, grammar and punctuation.
Mental health professionals have an ethical responsibility to safeguard their clients' confidentiality. There are many reasons why the communication between the therapist and the client is held confidential. A client feels more at ease in disclosing personal information if he or she knows that this information will not be shared outside the therapist's office. However, the therapist is allowed to break client confidentiality in certain exceptional cases when client welfare is in question. We will discuss this in detail later in the course.
Confidentiality violations often occur in the counseling process and can have very damaging effects on clients. Clients feel betrayed or deceived. The effects are often more damaging than what would be in everyday relationships because the counseling relationship is based on a high level of trust. Clients share their most personal information with their counselors and engage in a relationship where they feel very vulnerable. This increases their susceptibility to being more affected.
Clients who feel betrayed by their counselors suffer from a great deal of anxiety, depression, and trauma in the long term. If they have been purposefully deceived by their counselors, they may feel abandonment and betrayal, from which they may take years to recover.
Situations that force the counselor to break confidentiality are called the limits of confidentiality. These situations limit the confidentiality of the clients for their best interests. Specifically, the limits of confidentiality are as follows:
When the client is likely to harm himself or herself
When the client is likely to harm others
When the counselor reports suspected abuse or neglect of a child, an elderly person, the resident of an institution, or a person with a disability to relevant authorities
When the counselor is ordered by a court to release information
The two most frequently occurring situations when confidentiality has to be broken are when a counselor comes to know that a client is likely to harm himself or herself and when a counselor comes to know that a client is likely to harm another person.