A counselor’s ability to utilize the moral principle of confidentiality marks the cornerstone within which the counseling profession is founded. Mary must have trusted Jada, the school counselor, to great depths before disclosing that she was sexually active with an older boy. When dealing with minors, ethical dilemmas are evident, just as in this case, as to whether Jada should consider a breach of confidentiality for the sake of legitimate rights and concerns of stakeholders. While maintaining professional ethics, the school counselor should act according to the best interests of the student, while balancing the family’s legal rights as the guiding forces in the lives of these children (American School Counselor Association, 2018). Jada risks losing the trust of her client, Mary, when she discusses the detail of her relationship with her parents. Mary may like the therapist violated the privacy terms of the counseling session. Besides, Jada risks losing a client since Mary would experience feelings of betrayal and regret. Hence, Jada should encourage Mary to be the one to inform her parents first, failure to which the counselor might consider doing so herself. Counselor-minor communication privilege exists as a means of protecting information shared by the HIPAA statute, which limits the counselor’s jurisdiction to sharing information outside a counseling session.
A breach of confidentiality might damage the therapeutic relationship built earlier on. When a counselor contemplates breaking confidentiality, he/she should inform their clients about that possibility and give the client a chance of telling the caregiver. Upon breaking Mary’s confidentiality, Jada might dismantle the group since other members might start to feel insecure in case such an occurrence takes place in the future. The law states that neither privacy nor confidentiality is offered to minors as a legitimate right due to several stakeholders involved in the care process. However, a minor of fifteen years and older is termed eligible to give an informed consent to counseling sessions without the parents’ involvement, which makes it diligent in providing them the confidentiality rights just as an adult. Despite the mistrust formed by other group members towards Jada, she should let them know that their confidentiality will be given unless in revolves around issues that risk their wellbeing. Other students might feel as if Jada might breach their privacy, which could bring immense trust issues. That could result in broken therapeutic relationships with the rest of the student population since adolescents tend to value autonomy and discretion in their lives.
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There are more significant risks posed than the chance of keeping the relationship between Mary and her boyfriend a secret. Although the failure of disclosure could maintain the therapeutic relationship between Jada and Mary, it may increase other risks such as teenage pregnancy, sexually transmitted infections, physical health issues, emotional distress, and welfare and discretion issues. Mary’s boyfriend could impregnate Mary during their relationship. Since both of them are young, they are unlikely to have the financial resources to take care of the child. Besides, once the relationship becomes public, the therapist could lose her license of practice, and Mary’s boyfriend may be charged with statutory rape. Jada may be charged for not protecting Mary from harm that may arise from having an intimate relationship with an adult. Also, US laws prohibit adults from having intimate relations with minors.
Case Study Two
Mildred’s request to barter agreement in exchange for services seems like the ideal approach for Mrs. Green to continue therapy sessions for three months amid the financial crisis. Previously, the APA code of ethics would not allow the exchange of material items in place of therapy fees to cover the counseling services being offered. However, with its reversal in recent years, bartering is an alternative of payment worth considering. Despite the genuineness of the situation, I firmly believe that Mrs. Green should not contemplate bartering arrangements since they are likely to do more harm than good to the therapeutic relationship she has established with Mildred. According to Malmendier and Schmidt (2017), bartering has the potential for extortion of clients and damage to the professional relationship. Despite it being legal, professional judgment should be utilized to rule out any clinical contraindications and possibility for client exploitation before agreeing to barter arrangements with the client. Mrs. Green could have made this consideration from the view of reduced insurance covers for counseling and mental health services, and bartering being the best option for continued sessions with Mildred as she has shown remarkable progress.
Some of the legal and ethical implications, in this case, would include trust, social impacts, profound evaluations, dependency, conflicts of interest, and unfortunate consequences of the entire process.
Some of the ethical standards that I could apply in this situation would be allowing Mildred’s husband and therapist’s professional colleagues openly scrutinize the agreement before officiating to ensure it is per the code of ethics in counseling, possesses the potential for being therapeutically advantageous to Mildred, and ascertain the safety and steadiness of the therapeutic relationship.
If this case were referred to me, I would have involved both parties in the decision-making process and identifying potential violations of the professional boundary. Here, I would have considered going through the contract that existed between the Mildred and Mrs. Green and noting how the exchange of services contributed to the breach of the agreement. Then, I would have invoked the relevant ethical principles, such as integrity, accountability, and respect as the basis of the professional relationship. After considering these factors, I would then advise Mrs. Green against such a move since it violates the professional relationship that she had with Mildred.
Case Study Three
Suicidal ideations refer to an individual’s thoughts about killing oneself, which might include a plan to commit suicide. In this case, one contemplates taking his/her own life through inflicting self-harm. On the other hand, the suicidal attempt involves an individual practicing self-injurious behavior with the possibility of taking his/her own life but does not end in fatality.
The therapist could have ordered Tanisha’s hospitalization if she conducted a suicide risk assessment and found Tanisha’s risk of a suicide attempt to be high. According to Gillihan (2018), the standard approaches for therapists to discuss suicide with their clients include inquiries on client’s passive suicidal ideations, thoughts of inflicting self-harm, a desire to take own life, a plan to kill oneself, steps an individual has taken in preparation for a suicide attempt, and readiness to acquire means of killing oneself. As the patient furthers down the steps, the therapist might notice an increased risk of a suicide attempt. It is imperative to enquire about the reasons to commit suicide, which would assist in the formulation of an action plan.
A person with suicidal thoughts could present with excessive shifts of emotions from the usual such as being extremely sad and moody, which could last for a significant period. One could also exhibit hopelessness about the future, with minimal expectations of future situational improvements. Sleep discomforts such as insomnia could set in due to the tormenting thought process, as well as social withdrawal, which could show the possibility of one being depressed. Also, a person with suicidal thoughts could show self-harming behavior, be undergoing a traumatic life situation, be making suicidal preparations, and opening up about wanting to commit suicide (Shaughnessy & Johnson, 2019). Some teenagers make statements about the desire to kill themselves. More importantly, most of them act impulsively, making it vital to detect these signs early.
The therapist’s decision to inform Tanisha’s employer and her professors about her 24-hour suicidal watch seems like an ineffective intervention for the current situation, which is the avoidance of self-harm. However, since the patient will be unavailable to attend normal life activities, it is ideal for the therapist to inform any related party to avoid disruption and unnecessary reprimanding. Such actions would utterly disrupt the patient’s flow of life even further, which could result in a future suicide attempt. Besides, the patient needs moral support from people in her social circle to prevent the recurrence of such an incidence. Therefore, it is the therapist’s responsibility to ensure Tanisha’s professors and employer are aware of her current situation.
References
American School Counselor Association. (2018). The school counselor and confidentiality . School Counselor. https://www.schoolcounselor.org/asca/media/asca/PositionStatements/PS_Confidentiality.pdf.
Gillihan, S. (2018). What happens when you mention suicide in therapy? Psychology Today. https://www.psychologytoday.com/intl/blog/think-act-be/201809/what-happens-when-you-mention-suicide-in-therapy.
Malmendier, U., & Schmidt, K. M. (2017). You owe me. American Economic Review , 107 (2), 493-526. https://doi.org/10.1257/aer.20140890
Shaughnessy, M. F., & Johnson, A. (2019). Depression and suicide: The need for awareness of signs of suicidal cognitions and lethality. Journal of Advances in Medicine and Medical Research , 29 (8), 1-8. https://doi.org/10.9734/jammr/2019/v29i830109
