Ethics for Counselors: Two Case Vignettes Case 1: What are the issues John is facing? What would an ethical counselor do? 

John is facing a serious issue of confidentiality. Nilusha is a minor who has admitted to drug use to John. It is not minor drug use either—but weekly use of cocaine and methamphetamines. This is a serious issue that has to be addressed. When Nilusha’s parents call to ask what is going on with their daughter, John is in a position of deciding whether or not to break his client-patient confidentiality. If he tells Nilusha’s parents, Nilusha says she will not trust him any longer. If he does not tell her parents, Nilusha may come to serious harm through her frequent and continuous exposure to drugs and the drug environment she is hanging around in.

Ethical Issues Involved

Confidentiality and the therapist-patient relationship are critical to the success of counseling (ACA, 2014). As Nilusha points out, trust is very important to her and she will not return for counseling if she feels she cannot trust John (“Case 1: Nilusha,” n.d.). However, it is also important that Nilusha’s health and safety be considered and protected—especially if there is a risk of her harming herself or injuring others. As the Code of Ethics for Professional Substance Abuse Professionals (n.d.) states, “The addiction professional will inform each client of the exceptions to confidentiality and only make a disclosure to prevent or minimize harm to another person or group” (p. 8). Nilusha has divulged in counseling that she has recently started using cocaine and ice (aka “meth”). Both cocaine and ice are serious drugs that can ruin a person’s health and lead to terrible consequences—such as prison time or death. Since Nilusha is only 16, her parents still exercise authority over her and John may have a duty to inform them of the danger or threats that their daughter is facing.

Ethical Trap Possibilities

John must avoid falling into two possible ethical traps with Nilusha. First is the who-will-benefit trap. This trap indicates that there are two different interests at stake—the short-term interest and the long-term interest. The short-term interest of the patient may be protected by maintaining confidentiality: the patient’s trust will not be lost and the patient-counselor relationship can continue (Steinman, 1998). However, the long-term interest is the person’s safety, which may be at risk if the proper authorities are not alerted as to the patient’s practices or intentions in the immediate future. In the case of Nilusah, it is clear that she is a weekly drug user of cocaine and ice, both of which could seriously harm her health or lead her to serving prison time. It would serve Nilusha’s short-term interest to maintain confidentiality, but it would not serve her long-term interest.

The other trap is the circumstantiality trap. This trap indicates that there is no right or wrong answer to an ethical quandary and that every problem has to be analyzed by its own set of circumstances (“Ethics,” n.d.). In reality, there are actions that can be determined as right or wrong by measuring them against professional ethical standards. This can be done regardless of the circumstances or situation in which the actions are being presented. In the case of Nilusha, there is the serious threat or risk to her safety; thus, it is not a matter of gauging the circumstances. If Nilusha were only smoking marijuana and her environment was not one that would likely lead to greater risks or threat to safety, the counselor could take that into consideration before deciding whether or not to inform the minor’s parents. However, Nilusha is not just smoking marijuana. She is engaging in weekly serious drug use, which needs to be reported before she comes to serious bodily harm.

Preliminary Response

John should have made clear to Nilusha at the outset that there are limits to the confidentiality agreement between the counselor and the patient. Confidentiality will be preserved but only so long as the counselor believes that patient is not a harm to herself or to another. This would have made it clear to Nilusha that if she divulges something serious, like the use of serious drug usage, the counselor may deem it appropriate to inform her parents. Since it appears that he did not make this known ahead of time, he now finds himself in this problem.

His preliminary response should be to review the ACA Code of Ethics....

He would find the following mandate the pertains to this case:
A.2.e. Mandated Clients: Counselors discuss the required limitations to confidentiality when working with clients who have been mandated for counseling services. Counselors also explain what type of information and with whom that information is shared prior to the beginning of counseling. The client may choose to refuse services. In this case, counselors will, to the best of their ability, discuss with the client the potential consequences of refusing counseling services (ACA, 2014, p. 4).

Following this mandate would have been helpful. At the same time, Nilusha might not have divulged her serious drug use—so perhaps it has worked out for the best. More will be said on this in the next section. If John is still uncertain about what to do, he should discuss the matter with a colleague. The worst that can happen is that John informs the parents of Nilusha’s drug use, and Nilusha is re-assigned to a different counselor for refusing to work with John any longer. At least her parents, who have authority over her, will be informed of the threat that exists to her health and safety, and she will receive the attention she requires.

John can also explain to the parents about confidentiality between the patient and the counselor so that there is no mistake about what John’s role is with regard to his duty to Nilusha. However, while John does not have to disclose the particulars of the case, he should follow the recommended state and federal laws regarding confidentiality and take measures to ensure that Nilusha’s health is protected (APA, 2017). As the ACA (2014) notes in mandate B.5.b. Responsibility to Parents and Legal Guardians: “Counselors inform parents and legal guardians about the role of counselors and the confidential nature of the counseling relationship, consistent with current legal and custodial arrangements” and in mandate B.5.c. Release of Confidential Information: “When counseling minor clients…counselors seek permission from an appropriate third party to disclose information. In such instances, counselors inform clients consistent with their level of understanding and take appropriate measures to safeguard client confidentiality” (p. 7). Thus, in this case, John should seek third party permission to disclose Nilusha’s serious drug use to her parents.

Possible Consequences

The possible consequences of informing Nilusha’s parents are that Nilusha’s trust is broken. The short-term and long-term effects have to be considered (Jordan, 2010). The short-term effect is that she does not want to see the counselor anymore. She may also be placed in a drug rehab facility against her will. The issue here, however, is that she receives the care she needs that is appropriate for her age. She is clearly showing an addiction to drug use that is consuming her life and energy and she may not be in a position to address this on her own.

If John chooses to respect Nilusha’s wishes about not breaking confidentiality, he could discuss with her the need to stop her drug usage and gauge whether or not she has the capacity to do this. If she can, then there may not be any need to break confidentiality. From what is given in the text, however, it is highly unlikely that she has this kind of potential.

Ethical Resolution

The best ethical resolution is for John to inform the parents and tell them what is going in with Nilusha’s serious drug use, offer steps that they can take to address the situation in a positive manner, and show that he is willing to help and collaborate with them and with Nilusha to resolve the problems that Nilusha is having. He must make it clear that this is in the best interest of Nilusha with a long-term vision of helping her achieve a happy life. In this case, ACA (2014) mandate B.2.a. Serious and Foreseeable Harm and Legal Requirements applies: “The general requirement that counselors keep information confidential does not apply when disclosure is required to protect clients or identified others from serious and foreseeable harm or when legal requirements demand that confidential information must be revealed.”

Self-Reflection

The aspects of the case that I would have found to be most challenging would have been deciding whether or not I could trust Nilusha to break her drug habit. I would not want to break her trust—so that would make me hesitate to tell her parents about her serious drug use. However, I would realize that…