Code of Effects in Counseling

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 there are many other counselors who could fill my place if Nilusha refused to come see me again after I reported her risks to her parents. I would feel bad about breaking her trust, but I would realize that I also owe trust to the parents as they are her guardians since she is a minor and they have a need to know if she is at serious risk of harming herself or others around her. If she is taking serious drugs like cocaine and ice on a weekly basis, she is at serious risk to herself and to others and her guardians need to know.
Case 2: What are the ethical issues Tarek is facing? What would an ethical counselor do?   
Leah, a new counselor at the agency, has posted pictures online of her seemingly having intimate time with one of her clients. Tarek has also noted that her breath smells of alcohol in the morning. Tarek has observed Leah violating the ACA (2014) mandate A.5. Prohibited Noncounseling Roles and Relationships—possibly A.5.a. Sexual and/or Romantic Relationships Prohibited, and most likely A.5.e. Personal Virtual Relationships With Current Clients, and quite possibly even C.2.g. Impairment. It may be the case that Leah is adhering to mandate A.6.b. Extending Counseling Boundaries, in which case a counselor may attend an event for the client—but this should not lead to intimacy with the client and/or posting pictures with the client on Facebook that suggest intimacy. The fact that Leah removed the picture immediately suggests she knew it was wrong to post it; however, there may be an issue of impairment here.
Ethical Issues Involved
Tarek cannot confirm for sure that Leah is meeting with clients outside of the office for intimate time unless he or someone from the agency discusses the matter with her directly. As the ACA (2014) mandate C.2.g. Impairment notes:
Counselors monitor themselves for signs of impairment from their own physical, mental, or emotional problems and refrain from offering or providing professional services when impaired. They seek assistance for problems that reach the level of professional impairment, and, if necessary, they limit, suspend, or terminate their professional responsibilities until it is determined that they may safely resume their work. Counselors assist colleagues or supervisors in recognizing their own professional impairment and provide consultation and assistance when warranted with colleagues or supervisors showing signs of impairment and intervene as appropriate to prevent imminent harm to clients.
It is important that Tarek provide assistance to Leah to determine if she is impaired as a professional, due to drinking alcohol and/or seeing clients at an intimate level. If the latter is true, then Leah is also in violation of the mandates A.5. Prohibited Noncounseling Roles and Relationships, possibly A.5.a. Sexual and/or Romantic Relationships Prohibited, and most likely A.5.e. Personal Virtual Relationships With Current Clients.
Ethical Trap Possibilities
Two ethical trap possibilities are the value trap and the circumstantiality trap. The value trap would suggest that Tarek is projecting his own personal values on the situation and that Leah is not really engaging in any prohibited manner. He does not have any positive proof of misdoing, just hunches and fleeting signs of issues. However, he knows what he saw and what he smelled. There is only one way to know for sure and that is to address the situation directly by coming clean with Leah about what he has seen.
The circumstantiality trap would have Tarek wondering if Leah’s circumstances—being lonely in a new city and not knowing anyone outside of her job—would make it okay if she meets with clients outside of work (“Case 2: Tarek,” n.d.). She has no other options to meet people, so perhaps in this circumstance it is all right. That is the circumstantiality trap that Tarek has to avoid.
Preliminary Response
Tarek should review the ACA (2014) Code of Ethics in order to identify what his duty is in this situation. He knows there may be an issue of impairment since he has smelled alcohol on Leah’s breath in the morning: she could be drinking on the job or drinking all night and coming in to work at a sub-professional level. This is a risk to her clients and to herself and her integrity as a counselor. It should be addressed and the ACA (2014) will show him that if he consults it before doing anything.
Tarek has two mandates that he must observe according to the ACA (2014) Code of Ethics: D.1.h. Negative Conditions: “Counselors alert their employers of inappropriate policies and practices…Such action may include referral to appropriate certification, accreditation, or state licensure organizations, or voluntary termination of employment” and D.1.d. Establishing Professional and Ethical Obligations: “Counselors who are members of interdisciplinary teams work together with team members to clarify professional and ethical obligations of the team as a whole and of its individual members. When a team decision raises ethical concerns, counselors first attempt to resolve the concern within the team. If they cannot reach resolution among team members, counselors pursue other avenues to address their concerns consistent with client well-being” (p. 10). In this case of Tarek and Leah, it is clear that Tarek should consult with the agency or other team members to discuss the ethical implications of Leah’s behavior so that she can be made aware of the risks she is taking and the mandates that she may be violating.
Possible Consequences
The possible consequences of taking no action are that Leah’s behavior escalates and she damages the reputation of the agency and her own integrity as a counselor as well as the life and mental health of her clients. Leah should be made aware that she has a duty to keep relationships with clients professional.
It Tarek addresses Leah’s behavior with her, it should be in a professional and positive way so that she can understand the risks she is taking and the ethical implications of her actions. She may protest or deny or fight against Tarek’s message—and in those cases, further action might be required on the part of the agency. They may be forced to let her go or communicate her violations of ACA mandates to the state licensure organization or simply terminate her employment.
Ethical Resolution
The ethical response for Tarek to make is to address the matter directly with Leah or with Leah and the agency leaders together. It is important, however it is done, that Leah be confronted with the ethical implications of her actions so that she can modify her behavior, correct her actions, and restore propriety so that the agency’s reputation is not damaged, her own professionalism is not diminished, and clients’ safety and well-being is not threatened. This should be done immediately before the situation escalates any further and in spite of the fact that Tarek has no solid evidence or proof—just what he knows of Leah, what he has seen, and what he has smelled. That is enough to intervene and bring these issues to light with Leah.
Self-Reflection
Aspects of the case that I would find to be most challenging would be Leah’s obvious need for intimacy and closeness with someone. I would have sympathy for Leah and would feel bad about her having to stop any improper relationships that she has just begun, because I would know how much just having a friend at this time in her life would mean to her. However, I would also realize how important it is to maintain ethical practices at all times. Clear boundaries have to be drawn between professional relationships and personal relationships, and Leah is muddying those boundaries if not crossing them completely and deliberately.
Confronting Leah with these issues would be challenging because I would feel uncomfortable having to direct a colleague who seems to be failing at maintaining ethical practices. I would expect all professionals to abide by the Code of Ethics and it would surprise me to find one who was clearly not following the Code. I would feel embarrassed by the whole situation and would likely seek advice from the agency regarding what to do and how to proceed with Leah. Since Leah and I are friends, too, I would feel bad about violating her trust—however, in a professional environment it is necessary that the law or code of ethics be above personal feelings. This is why I know what the right thing to do would be and I would feel compelled to do it, in spite of whatever personal respect or sympathy I might have Leah in this particular case. I would have to overcome those feelings and think of our professional duties first and foremost.
References
ACA. (2014). Code of Ethics. Retrieved from
https://www.counseling.org/resources/aca-code-of-ethics.pdf
APA. (2017). Confidentiality. Retrieved from
http://www.apa.org/helpcenter/confidentiality.aspx
Case 1: Nilusha. (n.d.). Case Vignettes.
Case 2: Tarek. (n.d.). Case Vignettes.
Code Ethics for Professional Substance Abuse Counselors. (n.d.). Quantum Units
Education. Retrieved from http://www.quantumunitsed.com/materials/1107_Ethics-Substance-Abuse-Counselor.pdf
Ethics. (n.d.). Quizlet. Retrieved from
https://quizlet.com/11990379/ethics-lecture-flash-cards/
Jordan, K. (2010). An ethical decision making model for crisis counselors. Retrieved
from http://counselingoutfitters.com/vistas/vistas10/Article_89.pdf
Steinman, S. (1998). The ethical decision-making manual for helping professionals.
Pacific Grove, CA: Brooks/Cole.