Ethics for Counselors: Two Case Vignettes Analyzed

Case 1: Confidentiality and a Minor Client's Drug Use

John is facing a serious issue of confidentiality. Nilusha is a minor who has admitted to drug use in their counseling sessions. It is not minor drug use — she is engaging in weekly use of cocaine and methamphetamines. This is a serious issue that must be addressed. When Nilusha's parents call to ask what is going on with their daughter, John must decide whether or not to break client-patient confidentiality. If he tells Nilusha's parents, she says she will no longer trust him. If he does not tell her parents, Nilusha may come to serious harm through her frequent and continuous exposure to dangerous drugs and the environments associated with them.

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 Counselors (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 (also known as methamphetamine). Both cocaine and ice are serious drugs that can ruin a person's health and lead to severe consequences — such as incarceration 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 dangers their daughter is facing.

Ethical Issues and Traps in Case 1

John must avoid falling into two possible ethical traps when handling Nilusha's case. The first is the who-will-benefit trap. This trap highlights that two different interests are 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 counseling 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 to the patient's practices in the near future. In Nilusha's case, it is clear that she is a weekly user of cocaine and ice, both of which could seriously harm her health or result in criminal consequences. Maintaining confidentiality would serve Nilusha's short-term interest but not her long-term well-being.

The second trap is the circumstantiality trap. This trap suggests that there is no right or wrong answer to an ethical quandary and that every problem must be analyzed according to its own unique circumstances ("Ethics," n.d.). In reality, actions can be determined to be right or wrong by measuring them against professional ethical standards — regardless of the circumstances or situation in which they arise. In Nilusha's case, there is a serious threat to her safety. If Nilusha were only occasionally smoking marijuana in a relatively safe environment, the counselor might weigh those circumstances more carefully before deciding whether to inform her parents. However, Nilusha is engaging in weekly use of serious substances, which needs to be reported before she comes to serious bodily harm.

Case 2: Colleague Impairment and Boundary Violations

Leah, a new counselor at the agency, has posted pictures online that suggest she is spending intimate time with one of her clients. Tarek has also noticed that her breath smells of alcohol in the morning. Tarek has observed what may be violations of the ACA (2014) Code of Ethics, specifically mandate A.5. — Prohibited Noncounseling Roles and Relationships — possibly A.5.a. Sexual and/or Romantic Relationships Prohibited, most likely A.5.e. Personal Virtual Relationships With Current Clients, and quite possibly C.2.g. — Impairment. It may be that Leah is attempting to adhere to mandate A.6.b. — Extending Counseling Boundaries — under which a counselor may attend a client's event. However, this provision does not sanction intimacy with a client or posting pictures suggesting intimacy on social media. The fact that Leah removed the picture immediately suggests she was aware that posting it was inappropriate; however, there may be a deeper issue of professional impairment at play.

Ethical Issues and Traps in Case 2

Tarek cannot confirm for certain that Leah is meeting with clients outside the office for intimate purposes unless he or someone from the agency speaks with her directly. As the ACA (2014) mandate C.2.g. — Impairment — states:

"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 help determine whether she is professionally impaired, whether due to alcohol use or involvement with clients at an inappropriate level. If the latter is confirmed, Leah is also in violation of 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.

Two ethical traps are relevant here. The first is the value trap, which would lead Tarek to assume he is projecting his own personal values onto the situation — that Leah is not actually engaging in any prohibited behavior, and that what he observed was innocent. He does not have conclusive proof of wrongdoing, only observations and a strong sense that something is wrong. However, he knows what he saw and what he smelled. The only way to know for certain is to address the situation directly by speaking honestly with Leah about his concerns.

The second is the circumstantiality trap, which would have Tarek wondering whether Leah's circumstances — being alone in a new city, knowing no one outside of work — make it understandable, or even acceptable, for her to spend time with clients outside the professional setting ("Case 2: Tarek," n.d.). The circumstantiality trap would suggest that her situation makes an exception reasonable. This is the trap Tarek must be careful to avoid.

References

ACA. (2014). Code of Ethics. Retrieved from

APA. (2017). Confidentiality. Retrieved from

Case 1: Nilusha. (n.d.). Case Vignettes.

Case 2: Tarek. (n.d.). Case Vignettes.

Code of Ethics for Professional Substance Abuse Counselors. (n.d.). Quantum Units Education. Retrieved from http://www.quantumunitsed.com/materials/1107_Ethics-Substance-Abuse-Counselor.pdf https://quizlet.com/11990379/ethics-lecture-flash-cards/

Ethics. (n.d.). Quizlet. Retrieved from

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.