Ethical Issues in Counselling
In any counselor-client relationship, confidentiality is the keystone. Counsellors should keep honored status of their clients and ensure all confessions are made behind closed doors. If trust placed by clients on counsellors is violated, it will create irreparable damage of the client-counsellor relationship. As a result, the client will require other intervention measures.
Even so, the confidentiality between a therapist and a client has been in the recent past challenged. The courts placed a ‘duty to warn’’ on the counsellor whenever they feel that a client is likely to put at risk of injury on a third party whether emotional or physical. Therefore, the legal measure that therapists have a duty to warn gives the counsellor a lot of responsibility.
A counsellor has to make a decision on when and whom to warn. This is a fact that raises a serious ethical dilemma and the decision that a therapist must always take. The decision to be undertaken consists of a choice between two evils. Breaking confidentiality is no doubt detrimental to the therapist-client relationship.
On the other hand, keeping quite can be harmful to the third party. In recognition of trouble in deciding when and whom to warn, the duty to warn has been changed from an essential legal requirement to something that is left to a therapist’s discretion. This paper therefore outlines some of the instances under which, it is justifiable to break the confidentiality between a therapist and a client.
The paper also recommends a framework under which the confidentiality of a client can be broke and in such a way that it reduces possible damages to clients and potential danger to a third party.
Ethical issues in Counselling
Therapists working with couples at one point face a confidentiality dilemma. This is common in cases where private sessions scheduled by an individual with his or her partner. Individual sessions tend to lead to more secrets that a person may not be willing to share with a partner. The ACA code (2005) also specifies that therapists must always respect the right to privacy of a client. Therefore, they should not share confidential information without a client’s consent without legal or sound justification.
However, such a position raises serious ethical dilemmas when a therapist learns that a client is suffering from AIDS. AIDS can be easily spread from one person to the other because it is contagious. Morrison (2001), states that the disease is transmitted through sexual intercourse from an infected person and another person.
The disease can also be transmitted through other methods including the use of injectable drugs for those who share the needles and mother to child transmission. Johnson & Barre-Sinoussi (2012), states that despite progression in anti-retroviral therapy programs that help to prolong life and reduce viral load, AIDS presently has no cure.
The Tarasoff vs regents of the University of California case created a basis for the duty to warn necessity among therapists (Walcott, Cerundolo, and Beck 2001). The parents of Tarasoff’s who felt that the university was neglectful by not warning Tarasoff, that a Podar a fellow student wanted to kill her founded the case.
Podar, had opened up to the institution’s psychologist that he wanted to kill someone and later on killed Tarasoff. The court, in their favor ruled that the psychologist indeed has a responsibility to warn Tarasoff of the impending danger she faced. Later on, the same court in a decision dropped the ‘’duty to warn’’ necessity in favor of ‘’duty to protect’’ requirement. Therapists are therefore required to grant third parties protection from predicted harm.
The ruling generated a heated debate amongst mental health experts, legal scholars and courts on the extent to which a psychotherapeutic relationship confidentiality should be sacrificed in favor of third party’s protection that are outside the relationship (Walcott, Cerundolo, and Beck 2001). The duty to protect was however until recently accepted as a lawful duty following the ruling of Tarasoff.
However, there have also been changes in application and sensitivity of Tarasoff issue. There are other limitations being applied to the necessity of the ‘duty to protect’, suggesting that the significance of the case is gradually declining. There are courts that have limited Tarasoff by pointing stating the psychiatry is a complicated field, fraught with unknowable, to expect that a medic in the field will have all details of a client thus, be in a position to protect.
Based on the growing scope of ‘duty to care’ the APA also engaged in a legislative advocacy. The Council on Psychiatry and Law association created a duty to protect model statute that advocates for the development of laws that limit Tarasoff. APA advocacy has also reduced the influence of Tarasoff in some instances.
The duty of a therapist in many states is now limited to two strict conditions. First, a therapist has a duty to care if a patient threatens a named person or explicitly identifies a victim. Secondly, a therapist has a duty to care if a patient has a violence history and the therapist has a solid reason to believe that he or she can commit an act of violence.
The therapist however has immunity against suits for breach of confidentiality in the event where he or she cautions in good faith. In the event where more than the duty of care should be exercised, the therapist should settle for an option that is clinically prudent. In other situations, it is more than one option if another strategy does not protect the potential victim sufficiently.
Working with people living with AIDS raises various legal, ethical, professional, moral and in some cases personal issues. There are many challenging and complex ethical dilemmas to keep in mind when working with the patients (Phillips 2011). Despite the fact that the disease has been in existence for more than 30years, widespread ignorance is still witnessed on how the disease is being spread in the United States.
Approximately 34percent of Americans have a misconception on how the disease is transmitted. Therefore, they have unfounded fears of the disease (HIV Stigma and Discrimination in the US. 2010). Such ignorance has led to the increase in stigma against those living with the disease in the US. AIDS is one of the highly litigated diseases in the country and it shows how the case is handled with a lot of sensitivity (Nary 2004).
The issues have an effect on a therapist’s decision when handling a patient who is HIV positive. Phillips (2011) recommends that a duty to war can arise under some circumstances. First, if a patient declines to cooperate when it comes to medication, then a therapist has a duty to caution. If the client does not want to reveal his or her status to a third party who is at risk from him or her, the therapist can also warn.
The therapist can also warn is the victim is not suspecting and the therapist knows him or her. Additionally, if a patient does not want to let public officials or a therapist to inform his or her contacts, then he has a duty to warn. The therapist can also warn if the client starts to engage in high risk behaviors. This may include engaging in unprotected sex whether homo or hetero and if the patient starts to use injectable drugs in a place where sharing of a needle is possible.
In the event where it is realized that there is an ethical responsibility to caution following consultations with supervisors, colleagues and legal supervisors, a therapist has to abide.
It is also essential to note that the duty to warn should not be taken for granted and a therapist should therefore caution before serious incidence occurs and confirmation that all possible avenues are closed. A therapist must however document the process behind breach of confidentiality before cautioning a third party. This should be recorded in the file of a patient.
Once the counsellor takes breach of confidentiality, the patient should be informed that a third party will be notified of the situation and the way in which he person will be contacted. A therapist should additionally inform the client who will also contact the third party. Where possible, the therapist should caution a third party without revealing the client. This is to avoid damaging the relationship between the therapist and a client.
Therefore, a therapist should consider having another person to caution on his or her behalf. The therapist can alternatively get another therapist for a client if the patient still requires counselling services. Therapeutic relationships can take long to establish and it is a painstaking process to earn a client’s trust.
The process needs dedication from the therapist and client. As a result, a counsellor should explore all possible means before breaching the confidentiality of the relationship.
ACA code of ethics (2005). American Counseling Association. Retrieved from http://www.counseling.org/resources/aca-code-of-ethics.pdf
HIV stigma and discrimination in the U.S.: an evidence-based report (2010). Lambda Legal. Retrieved from http://data.lambdalegal.org/publications/downloads/fs_hiv-stigma-and- discrimination-in-the-us.pdf
Johnston, R. & Barré-Sinoussi, F. (2012). Controversies in HIV cure research. Journal of the International AIDS Society 15 (16).
Nary, G. (2004). The AIDS pandemic: complacency, injustice, and unfulfilled expectations. Thoughtleaders 2(2)
Phillips, P. (2011). HIV and ethics. Retrieved from http://www.hawaii.edu/hivandaids/HIV%20and%20Ethics.pdf
Walcott, D., Cerundolo, P & Beck, J. (2001). Current analysis of the Tarasoff duty: an evolution towards the limitation of the duty to protect. Behavioral Sciences and the Law, 19, 325- 343.