Ethical Decision Making: Confidentiality, Essay Example

Introduction

The purpose of this paper is to review a case study that involves a referral of a congregant (church member) by a reverend to a therapist in which the therapist found herself faced with an ethical dilemma when all effort to get in contact with her client proved futile. In this paper, the writer will identify the ethical issues and dilemmas and select an ethical decision making model that could be employed to address the issues identified. Furthermore, the writer will clearly discuss and apply important American Association of Marriage and Family Therapy (AAMFT) and Board of Marriage and Family Therapy (BMFT) ethical codes as well as applicable Minnesota state rules and statutes as they apply to marriage and family. Finally, this writer will provide a personal reflection on her personal growth and professional development as a Marriage and Family Therapist over the period of this course.

Case Description

The case study addressed in this paper involves a reverend who had referred one of his members to a Marriage and Family Therapist (MFT) for services because the member was

going through some issues in her marriage. After receiving the information from the reverend, the church member then contacted the therapist and scheduled an appointment to meet. Prior to meeting with her prospective client, the therapist emailed pertinent forms to the church member for her review and signature. Eager to get her issues heard, the church member hastily signed the forms without taking the time to thoroughly go through the forms to learn about what services were being offered by the therapist, the terms and conditions, privacy notice or confidentiality. At her first visit with the therapist, the church member, now officially a client, failed to ask questions so the therapist proceeded with providing therapeutic counseling to her client. As sessions progressed, the therapist had to adjust some of her client’s appointment time and made several attempts to get in touch with her client and when she could not reach her, she did what she thought was in the interest of her client; she left a voice message on a voice mail which she thought was the best way to reach her client.The action of the therapist leads to her client becoming upset and subsequently discontinuing her therapy sessions with the therapist. Now, the reverend had no idea about what had transpired between the therapist and the client; so when he happened to meet the therapist, he asked about his church member and wanted to know how things were coming along in the therapy. Hence, the ethical dilemma faced by therapist.

Establishing therapeutic relationship between clients and therapists during the intake session is very crucial.

The Ethical Issues

American Association for Marriage and Family Therapy (2001) emphasized that therapists obtain appropriate informed consent and related procedures as early as feasible in the therapeutic relationship and use language that is reasonably understandable to clients. Further areas might include the benefits of counseling, the risks involved, and the possibility that the client’s case will be discussed with therapist’s colleagues or supervisors.At the beginning of the first session the therapist did not do a good job in making sure that the client understood the policies and procedures/informed consent that she received in the mail. As presented in the case, the client was so distraught that her only focus at intake was to discuss her marital issues. The question then becomes the client’s capacity to give informed consent or understanding the risk of not thoroughly reviewing the consent forms.  It is incumbent on the therapist to educate the client about her rights and responsibilities which can empower and build a trusting relationship. According to the Board of Marriage and Family Therapy Code of Ethics (2009), 148B subpart 5 the therapist’s role is to make sure that every paper is clearly explained and signed.

Kitchener’s (1989), model of ethical decision making describe four type of model that could be used in counseling. However, for the purpose of this paper, “non-maleficence” decision-making model would best fit the situation in the case study. Kitchener’s non-maleficence model states that the therapist’s focused is to avoid any action that could cause harm to the client. In relating it to this case, the therapist had already unknowingly and unintentionally harmed her client by leaving a message on the voice mail that was accessed by a coworker, thereby putting the client at a potential risk of breach of confidentiality. According to the case study, after the initial welcome, the therapist inquired whether there was any question regarding the information the client had received and it also stated that the client was eager to address the marital conflict that brought her to therapy in the first place. There was a miscommunication between the therapist and the client that the therapist should have been aware of and try to avoid non-maleficence but was ignored. The ethical responsibility of the therapist is to do no harm to the client.

Application of Professional Rules

As a therapist, it is unprofessional to make assumption that the client understands the informed consent and confidentiality forms that clients fill out. According to Woody and Woody (2001), clients will be forthcoming during therapy session when therapists provide pertinent and reliable information that would allow the client to make informed decision regarding his/her successful and active involvement in therapy. The client must be able to build a trusting relationship with his/her therapist; therefore, during the duration of contact with clients, that is, at first contact, the client needs to feel a connection with the therapist. Failure on the part of the therapist to establish that initial trust with the client, chances is that the client may tend to hold back and remain uncooperative during the session. Hence, therapist should be more focused on gaining the trust of the client and less focused on getting signed consent from the client (p.162).

Corey and Callanan (2011) established that the most important part of therapeutic relationship is the therapist’s ability to understand and empathize with the client. Therapist empathy can help to motivation client to express feelings and experiences. The case study did not say how long the therapeutic relationship lasted, but it is important to note that making a change was too early for their relationship. The client responded to the change in their meeting time as a closed off conversations about her emotional issues, such as her self-image. For this reason, I feel as if I have to make a lot of assumptions about client’s subjective experience, which limited the therapist’s ability to fully understand what the client was going through. The therapist must not question her resistance to attend therapy because the rejections and disappointments experienced in her family, and now the therapist disregarded her feeling by rescheduling their time together. Meanwhile, she has no one to talk to in her community that’s why she came to therapy in the first place.

The Board of Marriage and Family Therapy Code of Ethics (2009) state that marriage and family therapists do not disclose client confidences except by written authorization or waiver, or mandated or permitted by law. Confidentiality is an aspect of privacy concerns how client information is treated by therapists. The very nature of a therapeutic relationship is built on the establishment of trust; largely stemming from the expectation that therapist will maintain client confidentiality. As a therapist, I am legally and ethically required to make sure that what clients communicate to me stays with me, but will certain specific exceptions.

Confidentiality and privacy was very important for this client; it was her right to seek therapy and grief without additional confrontation. As it is the custom in church community for husband and wife to be seen together in worship services but that was compromised because of marital conflict, which wounded her self-image. According to the case, the pain she was experiencing and the eagerness to address her marital conflict was far beyond therapist’s policy and procedures. Therefore, it was the responsibility of the therapist to ask for all forms of contacts during intake, check the client’s file and Release of Information (ROI); use all necessary authorized alternative contacts provided by client at intake. However, if that was the only contact phone number that client had provided to the therapist at intake and had given the therapist permission to leave message with the understanding that her co-workers had access to that voicemail, then the burden lies on the client. On the other hand, the therapist should have continued to attempt to reach her client by phone but cannot leave a message if it was not authorized. In the therapeutic alliance, it is the responsibility of the therapist to ensure that the client understands the content of the ROI that is being signed. In this case, none of the informed consent content was discussed with the client at intake which is a violation of the Minnesota state statute (BMFT Code of Ethics, 2009).

Application of State Rules on Therapist Ethical Values

Marriage and family therapist do not disclose client confidences except by written authorization or waver, or where mandated or permitted by law. Verbal authorization will not be sufficient except in emergency situations and unless prohibited by law. When providing couple or family therapy, the therapist cannot disclose or reveal any individual’s confidences to others in the client network without the consent of the client. One benefit of informed consent is that client will willingly be involved in the therapeutic relationship and get educated about the process by the therapist. The therapist cannot acknowledge working with or not working with that client unless there is an ROI on file naming the Reverend as someone with whom the therapist can communicate. Even though the Reverend was the one who made the referral; there were no releases from the client authorizing the therapist to give information to the Reverend about their meeting. There is still a confidential relationship that the therapist must not breach (American Association for Marriage and Family Therapy, 2001).

Reflection and Reaction

Prior to beginning this course, it was my understanding, in regards to confidentiality, that it was ok to share information about a client with a person who I considered to be a close family member or for example in the case study, prior to my enrollment in this course that since it was the reverend who had made the referral, it was not a problem to share information about his church member with him. Knowledge is indeed power, after conducting several research about patient/clients rights and confidentiality, my perception has totally changed with the understanding that if a client does not provide consent to share his/her information with others, regardless of who the person is, I, as a therapist would be in violation if I go against the clients’ right to privacy and confidentiality.

To conclude, it is imperative for therapists to understand that confidentiality is an aspect of privacy, and concerns how client information is treated by therapists in and out of therapy. The very nature of a therapeutic relationship is built on the establishment of trust, largely stemming from the expectation that I, as a therapist, will maintain client confidentiality. As a therapist, I am legally and ethically required to make sure that what clients communicate to me stays with me, but will certain specific exceptions.

References

Corey, G. Corey, M., & Callanan, P. (2011).Issues and ethics in the helping professions. Belmont, California : Brooks/Cole,.

Revisor of Statutes (2013). Minnesota statutes chapter 5300: Marriage and Family Therapy. Minnesota Law.

Woody, R., & Woody, J. (2001).Ethics in marriage and family therapy. Washington, D.C. : American Association for Marriage and Family Therapy.

American Psychological Association. (2009). Publication manual of the American Psychological Association (6th ed.).Washington, DC: Author.