Ethical standards dictate that counselors have the duty of maintaining the confidentiality of clients, informing them limits to confidentiality, duty to protect communications that are privileged and also to avoid any kind of harm towards the clients or groups that have presented themselves for counseling, (ACA, 2014). It is also essential for counselors to inform the clients about confidentiality, the therapeutic process, limits to observe in relation to confidentiality and also to provide a tangible report which bases on the existing laws and standards of practice used by the mental health professionals. Also, it is the counselor’s duty to provide answers to any questions from the clients as well as addressing concerns being raised during the counseling sessions. Informed consent is one of the most important element when handling clients. This helps in building confidentiality because both parties have consented to take part in the counseling session. As such, trust is built hence a positive state of the therapeutic alliance between a client and a counselor, (Corey, Corey, Corey, & Callanan, 2015).
During the therapy process, clients reveal a lot of information hence the need for confidentiality as stated before. In most cases, the issues raised by the clients may clash with ethical virtues against statutory requirements and mandatory ethics which also may be against the professional code of ethics. In such situations where values, ethics as well as laws clash, the mental health practitioner is supposed to handle this with the help of methodologies used in solving ethical problems. These methodologies must put into consideration client care and ethical dilemmas in question, (Executive Order, 1955, page no. 11). It becomes harder to handling privacy and confidentiality in group sessions and despite this, counselors still have the duty of protecting individual member’s confidentiality as well as privacy. This also applied to the confidentiality in the entire group. However, the law does not require group members to observe confidentiality of other members and this is also hard to be reflected in ethical codes because these codes usually govern confidentiality between counselors and clients only- not group members. However, there is a need to inform group members about confidentiality. This is mainly spearheaded by the Association for Specialists in Group Work, (Mcclanahan, 2014, 32). This is mainly directed at counselors who are reminded that they are duty-bound to inform or educate group members about how confidentiality is important, consequences of breaching member confidentially as well as limits in which communications in a group setting are set. As such, these factors that also raise the ethical dilemma herein of whether one should report or he or she should not.
James Peterson is a 48-year-old African American who constantly has instances of flashbacks of his firefighting missions, rescuing accident victims or handling corpses on many occasions. He has been part of firefighting teams sent to aid in the 2001 September 11 attacks, has been active in rescuing house fire victims as well as helping victims in road accidents. As such he has had a lot of exposure to trauma for many years. After being evaluated, he was diagnosed to have Post-Traumatic Stress Disorder which was based on the DSM-5 criteria. This prompted his admission to a treatment facility where he was enrolled in a residential treatment program for firefighters- for a period of 6 weeks. He is also a member of a group of seven firefighters receiving the same treatment. In one of the most recent counseling session, James was processing his trauma which made his memory flood with fresh details. In his description, he recalls how his unit was responding to a fatal accident that involved school children in a bus that had collided with a fuel tanker. The scene was horrible with children screaming out of excruciating pain, some with broken limbs, some already dead and the tanker spilling fuel exposing approximately 70 children to an explosion. In the process of saving the lives of other children, he notices that one of the children was in a bad state- all legs were broken and a sharp metal had pierced his eye straight through the head. The group members are shaken up on hearing Jame’s trauma amid sobs. What James narrates next sends them into shock. On seeing the critical condition of the child and knowing that he may live the rest of his life in pain or may have a painful death, James confesses to having killed the boy by driving a broken metal straight into his heart- ending his life. The group now realizes that James killed the boy. Now, what next?
This is an ethical decision-making model which is helpful in solving problems or dilemmas that do not have a clear inclination towards Code of Ethics. For this to be achieved a framework is important so that analysis is made hence the proper making of ethical decisions, (Mills, 2014, page no. 96). Therefore, these are the steps to be followed using Corey’s eight-step Mode.
Step 1: Identifying the Dilemma or the Problem.
James has just admitted that he killed the child so that he could stop his continuous pain as well as future implications due to the destroyed limbs, eyes and head/brain injury. The revelation from James now holds moral, legal as well as professional issues to be faced and determined by the counselor, (Blessing et al., 2018, 9). This clearly indicates a past homicide and a question is raised as to whether one is mandated to report the individual or incident. Secondly, was the issue discussed in the group with the presence of informed consent? Also, is the counselor in any way obligated to report the incident or killing? Statutes should also be looked into and as such, what do the Samoan Statutes stipulate? Lastly, what suggestion is provided by the ACA Code of Ethics?, (Nahon & Lander, 2013, page no. 164)
Step 2: Identification of the Potential Issues involved.
Some of the issues that a counselor has to consider include the legality of the confusion made by James as well as the requirement for one to report such homicide cases to the law enforcers. In addition, the counselor has to look into the negative aspects this may cause to both the client and other members of the group especially when the aspect of confidentiality is broken in the process. According to Cottone and Tarvydas (2016), the counselor must strictly put emphasis on the importance of confidentiality and as such, must apply this aspect to all disclosures in the group. It is therefore important to practice confidentiality since this will help the group to progress in a positive path that leads to recovery, (United Sates Government, 2008).
Another issue to be developed is the existence of moral principles especially when handling the ethical dilemma. According to Non-maleficence, counselors should be able to minimized risks that a client may face especially from instances of exploitation, (Corey et al., 2015)
Trauma processing sessions may also lead to countertransference. The entire therapeutic process may be affected negatively depending on how the counselor feels after listening to the confession. This also relates to how he or she feels towards the client. This leads to the need of having an analysis of the situation that is well informed and deliberate so that the ethical decision to be made at the end can favor both the client and the counselor, (Thomas & Pender, 2008, page no. 2).
Step 3: Review the Relevant Ethics and Codes
The American Counselling Association’s Code of Ethics is the main Code of Ethics that applies in Samoa and the American setting at large. One particular purpose of this code entails the enablement of counselors in making informed decisions that are arrived at after thorough evaluation of situations so that the client’s development and growth is promoted, (ACA, 2014). In this particular scenario, there are sections which apply directly- as seen in the 2014 ACA Code of Ethics.
James is a fire fighter who has been dedicated to his job for more than 20 years. According to the firefighter code of ethics, all firefighters are sworn in and mandated to carry out their duties in a respectable manner which reflects integrity and proper ethical behavior, (Reader, Foulkes & Robinson, 2017, page no. 3). Firefighters also pledge to accept responsibility for their actions as well as their consequences, act in a fair way, avoid situations that may affect negatively their credibility before the public, respect others’ welfare and safety, exercise professionalism, and exercise honesty at all times.
Under Section 40 of the Samoa Fire and Emergency Service Act 2007, one may face disciplinary action if he or she breaches any regulations, get s involved in acts of misconduct. Recklessly or carelessly handles his duties and also acts in a manner that is disgraceful and this act or omission may lead to the disapproval of the firefighting entity, (Dawson et al., 2017, page no. 216).
After considering the provisions above, it is evident that James broke the Code of Ethics and his allegiance and as such, he should be held liable for his actions. The act if ending one’s life is unethical and also considered a sin and as such, it is punishable under law. This also means that he broke the bonds and ethos of service towards the general public no matter the condition they are in and as long as they attempt to save lives.
Step 4: Know the Applicable Laws and Regulations.
All counselors in Samoa must be conversant with the regulatory and legal environment that they mainly practice in. James and the counselor have considerations to be put in place. Under the Federal LA and Samoan State law, there are no statute limitations on felonies that are serious like murder, (Dunn, Clark & Pearlman, 2017, page no. 3498). As stated earlier, firefighters have the duty of saving lives and acting in a humane way hence upholding what their dignity and that of the institution. Any transgressions are punishable by law and as such, there is no law that prevents James from being convicted for his crime especially after personally confessing that he committed it.
Regulations and laws applicable to the counselor.
The confidentiality between clients and counselors is strongly protected by the law in Samoa. This is mainly seen in the mental health practice Act which states that no mental health practitioner is supposed to be disclosed any kind of information that he or she receives while carrying out her duty and also in the course of treatment, (Torous &Roberts, 2017, page no. 438). This can only be divulged when consent has been obtained from the client. In case there is a group of clients, consent should be received from them inclusively. On the other hand, privilege and confidentiality do not exist in certain cases where children or the elderly have faced acts of violence or when there are imminent threats and attacks against them. This also extends to where the client is prone to self-inflicted injuries. It is also essential to protect the clients or take any kind of precaution. In this scenario, it is also important to put into consideration that the client confessed about his past actions, and as such, he has no intention whatsoever of doing the same act, (Sachsse et al., 2016, page no. 125).
Step 5: Get a Consultation
In the attempt of making an ethical decision, one proves his or her good-will by seeking advice or consulting from other colleagues such as supervisors, peers, lawyers, and similar professionals. In this scenario, it is wise to seek consultation from a trusted lawyer or supervisor as well as the Professional Standards Department of the ACA, (Gelpi, 2017, page no. 117). An important element to factor in is morality with the consideration of personal values, law, ethics, and beliefs.
Step 6: Consider Probable and Possible courses of Action
Putting everything in context is essential when developing the course of action to be taken, (Corey, 2015).
Action 1. The crime can be reported to the Law Enforcement. In this case, the counselor sees the need for justice to be done, (Dudley et al., 2011, page no. 202). This makes the counselor have a moral code and as such, the client’s wellbeing is not placed first, followed by ethical practice and morals. In this case, James will not receive the required treatment and other members in the group may become silent and suffer from it instead of sharing their own details.
Action 2: Members should be reminded that anything said in the group must always remain in the group. In that regard, the move made by James in processing his state of trauma helped him in moving onto the next step.
Action 3: the group members should be involved in the determination of how confidentiality is valuable especially when a confession is made, (Yoneda et al., 2016, page no. 1650). By collaborating and discussing, the members will see the importance of helping each other as they move forward in trying to treat their stress conditions, (Butz, 1985, page no. 84).
Step 7: List the consequences of different decisions
The cause of actions explained above has their own risks and benefits for the clients and the counselor. Action 1 is seen as being disruptive especially to the therapeutic process because James will be arrested and the entire healing process will be curtailed. Also, other group members will have the fear of opening up and expressing their trauma. On the other hand, the family of the child that James killed will also be affected. However, the aspect of reporting the crime emanates from the counselor’s morals, ethics, and beliefs, (Glosoff & Pate, 2002, page no. 21). The action taken herein goes against the Code of Ethics, Section A.4. b of the ACA. It states that counselors should not impose their beliefs and values to their clients. Also, the confidentiality in the group will be broken.
Action two promotes confidentiality within the group under the support of Section B.1.c and Section B.4. a, which stand for respect to confidentiality and limits to confidentiality in a group respectively. Confidence is an aspect which should be agreed on and maintained in the group at all times. His action of revealing his actions was driven by the knowledge that the group members will not disclose his actions, (Angoti et al., 2009, page no. 2263).
Action 3 gives power to the whole group by enabling them to discuss the issue of confidentiality. As such, more dialogue in the group is realized hence the understanding of how confidentiality is important, (Hardon et al., 2012, 26). For the members to successfully treat their conditions, they have to share their experiences with the knowledge that all information is confidential. In the end, the counselor and the group members will be confident about each other hence positivity and success in the treatment process,.
Step 8: Select what the Best Course of Action may be
After a thorough research and consultation process, the best course of action that can apply to James’s situation is Action 3. The aspect of confidentially is thoroughly stressed in action 3. Also, all group members have the opportunity of processing their personal feelings in a clear and safe therapeutic environment, (Weniger et al., 2013, page no. 117). Most importantly, this kind of environment focuses on the well-being of all members. However, countertransference should be avoided by the therapist so that he or she should solely focus on providing psychological treatment as opposed to feeling pitiful to the clients. As a leader, the counselor should also ensure that any issues arising are worked upon together so that there is better interaction. After consultation with professionals, what came out clearly is the need for self-care when avoiding countertransference and handling moral clashes.
While handling this scenario at the start, I thought that I had a perfect solution to the situation. Reporting the incident was seemingly the best solution to it. From this, it is evident that the remedy was based on morals, personal beliefs and from the responsibilities of how firefighters should be loyal and committed to their work of saving a life. The act of ending another person’s life is unimaginable despite the severity of the injuries. However, a better understanding of the American Counselling Association’s Code of Ethics 2014 enlightened my thoughts. The most important information was how confidentiality plays a key role in a psychologists or counselor’s life. By reporting an incident to the authorities, one’s life is worsened because the client may not receive the desired treatment for stress disorders. Similarly, fear will be instilled on other group members who will end up “dying” with their problems instead of expressing them. Therefore, I have learned that personal thoughts and values should not be imposed in clients and the right thing to do is to adhere to the Code of Ethics and professional conduct when dealing with clients and situations of a dilemma.
References
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