Ethical Case Study Discussion Module 4 Client's rights and Counselor Responsibility and Confidentiality

Sample Ethics Case Study Discussion

Main Post: Case #1: The Case of Marianne

1. Identify the Problem

Marianne began providing therapy to a client named Ellen, a young woman who originally began receiving therapy to stop being so hard on herself. Several sessions in, Marianne knows that Ellen is fearful of becoming fat and engages in self-induced vomiting after meals, abuses laxatives, and exercises excessively. Marianne determines that these are symptoms of Anorexia- Nervosa/Bulimia Nervosa, which she has little experience treating.

2. Apply the ACA Code of Ethics CRCC Code of Ethics:

AVOIDING HARM. Rehabilitation counselors act to avoid harming clients, trainees, supervisees, and research participants and to minimize or to remedy unavoidable or unanticipated harm (CRC, 2010, A.4.a)

APPROPRIATE TRANSFER OF SERVICES. When rehabilitation counselors transfer or refer clients to other practitioners, they ensure that proper counseling and administrative processes are completed promptly, open communication with both clients and practitioners. Rehabilitation counselors prepare and disseminate, to identified colleagues or records custodian, a plan for the transfer of clients and files in the case of their incapacitation, death, or termination of practice (CRC, 2010, A.8.d.)

BOUNDARIES OF COMPETENCE. Rehabilitation counselors practice only within the boundaries of their competence, based on their education, training, supervised experience, professional credentials, and appropriate professional experience. Rehabilitation counselors demonstrate beliefs, attitudes, knowledge, and skills pertinent to working with diverse client populations. Rehabilitation counselors do not misrepresent their role or competence to clients (CRC, 2010, D.1.a.)

ACA Code of Ethics:

Primary Responsibility: The primary responsibility of counselors is to respect the dignity and promote the welfare of clients (ACA, 2014, A.1.a).

Avoiding Harm: Counselors act to avoid harming their clients, trainees, and research participants and to minimize or to remedy unavoidable or unanticipated harm (ACA, 2014, A.4.a).

Boundaries of Competence: Counselors practice only within the boundaries of their competence, based on their education, training, supervised experience, state, and national professional credentials, and appropriate professional experience. Whereas multicultural counseling competency is required across all counseling specialties, counselors gain knowledge, personal awareness, sensitivity, dispositions, and skills pertinent to being a culturally competent

counselor in working with a diverse client population (ACA, 2014, C.2.a).

3. Determine Nature of Dilemma

1. The nature of the dilemma is that if she continues to treat Ellen, now that she's aware of more intensive needs related to Anorexia-Nervosa/Bulimia-Nervosa, she may violate her scope of practice and could do harm to the client.

4. Generate Potential Courses of Action & Possible Consequences

1. Marianne could continue to treat Ellen for her perfectionism issues and allow the possible eating disorder to go undiagnosed and untreated.

2. Marianne could continue treating Ellen and begin treating her for Anorexia- Nervosa/Bulimia-Nervosa and risk practicing out of her scope of practice, out of her competency, and could risk malpractice suits.

3. Marianne could continue to refer Ellen to another therapist better trained in treating Anorexia-Nervosa/Bulimia-Nervosa; therefore, terminating services and not having full confirmation of the diagnosis.

4. Marianne could inform the client of her concerns, recommend receiving outside assessment for Anorexia-Nervosa/Bulimia-Nervosa. If trained specialists determine that she has an eating disorder, continue discussing the importance of referral to a more qualified therapist in this area of treatment.

5. Determine Course of Action

1. My choice would be option D. I would provide full disclosure of my concern for her overall health and well-being. We'd discuss the effects of untreated eating disorders and how the underlying eating disorder symptoms could manifest itself in other areas of her mental health. I would explain my limited experience in the area and explore with the client the importance of obtaining further assessment by a qualified clinician. If the clinician determines that Ellen does have an eating disorder, we will discuss termination and referral for more intensive services. This course of action aligns with the concept of "duty to care, which is a legal obligation of health providers not to act negligently" (Gladding & Newsome, 2018).

6. Evaluate Selected Course of Action

1. By sending the client for further assessment, we can prevent unnecessary termination of the counselor-client relationship if the client does not have an eating disorder. If she does not have an eating disorder, we can continue our therapy sessions contingent upon agency policy.

7. Implement Course of Action

1. I would obtain informed consent to send a referral for further assessment and follow up with the client to review results. If she does not have an eating disorder, I will continue to provide therapy while continuously monitoring for signs of eating disorder and treatment effectiveness. If she does, we will prepare her case for transfer for more suitable treatment. In the client's case, I would also document why and how the decision was made to terminate and transfer services.