Running head: CEFS-501, Vignette, Wk. 4 1
Ethical Vignette
The Department of Behavioral Sciences Liberty University
CEFS-501: Ethical and Legal Issues in Counseling
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The scenario I chose for this paper was the second video, Whose Records? The facts of
the scenario, simply put, were that the patient was not happy or satisfied with the current
therapist. This ultimately led to a confrontation between the therapist and the client. While both
individuals stated valid points, it is ultimately the prerogative of the client to decide which
therapist is correct for them.
Apply
Problem One
The first problem is that the clinician tried to be helpful and stated a problem she had
noticed in the client's history. The client was choosing a new therapist every 3-4 weeks, which
shows that the client was not happy with the care that she was receiving up to that point, or it
could be simply that the therapists that she was seeing up until that point were saying things she
did not want to hear. The therapist was practicing beneficence in her decision to challenge the
patient in her request to end the therapy with her current counselor and seek a new one.
The concept of beneficence pertains to the counselor's duty to promote their client's well-
being. It means to do good, be proactive, and prevent harm when possible (Forester-Miller &
Rubenstein, 1992). Beneficence can encompass many actions that improve the clients' lives, such
as immediate intervention and deterrence techniques. This is an important point as the patient's
track record for new counselors every few weeks limits the effectiveness of any therapy and can
even be detrimental to the patient. There is no form of growth, progress, or even any resolution
to the patient's difficulties that she was having.
Problem Two
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Secondly, the therapist showed nonmaleficence when challenging the patient to seek a
new therapist. The ethical principle of nonmaleficence is paramount in avoiding harm to others
and is often summarized as "first, not harm." Some argue that nonmaleficence carries more
weight than other ethical principles (Kitchener, 1984; Rosenbaum, 1982; Stadler, 1986). This
principle stresses the importance of refraining from actions that could intentionally harm others
or put them in danger (Forester-Miller & Rubenstein, 1992). The ethical principle of
nonmaleficence is paramount in avoiding harm to others and is often summarized as "first, no
harm." Some argue that nonmaleficence carries more weight than other ethical principles
(Kitchener, 1984; Rosenbaum, 1982; Stadler, 1986). This principle stresses the importance of
refraining from actions that could intentionally harm others or put them in danger (Forester-
Miller & Rubenstein, 1992). Weighing potential harm against potential benefits is essential in a
counselor's efforts toward ensuring "no harm."
Problem Three
The third problem was that of fidelity. In counseling, fidelity is essential. It is the
cornerstone of a strong, trustworthy therapeutic relationship. Counselors must prioritize clients'
needs and be utterly committed to their growth and progress. Any misstep could jeopardize the
relationship and hinder the therapeutic process. Therefore, counselors must remain loyal, faithful,
and mindful of their obligations. There was no fidelity between the counselor and the patient,
which escalated the situation when the patient requested her medical records from the clinician.
The lack of fidelity is the biggest issue and has the most problems. If there is no trust between
the patient and the counselor, how can any progress be made in therapy? If the patient does not
trust the counselor, they will not share details, open, or be receptive to any form of therapy. This
is a problem of both professional and ethical nature and one that needs to be corrected.
CEFS501, Vignette, Wk. 4 4
Apply
With any form of patient care, and specifically within counseling and therapy, it is shown
that a client's autonomy is an important aspect of the treatment plan and should be encouraged.
This will help to establish fidelity between a counselor and a patient. In turn, this will help to
improve the therapeutic outcome that is desirable by both parties.
While fidelity is vital to the client/counselor relationship, it is built on and established
over time. If the patient does not trust the counselor, it leads to a lack of therapeutic progress.
Additionally, the counselor denying access to the medical records brings a legal issue. This
brings into question the legality and patients' rights.
A patient has a right to their medical records if requested appropriately. However, the
patient must request them from the practitioner's office in writing, and it would only be for that
specific practice. If she wants other records, they must be requested from different offices.
The oversight of the Health Insurance Portability and Accountability Act (HIPPA) (Kibbe,
2021) falls under the U.S. Department of Health and Human Services. Providers must comply
with all federal patient rights standards. Listed are some of the rights that apply to the scenario:
You can apply a written request to view. You can get a hold of your health records by
requesting a copy. It is also possible to make corrections to your health information
(subsection-E, § 54.1-2969).
You will also receive a notification explaining how your health information may be used
and shared (Va. code, title 8.9A, part 6, part 1, section 8.9A-614).
You can determine whether you wish to grant permission before your health information
is used or shared for purposes such as marketing (title 13.1, chapter 9, section 13.1-771).
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You can ask a healthcare organization to limit how they use or disclose your health
information (Va, code, title 38.2, chapter 6, section 38.2-613).
Additionally, you can receive a report detailing when and why your health information
was shared for specific reasons (Va. code, title 64.2, chapter 5, section 64.2-508).
Course of Action
The legal solution for the counselor would be to provide the medical records according to
HIPAA laws and regulations. This will eliminate the legality questions from the scenario and
help smooth over the client's difficulties. Effective communication between the two allows the
counselor to discuss the other issues without creating a hostile environment.
The other solution would be to discuss with the client exactly what the problem is. If you can
get to the root of the problem with the counselors, you can either find a good fit for the patient
with a new counselor or build trust with the patient and establish a relationship. This will enable
you to understand better the patients' needs and desires, which could lead to a productive
relationship. Regardless of the outcome, you must first not harm.
By completing the first two steps, you can establish trust and fidelity, which would help
eliminate any potential problems in the future. If the client does not trust you, there will be no
progress. This will take time and must be firmly established before you can move forward.
Experienced Counselors
I would consult are my co-workers, Jeff Kennedy, and Brian O'Quinn, who both provide
and practice ethical standards in the workplace and as Christian counselors.
Professional Literature
In preparing for this assignment, I reviewed two scholarly journals.
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1. Maurya, Bruce, & Therthani (2020) discussed the importance of practitioners considering
certain best practices. Encryption of all data, use of compliant software, emergency procedures,
and liability insurance should be considered (HIPAA et al., 2013, p.5). I found this information
relatively when the client changes counselors often; the records need extra protection because the
information falls into many hands and risks violations.
2. Luke, Beeson, Miller, Field, & (2020, p.74) explained how counseling is a highly effective
practice that involves delving into individuals' physiological and mental disorders. Its scope
includes screening and diagnosis, treatment planning and delivery, evaluating outcomes, and
promoting wellness.
When dealing with mental disorders or indecisive individuals, a counselor must consider the
client's well-being and act ethically.
References
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Forester-Miller, H., & Rubenstein, R. L. (1992). Group counseling: Ethics and professional
issues. In D. Capuzzi & D. R. Gross (Eds.), Introduction to group counseling (2nd ed., pp. 307–
323). Denver, CO: Love.
Kibbe, D. C. (December 2021). "What the HIPAA Transaction and Code Set Standards Will
Mean for Your Practice." 1069- . (10): 28–32. Family Practice Management 8ISSN
5648 PMID 11757237. .
Kitchener, K. S. (1984). Intuition, critical evaluation, and ethical principles: The foundation for
ethical decisions in counseling psychology. , , 43–55.Counseling Psychologist pp. 12
Luke, C., Beeson, E. T., Miller, R., Field, T. A., & Jones, L. K. (2020). Counselors' Perceptions
of Ethical Considerations for Integrating Neuroscience with Counseling. Professional
Counselor 10, (2), 204–219. EJ1259890.pdf (ed.gov)
Maurya, R. K., Bruce, M. A., & Therthani, S. (2020). Counselors' perceptions of distance
counseling: A national survey. Journal of Asia Pacific Counseling, 10(2), 1–22.
Rosenbaum, M. (Ed.). (1982). Ethics and values in psychotherapy: A guidebook. New York, NY:
Free Press.
Stadler, H. A. (1986). Making hard choices: Clarifying controversial ethical issues. Counseling
and Human Development, 19, 1–10
