ETHICAL VIGNETTE PAPER 2
Identify the Problem:
There is a woman in a counseling session, someone arrives at the office and approaches
the receptionist and states who they are and informs the receptionist that they need to leave the
area for business. He asks the receptionist to let his wife know and tell her she needs to pick up
the children for soccer practice, the receptionist states that she can give her the message for him.
Once the wife is done with her session, she goes by the receptionist’s desk and the receptionist
lets her know the message that her husband left. The wife informs the receptionist that she is
concerned about something like this occurring and lets her know that they are going through a
divorce and that the husband had the intention of using going to counseling against her. The
problems in the scenario are a breach of confidentiality, lack of consent, and boundary crossing.
The receptionist's response indicates a potential breach of confidentiality by disclosing the
client's presence and possibly their personal information to their spouse without the client's
consent. This violates the client's right to privacy and confidentiality in the counseling
relationship. The client's consent was not obtained before disclosing any information to their
spouse. In counseling, it's essential to respect the client's autonomy and right to control the
disclosure of their personal information. The spouse's request and the receptionist's response blur
the boundaries between the client's personal life and their counseling session. Counseling
sessions are typically considered private, and the involvement of a third party without the client's
consent can disrupt the therapeutic process and erode trust.
The problem presented in the scenario encompasses ethical, professional, and potentially
legal aspects, making it a combination of these factors. The breach of confidentiality and lack of
consent by the receptionist can be primarily categorized as ethical issues. The violation of the
client's right to privacy and confidentiality goes against ethical principles upheld in counseling
ETHICAL VIGNETTE PAPER 3
professions. The scenario also involves professional standards and norms expected within the
counseling profession. This includes maintaining boundaries, respecting client confidentiality,
and upholding the trust and integrity of the counseling relationship. The receptionist's actions
represent a failure to meet these professional standards. Depending on the specific laws and
regulations governing confidentiality and privacy in the jurisdiction where the counseling session
takes place, there may be legal implications to consider. If the receptionist's actions result in
harm to the client or if there are specific legal mandates regarding confidentiality in counseling,
there could be legal repercussions for the breach. While the problem primarily stems from ethical
and professional considerations, there is a potential intersection with legal requirements, making
it a combination of ethical, professional, and potentially legal issues. There are no evident
clinical or technological aspects involved in the scenario provided.
Apply the ACA Code of Ethics
Standard A.1.a., the counseling relationship, and Standard A.2.b., types of information
needed, both be applied to and address the problems presented in the scenario. Standard A.1.a
emphasizes the importance of respecting client confidentiality. It states that counselors must
respect the confidentiality and privacy of their clients, disclosing information only with
appropriate consent or under specific legal or ethical mandates. The receptionist's potential
breach of confidentiality by disclosing the client's presence and discussing their personal
information with their spouse without consent violates this standard. Standard A.2.b outlines the
information that counselors should communicate to clients regarding the counseling process,
including the limits of confidentiality. It specifies that counselors should inform clients of the
circumstances under which confidentiality may be breached, such as when there is a risk of harm
to self or others or when legal requirements demand disclosure. In the scenario provided, the
ETHICAL VIGNETTE PAPER 4
client's consent was not obtained before disclosing information to their spouse, failing to adhere
to this standard. These standards highlight the ethical responsibilities counselors have regarding
client confidentiality and informed consent, both of which are relevant to the problems presented
in the scenario (ACA 2014 Code of Ethics).
Applicable State codes/Laws and Federal Mental Health Laws
In Virginia, licensed professional counselors are governed by the Virginia Board of
Counseling and are subject to the Virginia Administrative Code and the Virginia Code of Ethics
for LPCs (Virginia Healthcare Data Center, 2023). Virginia Administrative code 18VAC115-20-
160 outlines the duty of licensed professional counselors to maintain client confidentiality and
protect the privacy of client information. Virginia Administrative Code 18VAC115-20-170
addresses the requirement for licensed professional counselors to obtain informed consent from
clients before disclosing any confidential information. Virginia Administrative Code 18VAC115-
20-50 outlines the general standards of professional conduct expected of licensed professionals
in Virginia. It includes provisions related to maintaining appropriate boundaries, respecting client
autonomy, and upholding the integrity of the counseling profession (Virginia Administration
Code, n.d.). Federal mental health laws in the United States encompass a variety of statutes and
regulations that govern mental health treatment, policy rights, and professional conduct. The
Health Insurance Portability and Accountability Act (Hippa) rule 45 CFR Part 164 sets standards
for the protection of individuals’ medical records and personal health information. It outlines
under which protected health information can be disclosed and the requirements for obtaining
client consent (OCR, 2022). The Protection and Advocacy for Individuals with Mental Illness
Program is a federally funded program established under the Protection and Advocacy for
ETHICAL VIGNETTE PAPER 5
Mentally Ill Individuals Act of 1986, aims to protect the rights of individuals with mental illness
and investigate incidents of abuse and neglect in mental health facilities.
Determine the Nature and Dimensions of the Dilemma
The receptionist’s response violates the principle of fidelity. Fidelity in counseling ethics
refers to the counselor's commitment to keeping promises and maintaining trust with the client.
In this scenario, the receptionist, as an extension of the counseling service, must to uphold the
client's trust and privacy. By disclosing the client's presence and potentially sensitive information
to her spouse without her consent, the receptionist breaches the trust and confidentiality expected
in the counseling relationship, thus violating the principle of fidelity.
Confidentiality is a fundamental ethical principle in counseling and mental health
professions. It entails the duty of counselors and related staff to protect the privacy and
confidentiality of client information disclosed during counseling sessions. Confidentiality is
essential for fostering trust between clients and counselors, maintaining the client's autonomy,
and promoting effective treatment outcomes. By safeguarding client confidentiality, counselors
uphold their professional obligations and respect the rights and dignity of their clients (Raphael,
2020).
The problem in the scenario is the potential breach of confidentiality by the receptionist
at the counseling office. When the spouse of a client arrives and requests information about their
partner's schedule and whereabouts, the receptionist responds by acknowledging the message and
indicating that they will inform the client. This exchange could lead to the disclosure of sensitive
information about the client's counseling session, including their presence at the office and their
involvement in counseling services, to a third party (the spouse) without the client's consent.
ETHICAL VIGNETTE PAPER 6
Such a breach of confidentiality can undermine the trust and privacy essential for effective
counseling and may have adverse consequences for the client (Luepker, 2022).
Venitta Johnson and Susan L. Troyanos, employed by Suffolk Psychotherapy Inc., are
both experienced professional counselors who abide by the ACA Code of Ethics that I can
consult to help me with this dilemma. The two counseling organizations that I will consult with
are the American Counseling Association and the National Board for Certified Counselors.
Generate Potential Course of Action
The courses of actions that I will take to resolve the problem of the receptionist breaking
confidentiality are to address the issue directly, provide training and education, and implement
procedural changes. These courses of action aim to address the breach of confidentiality by the
receptionist constructively and proactively, promoting a culture of ethical practice and
accountability within the counseling service (Smith et al., 2019). By addressing the issue
directly, providing education and training, and implementing procedural changes, I can ensure
similar incidents do not occur in the future and uphold the trust and confidentiality of clients in
the counseling setting.
I will address the breach of confidentiality directly with the receptionist, emphasizing the
importance of client privacy. I will provide comprehensive training sessions on ethics and
confidentiality for all staff members. Additionally, I will implement procedural changes within
the office, such as requiring written client consent before disclosing any information to third
parties, to prevent breaching confidentiality. These courses of action address breaches of
confidentiality constructively and proactively, promoting a culture of ethical practice and
accountability within the counseling service (Medendorp et al., 2021).
ETHICAL VIGNETTE PAPER 7
References:
(OCR), O. for C. R. (2022, March 31). Privacy. HHS.gov. https://www.hhs.gov/hipaa/for-
professionals/privacy/index.html
American Counseling Association. (n.d.). ACA 2014 code of ethics. ACA 2014 Code of Ethics.
https://www.counseling.org/resources/aca-code-of-ethics.pdf
Healthcare Workforce Data Center. Virginia Healthcare Worforce Data Center - Healthcare
Workforce Data Center. (2023, September 14).
https://www.dhp.virginia.gov/PublicResources/HealthcareWorkforceDataCenter/
Luepker, E. T. (2022). Confidentiality. Record Keeping in Psychotherapy and Counseling, 76–
95. https://doi.org/10.4324/9781003150008-5
Medendorp, N. M., van den Heuvel, L. M., Han, P. K. J., Hillen, M. A., & Smets, E. M. A.
(2021). Communication skills training for healthcare professionals in providing genetic
counseling: A scoping literature review. Patient Education and Counseling, 104(1), 20–32.
https://doi.org/10.1016/j.pec.2020.07.018
Raphael, D. D. (2020). Logic of moral principles. Moral Judgement, 23–34.
https://doi.org/10.4324/9781003051671-4
Smith, T. B., Lyon, R. C., & O’Grady, K. (2019). Integration or separation? addressing religious
and spiritual issues in Multicultural Counseling: A national survey of college counselors.
Journal of College Counseling, 22(3), 194–210. https://doi.org/10.1002/jocc.12137
Virginia law. Virginia Administrative Code. (n.d.). https://law.lis.virginia.gov/admincode/
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