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Benchmark Ethical Vignette Paper
Briana de Cola
Liberty University
COUC 500: Orientation to Counselor Professional Identity and Function
Dr. Green-Baker
November 19, 2023
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Identify the problem
In the video “Whose Records”, the client and counselor begin the session by continuing
their discussion from the previous session of the client requesting for a referral to see another
counselor and terminating their therapeutic relationship. The client reaffirms that she is still no
longer interested in continuing counseling with this counselor for the reason that she feels the
counselor is no longer helpful for her. The counselor paraphrases that the client feels frustrated
about the situation. Also previously discussed, the counselor again suggests the alternative of
having sessions every three to four weeks and then changing counselors. The client is visibly
agitated and reiterates that she is no longer interested in services and that she wants all her
records/clinical case notes from their sessions together. She also exclaims that she wants the
records/clinical case notes the counselor received from all previous counselors of the client. The
counselor states the notes will not be valuable to the client. The client is insistent that the
counselor’s clinical case notes are hers and she wants to take them with her. Despite the
counselor's hesitation and statement that the notes will be of no value to the client, the client still
complains about not being able to obtain the records. This upsets her even more, and she begins
to assert her rights to the records.
The problem in the scenario is that the counselor is not acknowledging or respecting the
repeated request from the client to get a referral to continue counseling elsewhere. Additionally,
there is a dilemma that the counselor is hesitant to release the client’s records due to her highly
emotional, agitated state of mind.
The scenario presents a combination of an ethical and legal problem. The counselor is
required to follow the ACA Code of Ethics and the laws and codes of their respective state
boards when making professional decisions. In addition to following the proper procedures in
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handling the situation, the counselor must decide whether to release or withhold the client's
records. Clients have a right to their records in most all cases, however if the client acts or
behaves in a certain manner, the counselor has authority to provide limited or no access to their
records. It is the counselor’s responsibility to evaluate the situation and make a decision based on
their professional experience and the ACA Code of Ethics.
Apply the ACA Code of Ethics
Code B.6.e states that a counselor must provide access to a competent Client Access
client’s records when requested in a reasonable manner. It further addresses the limitation of
access to a portion or all of a client’s records a counselor has authority to do if there is evidence
supporting the reasonable probability that the records would endanger the client’s life, causing
them substantial harm. “compelling evidence that such access would cause harm to the client”
(ACA, 2014, p.8). This ACA standard is applicable to this scenario due to the irate behavior and
emotional state of mind of the client which could potentially endanger the client if for example,
the counselor’s notes are interpreted incorrectly therefore causing more distress and possible
self-harm behaviors.
Code B.6.f. Assistance With Records states that a counselor must assist the client in
interpreting and provide consultation regarding the access of the client’s records upon their
requests (ACA, 2014, p.8). This standard could help to address the problem in this scenario in
that, the client may be more rationale and calm if the counselor agrees to give the client their
records; consequently, this would allow the counselor to aid in understanding the client’s records
which would alleviate any potential risk to the client.
Code A.12 would be a standard that would address the Abandonment and Client Neglect
client’s request for a referral, as it states that a counselor cannot abandon their client, that they
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must guide the client in their continuation of counseling (ACA, 2014, p.6). Part of the problem in
the scenario is that the counselor did not offer any aid in complying with the client’s desire to
continue counseling elsewhere.
Applicable State Codes/Laws and Federal Mental Health Laws
Florida Statute 456.058 Disposition of records of deceased practitioners or practitioners
relocating or terminating practice states that if a practitioner terminates practice or is no longer
able to counsel their clients they are under no obligation to inform their client(s). Florida Statute
456.057 (9(12) Ownership and control of patient records; report or copies of records to be
furnished; disclosure of information states that if a counselor is no longer able to counsel due to
being terminated or relocated they must publish their termination date or relocation address in
the largest published newspaper in circulation. This applies to the scenario because the counselor
is under no obligation to release information to the client even in the extreme case that their
practice is terminated.
Other than these circumstances there are no other Florida licensure law, rule or practice
act that gives any information regarding a client’s access to their records/clinical case notes,
assistance with their interpretation, nor directly contacting the client regarding abandonment.
Mental Health America (2018) states that individuals with mental health conditions have
the right to access their own medical records but does not mention access to clinical notes. Also,
according to the Health Insurance Portability and Accountability Act of 1996 although a client
has the legal right to see their medical records they do not have the right to all their information
(Department of Health & Human Services, 2013). However, on November 20, 2020, with the
enactment of new federal rules, healthcare providers are required to offer their patients access to
all clinical notes. Despite this mandate, psychotherapy notes are except from this requirement
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excluded, a health care provider can block information they deem unsafe due to the potentiality
of a patient harming themselves.
Determine the Nature and Dimensions of the Dilemma
I believe that autonomy and beneficence are moral principles that apply to this scenario
as it is the counselor’s duty to consider the rational state of mind a client is in when making
decisions. In this scenario the fact that she is so emotional may be why she is so adamant about
retaining her records when it may not be necessary or safe for her. The counselor should be
proactive and want to prevent any potential harm the client might inflict on herself by retaining
her records and interpreting them incorrectly causing more emotional troubles. By the same
token, nonmaleficence could also apply as the client has the typical right of access to their
records under state and federal law so not complying with the request of the client when they are
requesting access to their records could potentially cause emotional harm to their client. Fidelity
certain applies to this scenario because the client has requested twice to have help getting a
referral to another counselor and this particular counselor has not addressed this request which
not only harms their therapeutic relationship but also leaves their obligation as a professional
counselor to be unsatisfactory in abandoning their client.
Overall, I think that beneficence trumps all other moral principles regarding this scenario
because the counselor is not being proactive in helping the client transition to another counselor,
release any clinical case notes, nor is she listening to client by giving her the alternative of
meeting every three to four weeks when her client is obviously wanting to move on and leave
their therapeutic relationship. Compassion, as a precursor to caring, assumes sympathy and is
shown in beneficence (Varkey, 2021). However, the perspective of the counselor in this scenario
may not parallel that of her client. This may be that her perception of what ethical values are
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important and/or what ethical principles take precedence over others could have affected the way
she approached this scenario (Carlisle, et al., 2022).
The American Counseling Association and American Mental Health Counselors
Association are two national counseling professional counseling associations that offer myriad
services should I encounter a dilemma as a professional practicing counselor.
Generate Potential course of action
Counseling should be terminated appropriately in accordance with section A of the ACA
code of ethics. When this occurs, the counselor should offer the option to have a free “pre-
termination” session which would include the recommendation of other counseling service(s).
Pre-termination counseling along with offering referrals for continued counseling services which
would address the abandonment or neglect of the client (Bonner, 2020).
If the client requests a copy of her own records, they usually have that right to do so
under Florida law, HIPAA legislation, and according to the ACA Code of Ethics. Perhaps request
that the client put in writing a release of their clinical case notes with their reasonings behind
their request. The informed consent is essential in a client’s enrollment of counseling and a lot of
time is I believe that having a “pre-termination” is just as important (Radenković, 2023).
Blalock (2021) supports the imperative nature of superiors helping with barriers of counselors
faced with a dilemma. This parallels my potential course of action which would be to introduce a
supervisor into the situation of a client wanting to retain records and terminate counseling. After
the client conveys they would like to transition I would tell the client I will consult my superior
and/or personal supervisor/counselor. I would then consult my supervisor and take active based
on the advice of my superior.
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References
Bonner, E. (2020). Patient Termination as the Ultimate Failure of Addiction Treatment:
Reframing Administrative Discharge as Clinical Abandonment. Journal of Social Work
Values and Ethics, 17(1).
Mental Health America. (2018). Position Statement 21: Rights of Persons with Mental Health
and Substance Use Conditions. https://mhanational.org/issues/position-statement-21-
rights-people-mental-health-and-substance-use-conditions#_edn18. Accessed 15
November 2023
Carlisle, K. L., Levitt, D. H., & Neukrug, E. S. (2022). Mental Health Counselors’ Perceptions of
Ethical Behaviors. Counseling and Values, 67(1), 88-115.
Department of Health & Human Services. HIPAA Administrative Simplification. Regulation text
45 CFR Parts 160,162, and 164.
Blease C, Walker J, DesRoches CM, Delbanco T. New u. S. Law mandates access to clinical
notes: implications for patients and clinicians. Ann Intern Med. 2021;174(1):101-102.
doi:10.7326/M20-5370
Radenković, M. (2023). Importance of decisional capacity tools in obtaining informed consent in
clinical settings. Bioethics, 37(2), 146–153. https://doi.org/10.1111/bioe.13121
Varkey B. (2021). Principles of Clinical Ethics and Their Application to Practice. Medical
principles and practice : international journal of the Kuwait University, Health Science
Centre, 30(1), 17–28. https://doi.org/10.1159/000509119
