2
Abstract
This paper is written as a result of watching the video “Whose Records?”. It brought up
questions regarding appropriate counselor-client interactions and the foundational principles that
help counselors make ethical decisions. Counselors must adhere to the foundational principles of
autonomy, justice, nonmaleficence, beneficence, and fidelity when working with clients. In this
vignette, the client had a history of changing counselors after a few visits and is insisting on
procuring her records while the counselor is hesitant to provide them. The questions this vignette
brought are: 1) is the counselor honoring the client’s autonomy? and 2) is the counselor
demonstrating fidelity to the therapeutic relationship?
Keywords: ethics, foundational principles, laws
3
I chose to feature the video “Whose Records?”. There are any number of ethical issues
that can arise between a counselor and client. The premise of this video is the client is unhappy
with her counselor and is requesting her records. The client wants to take them to a new
counselor. The client has a history of changing counselors frequently and when questioned about
that, the client avoids answering, reiterating that changing counselors does not mean that she
should not have her records. The counselor in this video states that she does not feel like there is
anything helpful in the client's record. There are any number of ethical issues that can arise
between a counselor and client. The ACA code of ethics and my state ethics provide a basis for
working with clients particularly when there is a conflict. The foundational principles found in
the Practitioner's Guide to Ethical Decision Making also provide guidelines to ensure counselors
are providing the best service they can to clients.
Identifying the Problem
The initial problem I recognized is that neither the counselor nor client is working with
fidelity. The client admits to changing counselors frequently and when questioned demonstrates
a defensive attitude with the counselor. The counselor does not circle back to that question,
instead replies that there is nothing helpful in the record. To an already fragile therapeutic
relationship, this comment increases the lack of trust the client has for the counselor.
A second problem I recognized was the counselor not honoring the client’s autonomy. In
the Practitioner’s Guide to Ethical Decision Making, Forester-Miller and Davis (2016) define
autonomy as the principle that addresses independence and self-determination. In this video, the
client was exercising her choice and action while the counselor seemed to be hindering that
choice and action. The counselor would have been more successful in this session, if she had
4
acknowledged the client’s wishes while also discerning whether the client was being rational in
the decision to find a new counselor.
Applying the ACA Code of Ethics
The entirety of Section B of the American Counseling Association (ACA) code of ethics
discusses confidentiality and privacy. Section B.6 specifically talks about records and
documentation. While reading through section B.6.e, I found that it informs counselors of
appropriate client access to the counseling records. The first sentence makes it clear that as
counselors, we are to provide reasonable access and copies of records when requested by
competent clients. Section B.6.e also goes on to state that counselors can limit the access if there
is information that would be harmful to the client.
Applicable State Codes/Laws and Federal Mental Health Laws
In the state of Michigan, Michigan Compiled Law 330.1748 discusses confidentiality and
how records are released. Clients must request their records in writing unless requested through
subpoena. The Health Insurance Portability and Accountability Act of 1996 differentiates
between medical treatment notes and psychotherapy notes. Section 164.524 discusses the rights
of individuals to access their records. Individuals have the right to inspect and obtain a copy of
their health information in a timely manner. This right applies to either arranging an in person
appointment to pick up said records or to have records mailed to the client.
Determine the Nature and Dimensions of the Dilemma
According to Forester-Miller and Evans, there are five foundational principles that are
essential to counseling. These are autonomy, justice, nonmaleficence, beneficence, and fidelity.
In this particular vignette, the counselor is not applying autonomy or fidelity. Autonomy is the
principle that addresses independence and self-determination while fidelity is the notion of
5
loyalty, faithfulness, and honoring commitments (2016). The client is exercising her autonomy
by wanting to see a different counselor and requesting her records. The counselor is not
encouraging that autonomy by hesitating to provide the client her records as well as asking why
the client changes counselors every few weeks.
Neither party is demonstrating the principle of fidelity. Without more information, it is
difficult to determine the reason why the client is constantly changing counselors. With my
personal counseling experience, I do not believe that the first counselor you encounter is
necessarily the best fit. The counselor may not understand why you are in counseling; the client
may prefer a different style of counseling. The counselor in this vignette is not treating the client
professionally. The counselor may be trying to protect the client and escalating her emotions and
stress by not readily agreeing to provide the client her records. If the counselor was working with
fidelity, she would explain in a calm manner what was in the client's record that may or may not
be helpful.
Potential Course of Action
Given the emotions of the client, it would be appropriate for the counselor to explain to
the client the method for ending the counseling relationship. This would mean at least one
additional session where the counselor would have the client’s record available for the two to
review together. The hope would be to identify what issue or issues the client has been having
with previous counselors in an effort to provide a referral that would be the best fit for the client.
Conclusion
In the video”Whose Records?”, the client is requesting her records and the counselor is
hesitant. It seems as though the counselor was not prepared or expecting the client to be so
insistent, almost to the point of panic to get her records. The counselor was not helpful to the
6
client or professional with the process of terminating service. This is one example of ethical
issues that can arise between counselors and clients. The ACA code of ethics and my state ethics
provide a basis for working with clients particularly when there is a conflict. The foundational
principles found in the Practitioner's Guide to Ethical Decision Making also provide guidelines
to ensure counselors are providing the best service they can to clients.
7
References
American Counseling Association. (2014). 2014 ACA code of ethics.
https://www.counseling.org/docs/default-source/default-document-library/2014- code-of-
ethics-finaladdress.pdf.
Forester-Miller, H., & Davis, T. E. (2016). Practitioner’s guide to ethical decision making. (Rev.
ed). Retrieved from http://www.counseling.org/docs/default-suorce/ethics/practioner’s-
guide-to-ethical-decision-making.pdf
Code of Federal Regulations (n.d.). U. S. Department of Health and Human Services. Retrieved
November 14, 2024, from
https://www.hhs.gov/hipaa/for-professionals/privacy/index.html
Rights of Recipients of Mental Health Services. Mental Health Code (Excerpt). Chapter 7.
Michigan Legislature. (n.d.). Retrieved November 14, 2024, from
https://www.legislature.mi.gov/documents/mcl/pdf/mcl-258-1974-7.pdf
Powered by TCPDF (www.tcpdf.org)
