ETHICAL VIGNETTE 1
Ethical Vignette: Whose Records
Taylor Davis
School of Behavioral Sciences, Liberty University
Abstract
Every licensed counselor is subject to ethical dilemmas throughout their career. In the case of
“Whose Records”, the counselor and client are at odds regarding terminating the therapeutic
relationship and the release of records. Ultimately, the release of records is well within the
clients’ rights. However, the records released should merely be a copy with the counselor
maintaining the original records in case of future incidents. Additionally, while the counselor is
still in the relationship with the client, he or she should take extra precaution to practice the
moral principles of autonomy, beneficence, and veracity. Of these, the most important is
ETHICAL VIGNETTE 2
veracity. This essay seeks to clarify the steps needed to address the dilemma of “Whose
Records”. A personal potential course of action will also be assessed on a personal basis,
evaluating for ethical codes and legal matters that provide insight on how to proceed through
such situations. Many professionals in the counseling field encourage using veracity in
counselors, as it is one of the staples of counseling.
Keywords: veracity, mental health laws, records, ACA Code of Ethics
Ethical Vignette: Whose Records
Ethical dilemmas are difficult to navigate, especially if they involve legal matters. In the
case of “Whose Records”, the ethical dilemma is that the client wants her records and a
therapeutic relationship termination, while the counselor wants the client to continue her care.
The ACA Code of Ethics, state laws, and federal laws all speak to this subject matter. Additionally,
moral codes apply to this situation. These include autonomy, benefience, and veracity. However,
the counselor should proceed with caution to not practice paradoxical interventions (Peluso &
Mozdzierz, 2023).
Identify the Problem
In this situation, a client came to the session requesting to terminate the therapeutic
relationship. She states that the counselor is not meeting her needs. This is the second time that
she has asked to terminate the counseling relationship. When the counselor tried to talk to her
about moving forward and continuing to work together instead of referring her to a new mental
health professional, the client became visibly upset. She continued to request her records. The
client states that the counselor kept notes on her to share with other people. The counselor
does not see how her notes will help the client, but the client remains adamant that she wants
her records to take with her. The main issue is that the client would like to obtain and take all
her records from the counselor. The counselor, however, is attempting to keep the client in her
care. This scenario is an ethical, legal, and professional problem.
ETHICAL VIGNETTE 3
ACA Code of Ethics
The ACA Code of Ethics addresses concerns regarding client records. The first standard
that applies is B.6.e. Client Access which states that if a competent client requests their records,
the counselor is to provide them with copies of their records (ACA, 2014, p. 8). This means that
ethically the counselor must give the client her records. Additionally, B.6.f. Assistance with
Records states that the counselor is to help the client understand the records by offering
reasonable interpretation (ACA, 2014, p. 8). Even though the counselor believes that the notes
will not be beneficial or useful to the client, the counselor must help her understand what was
recorded. Finally, standard B.6.h. Storage and Disposal After Termination decrees that a
counselor is to store client records following termination of services (ACA, 2014, p. 8). While the
counselor ethically must give the competent client her records, the counselor has an ethical
obligation to store her records as well. Therefore, the records that the client will obtain will only
be copies of her file.
Applicable State Codes/Laws and Federal Mental Health Laws
The Virginia Department of Health Professions requires that all licensed counselors
maintain client records for a minimum of five years after termination of the counseling
relationship (VDHP, 2021, section V.c.5, p. 18). There are, however, exceptions to this. One of
these exceptions is found in section V.c.5, which states that records do not have to be
maintained by the counselor if the counselor has given the client their own records or if records
were transferred to another mental health professional (VDHP, 2021, p. 18). According to this
state law, the client would be able to take all her records without the counselor retaining any of
them.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law
that provides mandates for health records. HIPPA states that any individual “has the right to
inspect or obtain a copy, or both, of the PHI (protected health information), as well as to direct
ETHICAL VIGNETTE 4
the covered entity to transmit a copy to a designated person or entity of the individual’s choice”
(1996, 45 CFR § 164.524). Under this law, clients are legally entitled to a copy of their records.
This means that the counselors should keep the original records.
Nature and Dimensions of the Dilemma
There are multiple ACA moral principles that apply to this situation. First, the patient has
a right to make their own decisions, which is autonomy. The client is well within her rights to
express her desire for termination of the therapeutic relationship. I also believe that
beneficence applies to this situation. The counselor expressed that the client had been through
multiple other counseling relationships. While the client may want to pursue another
therapeutic avenue, the counselor feels that it is in the client’s best interest to see their
relationship through. This is predominately due to the client’s habit of perceived frequent
transferring from counselor to counselor. However, the client believes that it is in her best
interest to move forward with a different counselor.
The ACA moral principle that stands out to me the most for this situation is veracity.
Under this ethical guideline, a counselor must always be open and honest with patients. That
includes difficult news. In my opinion, it was difficult for the counselor to tell the client that they
need to assess why they are moving between mental health providers so frequently and what
the client’s goal of counseling is. When the counselor addressed this, the client got visibly upset.
The counselor acknowledged that the conversation regarding the switch started last session, so
the client had some time to think about it. When it was readdressed, the client avoided the
topic and became adamant for her records. The veracity of the counselor is one to be admired.
Veracity has been widely studied and researched. Ultimately, it has been agreed upon
that it centers around being truthful to the client (Peluso & Mozdzierz, 2023). Lemma (2023)
describes veracity as sine qua non, which is Latin for without which, not. In other words, this
means that veracity is necessary in the counseling practice. The therapeutic relationship is
ETHICAL VIGNETTE 5
based on truth. Without it, the process of therapy is ethically compromised, and no relationship
can be established.
There is a fine line between veracity and autonomy. Concerns have been raised
regarding paradoxical interventions, which is when the counselor violates veracity to trick the
client (Peluso & Mozdzierz, 2023). This could be argued in the video clip. The counselor is trying
to keep the client in her practice while the client just wants to transfer, therefore using
paradoxical interventions and overriding autonomy. However, I believe that the counselor truly
has the client’s best interest at heart when she shares the reality of the therapeutic situation
with the client.
If I were faced with this counseling dilemma, I am grateful to already have colleagues
that I can call. First is Christie Gervase, a professional trauma counselor and dear friend. A
second colleague would be Chris Knuckles, an LPC and family friend. Both counselors strictly
abide by the ACA Code of Ethics. Additionally, I will be able to consult the American Counseling
Organization, a nationally recognized organization for counselors. I can also contact the Virginia
Counselors Association. They oversee all counselors in the state of Virginia, which I reside. I
would be able to consult with either or both organizations if faced with this ethical dilemma.
Potential Course of Action
If I was faced with this problem, I would first and foremost recognize that this is not a
personal attack. Not every client is suited for every counselor, and that is okay. Second, I would
need to apply the ACA Code of Ethics to the situation, which implies that I need to provide
copies of the records to the client. The client would need to sign a records release, according to
HIPAA laws (2024). Additionally, I would have an in-depth discussion with the client about her
habits. This should include what in causing her to switch mental health professionals so
frequently. The counselor in the example started to do this, but I would make sure it is done in a
ETHICAL VIGNETTE 6
way as which the client does not feel attacked or accused. If a counselor can address a difficult
issue with truth but also compassion, clients are less likely to get defensive (Peluso &
Mozdzierz, 2023). This means the counseling session is more likely to be beneficial through hard
or even potentially awkward circumstances. However, this step is likely to fail unless there has
been an establishment of epistemic trust (Lemma, 2023).
Conclusion
There are many ethical issues that can arise in therapeutic relationships. Possibly one of
the most challenging is the issue of releasing records and terminating a therapeutic relationship.
When faced with this dilemma, counselors should consult the ACA Code of Ethics, their state
counseling laws, and any federal laws that may apply. Ultimately, decisions should be made with
the moral principles of autonomy, beneficence, and veracity. Consulting with another licensed
professional or even a professional organization is also a good way to verify your thought
process and decision.
References
2014 ACA Code of ethics. American Counseling Association. (2014).
https://www.counseling.org/docs/default-source/default-document-library/ethics/
2014-aca-code-of-ethics.pdf?sfvrsn=55ab73d0_1/
Health Information Privacy Division. (2024, January 5). Individuals’ right under HIPAA to access
their health information. HHS.gov.
https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/access/index.html
Lemma, A. (2023). First principles: an essay in applied ethics for psychoanalytic practitioners /.
Oxford University Press.
Peluso, P. R., & Mozdzierz, G. J. (2023). Advanced principles of counseling and psychotherapy:
learning, integrating, and consolidating the nonlinear thinking of master practitioners
(Second edition.). Routledge. https://doi.org/10.4324/9781003088400
ETHICAL VIGNETTE 7
Virginia Department of Health Professions. (2021, August 18). Regulations Governing the
Practice of Professional Counseling. Virginia Board of Counseling.
https://www.dhp.virginia.gov/counseling/leg/LPC.docx
Powered by TCPDF (www.tcpdf.org)
