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Ethical Vignette
Abstract
The American Counseling Association's (ACA) Code of Ethics is the foundation on which
counselors appropriately practice within the counseling profession. Counselors are responsible
for ensuring they adhere to the specific guidelines, no matter if they are directly or indirectly
involved with a situation. With that, in the video "The Helpful Receptionist," there were
violations that could have been prevented, if the foundational principles in the Practitioner's
Guide to Ethical Decision Making (Forester-Miller & Davis, 2016), were followed. A few
principles, such as: autonomy, beneficence, nonmaleficence and fidelity should have been
followed by the receptionists because as an employee of the office, they must know the
guidelines the same as the counselors (Forester-Miller & Davis, 2016). Following the Ethical
Decision Making model along with the Code of Ethics can ensures measures are in place to
prevent violations or the breaking of laws.
Keywords: Ethics, decision-making, model, confidentiality, violations, principles,
autonomy, beneficence, nonmaleficence, fidelity, counselors.
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Ethical Vignette
Benchmark: Ethical Vignette Paper
Identify the Problem
In the vignette "A Helpful Receptionist" there were ethical, legal and professional
problems identified. First off, the lady at the front desk thought she was doing a good deed by
ensuring she gave the woman who was receiving counseling, an important message from her
husband. She thought what she did was harmless because the most important issue was the kids
getting picked up on time. However, what she did not realize, that by her giving that information
to the client's husband, she violated the Code of Ethics, foundational principles and quite
possibly the Health Insurance Portability and Accountability Act (HIPAA). A spouse receiving
counseling is confidential information unless someone has a need to know or a breach of
confidentiality is warranted. The receptionist should not have assumed that the woman was who
was receiving counseling informed her husband or wanted him to know that privileged
information. That leads to the most significant issue. The receptionist is not aware of the laws put
in place to protect in these such cases. As stated above, she does not know she was giving
protected information in this case which is something that must be addressed and rectified to
prevent any future occurrences. The guidelines that have been written and put in place should be
followed by not only the counseling professionals but by all the individuals working within the
construct of the program or facility.
Apply the ACA Code of Ethics
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Ethical Vignette
In regard to the vignette, there are a couple of ACA ethical standards that apply. One in
particular that resonates the loudest is in Section B, Confidentiality and Privacy. More
specifically, B.1.c "Respect for Confidentiality" of the ACA Code of Ethics, it states, "Counselors
disclose information only with appropriate consent or with the sound legal or ethical
justification" (pg. 7). This was definitely violated in the video. The client was distraught because
of the custody battle she may be subjected to in regards her divorce. The husband came in the
office with the mindset of finding out the privileged information and now has access to it without
legal consent of the client. The other standard that applies to this scenario is Section C,
Professional Responsibility. In C.2.e, "Consultations on Ethical Obligations" counselors should
consult with other professionals in the counseling field when they are inquiring about ethical
obligations or professional practices (pg. 9). The counselors within this practice should reach out
to their colleagues in the field to educate themselves on the matter and to help negate any future
missteps. No counselor or practice is perfect but taking the correct steps in the right direction to
ensure they are adhering to the standards within the ACA is imperative.
Applicable State Codes/Laws and Federal Mental Health Laws
In the state of North Carolina there are not many specific guidelines, other than to follow
the guidelines set forth by the ACA Code of Ethics, that apply to this vignette. However, in the
North Carolina Board of Licensed Clinical Mental Health Counselor Rules, 21 NCAC 53.0202
"Privileged Communication", it states, "Privileged Communication shall mean any
communication between client and counselor, given in confidence and not intended to be
disclosed to third persons other than those whom disclosure is made in the furtherance of the
rendition of professional services to the client". As stated earlier, the client did not indicate that
she wanted the practice to disclose her counseling to her husband, thus a breach in confidentiality
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Ethical Vignette
has commenced. Also, this violates HIPAA guidelines, that protects individuals from having any
medical information shared those who do not have a need-to-know. In the article by Gajwani et
al. (2022), he noted that the privacy rule that was set in place in 2000 was created to protect the
rights of the patients and to control the spread of their confidential protect health information.
Determine the Nature and Dimensions of the Dilemma
The ACA foundational principles that are applicable in this ethical dilemma are
autonomy, beneficence, nonmaleficence and fidelity. The clients themselves have the rights to
make their own decisions and in this case, the right to choose who the client wanted to disclose
her counseling with (Forester-Miller & Davis, 2016). Thus, this right was inadvertently taken
away from the client when the receptionist did so herself. Beneficence, according to Forester-
Miller and Davis (2016), states it's the responsibility of the counselor to help safeguard the
client's well-being and prevent harm as much as possible. In the same realm, nonmaleficence is
also prevalent. In this case, the client may feel as though a roadblock has been put in place
because of the actions of the receptionist. Carlin (2020) states in his journal that nonmaleficence
is, the moral obligation to refrain from harming others. The receptionist has caused more harm
than good in this case, even though she did so carelessly. Finally, fidelity or the notion for clients
to trust the counselor in their relationship has been diminished is this vignette (Forester-Miller &
Davis, 2016). The broken trust in this case can have significant damage the client/counselor
relationship. Dr. Ranjan Patel (2019) wrote, "A positive alliance reported by the client is the
strongest predictor of outcome". I consulted with a couple of colleagues of mine, Ari Allen
(LPC) and Kayla Williams (LCSW) and we all came to the agreement that beneficence is the
priority to get in front of going forward. Also, I would also consult with members of the National
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Ethical Vignette
Board of Certified Counselors and the North Carolina Board of Licensed Mental Clinical Mental
Health Counselors to assist me in navigating through these dilemmas.
Generate Potential Course of Action
In order to rectify the situation from I would first have my receptionist reconcile with my
client by offering a heart-felt apology. Apologies can heal damaged relationships and
demonstrate sensitivity towards the offended party and the acceptance of their wrongdoing
(Overstreet et al., 2019). Sometimes a simple apology can go a long way. Many people do not
apologize because of the admittance of themselves doing something wrong. However, as
counselors we must ensure we mend broken relationships and come to the understanding that
their feelings matter most.
Another course of action would be to retrain my receptionist to ensure the misstep does
not happen again. We all make mistakes but putting measures in place to limit or eliminate them
to the best of our abilities should be of the upmost importance. The receptionist must know that
breaching confidentiality could be detriment to the practice and violates the ACA Code of Ethics,
state and federal laws alike.
The third and final course of action is to offer to refer the client to another counselor if
she feels the breach of confidentiality and the broken trust is unmendable. Referring the client to
another counselor may what is best for all parties. If the client agrees and warm hand-off is
needed. Grover et al. (2022) wrote, "If the client appears to feel uncomfortable, explore further
and, if warranted refer to a colleague who may be better suited to this individual. The client and
their needs is what is most important, so doing what is necessary to meet those needs is what I
would do.
Conclusion
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Ethical Vignette
Many ethical dilemmas are preventable but may still happen. Confidentiality breaches
can cause a serious break in trust and other lawful issues. However, there are ways to overcome
such issues. The use of the Ethical Decision Making Model, as a tool can help rectify or remedy
such predicaments and produce a positive result in the midst of negativity. I can say with
confidence, that going the model properly, would generate more positive solutions and hopefully
help restore the client/counselor relationship.
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Ethical Vignette
References
ACA code of Ethics. (2014). https://www.counseling.org/docs/default-source/library-
archives/archived-code-of-ethics/codeethics05.pdf
Carlin, N. (2020). Nonmaleficence and Hope: a Correlation.'Pastoral Psychology,'69(4), 315-
330. https://doi.org/10.1007/s11089-020-00903-8
Ethics and moral principles in Psychotherapy. Ranjan Patel, Psy.D. M.F.T. Psychotherapy and
Mindfulness Training, Burlingame, San Francisco Bay Area, CA. (2019, June 27).
https://drranjanpatel.com/additional-info/ethics-and-moral-principles-in-psychotherapy/
Forester-Miller, H., & Davis, T. E. (2016). Practitioner’s guide to ethical decision making (Rev.
ed.). Retrieved from http://www.counseling.org/docs/default-source/ethics/practioner’s-
guide-toethical-decision-making.pdf
Gajwani, A., Shah, A., Patil, R., Gucer, D., & Osier, N. (2022). Training undergraduate students
in HIPAA compliance. Accountability in Research, 30(7), 530–541.
https://doi.org/10.1080/08989621.2022.2037428
Grover, S., Avasthi, A., & Nischal, A. (2022). Ethical and legal issues in psychotherapy. Indian
Journal of Psychiatry, 64(7), 47.
https://doi.org/10.4103/indianjpsychiatry.indianjpsychiatry_50_21
Overstreet, A. K., Pomerantz, A. M., Segrist, D. J., & Ro, E. (2020). Should psychotherapists
apologise after microaggressions? an empirical analogue study of perceptions of
