As a counsellor I have an obligation to follow professional standards and apply appropriate behaviour defined by mental health associations. The purpose of this is to prevent harm to clients as well as to define my own professional values. Working in the helping profession I will come across situations where I need to make a decision on whether to breach confidentiality in order to protect my client or others or “simply” practise within the framework of social equity and justice.
I will use the “Practisioner’s Guide to Ethical Decision Making” model of Holly Forerster-Miller and Thomas Davis published by the ACA American Counseling Association (1996) to guide me through the decision making process on an ethical dilemma which I am going to present in the following. The Ethical Dilemma I am working as a Counsellor in a shared Counselling Practise. My client is Heather, 38, who has been seeing me for about 4 sessions. She initially came in talking about her challenge working part-time and being a mother of 2 children aged 3 and 10.
In our recent sessions she talks about her concern in regards to her eldest son’s school performance. Jerrod used to be one of the best in his class and recently has failed in several tests which he would normally succeed in. Working through the situation in our session she mentions pressure from her husband Joe. She tells me that if Jerrod does not succeed he would punish him the way he used to be punished by his father which means he is slapping him. While she is understanding of her husbands “goodwill” in raising disciplined children she feels guilty of not stopping her husband and protecting her son.
At the same time she tells me about her fear of her husband finding out that she disclosed the violence. Heather is also worried that the reputation of their local family business is at risk which could cost them their existence. She asks me to keep it secret and not to report it. She also confirms that Joe is not generally violent. When inquiring further into the kind of punishment and its frequency Heather tells me that her husband gets angry every time Jerrod comes home from school with bad results. She recalls her husband saying: “He just needs a good kick in the butt”.
She reassures me that he does not get apoplectic as such but does hit him on his butt a number of times. Jerrod then gets very upset and responds with crying. Heather says that her husband seems absolutely sure about the educational value of his method and would not contemplate taking different actions at this point. The mother is torn between protecting her children, her son in particular, and telling her husband to stop. She tells me that she feels that I am the only person she can possibly talk to about this.
Upon inquiring how often her husband has been violent against Jerrod she recalls 4 incidents in the last half year but adds that he is also putting Jerrod under a lot of emotional pressure such as threatening him that if he does not “get his act together” to get a good mark in a certain test there will be consequences. As Heathers Counsellor I am aware of the ethical dilemma that arises out of the information she had just given me and I find myself wondering what I should do in this situation: Should I apply for an Intervention Order to protect Jerrod from his violent father and potentially the rest of the family?
Or should I protect Heather and keep her information confidential as she had previously asked me to do? Identify the Problem After the session has finished I am taking notes to record the information Heather has given me. I am becoming aware of the ethical dilemma that arises out of the family situation around the violence of the father and husband. I am asking myself the following questions: Is this a case of child abuse? If I breach confidentiality could an Intervention Order lead to the children being removed from the family?
Should I protect Heather and keep her information confidential as she had previously asked me to do and therefore protect our client-counsellor-relationship? Are there any other paths I could follow in this situation? The trust between Heather and me as a Counsellor is a vital part of our therapeutic relationship. I am aware that my client must feel that whatever she discloses in therapy will be treated confidentially. As a counsellor I am not to disclose information unless required by law or authorized by my client.
The informed consent document Heather has signed prior to our first session does not state particularly that the Counsellor has to break confidentiality in instances of child abuse. Applying the ACA Code of Ethics I am now reviewing the ACA Code of Ethics to find out whether I can use these guidelines to find a solution to the problem. Reading the Code of Ethics (ACA, 2005) I find the following aspects that are part of this dilemma: A. 1. a. Primary Responsibility My client is vulnerable and in need have trust in our therapeutic relationship.
Heather is generally not an outspoken person therefore I do not take her openness in my sessions for granted. Heather has expressed how much our sessions have helped her so far and that they have become an important part of her life. A. 4. a. Avoiding Harm I will have to find out whether the harm on breaching confidentiality is bigger than the harm we might do when keeping the violence of the father confidential. A. 4. b Personal Values When questioning my own values I do believe that violence is never to be used against anyone.
I find myself judgemental against Heathers husband at first but I am also working on understanding the whole situation of the family. In order to keep her dignity I would have to keep the matter confidential. B. 2. a. Danger and Legal Requirements The first step is to define whether a Counsellor has legal obligations to report suspected child abuse. Based on The Children Youth and Families Act 2005 (Vic), Mandatory reporting only applies to doctors, nurses, teachers and police.
Therefore, counsellors in Victoria have no legal obligations to report suspected child abuse or family violence. My next step is to check out the law around child wellbeing and safetey (Child Wellbeing and Safety act 2005, Department of Justice Victoria) which is designed to provide for intervention and to link the particular family to service to: 1. remove or ameliorate the causes of harm and 2. to strengthen the capacity and efforts of parents and communities to support the child as early as possible in the child's life.
Furthermore I find out that the Child Wellbeing and Safety act of 2005 consitutes that when the breach of confidentiality has been done in good faith it does not make the person subject to any liability. According to Victoria Legal Aid family violence is “… harmful behaviour that is used to control, threaten, force or dominate a family member through fear. It includes “ …physical abuse, such as hitting or pushing a person around as well as emotional or psychological abuse”. It also says “Children who are exposed to family violence are particularly vulnerable.
Family violence can have a serious impact on a child's physical, psychological and emotional wellbeing. If you are applying for an intervention order, you will be asked if you believe that your safety or the safety of your children is threatened by the respondent (person the application is against). ” (Victoria Legal Aid website, 2005). This information supports me in defining the situation as possible “physical and emotional child abuse” and its corresponding consequences on Jerrods development.
According to Heather’s statements about the father slapping the son when his school performance is not as expected chances are that this will happen on a regular base unless Jerrod will succeed in all his tests. Therefore I also identify the situation as “foreseeable harm”. C. 2. e. Consultation on Ethical Obligations A consultation with a fellow counsellor from my practise is going to put the situation in a different perspective and might help finding black spots which I have not considered yet. Determine the nature of the dilemma
After having applied the ACA Code of Ethics I am still not sure whether I should breach confidentiality in this matter. Inquiring into the regulations in Victoria I found out that there are no laws as such in place that force a counsellor to act in the situation presented by Heather. Even though there are no strict regulations I am leaning towards breaching confidentiality to prevent harm from being done to Jerrod. Adhering to the procedure of the decision making model I am using I need to determine the nature of the dilemma as well as its dimension.
The aspect of “beneficence” seems to be the most relevant for me in this case as it reflects my responsibility to prevent harm when possible. This responsibility changes my point of view as I am starting to consider the downside of breaching. Heather seems to be part of a generally functioning family. She describes her husband as loving and caring in the day to day context. He is hard working to keep the family business as successful as it has been under his fathers ownership. Heather also describes him as highly stress-resistant and as an over-achiever from a very young age.
I can tell that she worships her husband for what he is. His outbursts towards Jerrod school seem to only apply on the scenario if he is not achieving at school. Heather is also coming from a troubled background herself so her focus on “keeping the family together” is highly developed. She tells me how sorry she feels for Jerrod when Joe is being violent but she also can understand her husbands point of view on raising disciplined and determined children. When Heather asks me to keep the slapping confidential I ask her what it would mean if it did come out.
She tells me that her husband would get very angry of her because she had been talking about it. Heather also says that the reputation of the family business would be at risk and that they would potentially have to move away from the area facing contempt from the neighbourhood and their customers. We are also talking about the chance of a Child Protection worker being sent to their home to investigate if a child is at risk of significant harm. The consequence of the investigation could be that the family is being torn apart. Heather does not want any of this to happen.
She reassures me that the slapping is rather harmless. Following the session with Heather I am seeing my fellow counsellor, Gary, to discuss the pro and contra on this matter. Gary points out that he has been through a similar issue several years ago and he decided to invite both parents for a session to work out what triggered the anger and find ways to deal with it in a non-violent way. This case information helps me to question a potential course of action if I do not breach confidentialy. I get the sense of this course of action being a possible way to help the whole family.
I am now considering to invite both Heather and Joe to discuss where the tension results from. Thinking over Heather’s explanations again I am trying to see Joe as the caring husband and father who might have to juggle a lot of stress to support the family. It also seemed that his father has put a high amount of pressure on him at a young age which might have led him to either succeed or face punishment. Having grown up with this form of parenting he might see his father’s action as reasonable method in the bringing up of children.
I also would like to find out how he is coping with the pressure of running the family business and his corresponding stress management. Would Joe consider therapy after speaking about the amount of fear in the family and also the possible damage this might cause on his son? I am hoping that therapy could help Joe changing his violent methods into a more gentle approach of raising resilient children. I am also thinking about options to support Jerrod with his own stress-management and would like to link the family to a school counsellor at the same time hoping that Jerrod agrees.
Course of action, its consequences and evaluation I have decided to not go ahead and report child abuse to the Victorian Child Protection Service. Instead I am scheduling another session with Heather to discuss my concern towards Jerrod’s wellbeing. I invite her to imagine how it would be to ask Joe in for a session together. Being anxious about him finding out that she has spoken about the violence I am offering to help to facilitate. Heather is calming down when I tell her my concern for Joe’s stress-management and general wellbeing.
She admits that she is worried about him too and is ready to take the risk of him being angry if it was useful. She admits that she has thought of therapy for him but was afraid to even ask him since he claims “there’s nothing wrong with him”. Heather is delighted to think through the possibilty of Joe starting a therapy in the safe environment of my practise. She seems relieved and full of hope and decided to ask Joe when he comes home that night. I am also telling Heather about my concern in regards to Jerrod’s well-being and development and the damage the violence might have caused already.
Heather is positive about the outcome of counselling for Jerrod if he agrees on seeing the school counsellor. We are also discussing the option of Family Therapy in case Jerrod does not feel comfortable seeing a school counsellor by himself. Implementing the course of action Joe has agreed to come into my session. We determined his levels of stress were very high. Joe says he is aware of his anger but does not know how to cope when is comes up. I am telling him about Emotion Focussed Therapy (EFT) which is aimed at reducing stress and anxiety. He learns about this approach in terms of assessing “ ... lient emotions and then to reformulate those emotions into a new and more positive basis between family members. ” (Marriage and Family Therapy – A Practise-oriented Approach, Linda Metcalf, p. 343). Joe seems interested in this kind of therapy and tells Heather that he already feels some relief knowing that there is help out there. I am referring Joe to a fellow colleague who is focussing on EFT but agree at the same time with both parents that we will regularly review the development of Joe’s stress-management. Heather remains my client but is reducing the sessions to once a month instead of fortnighly sessions.
Jerrod is willing to try the school counsellor as his best friend is doing the same thing. Conclusion Having faced my first ethical dilemma I am surprised how a structured decision making course can lead to different actions than previously assumed. My first intention was to report the incident to the Victorian Child Protection Service just by judging from my own values. While considering all the advantages and disadvantages I am working through different scenarios which changed my point of view. I regard my decision as the one that protects this whole family the most considering the father is not generally violent.References * “Practisioner’s Guide to Ethical Decision Making” model of Holly Forerster-Miller and Thomas Davis published by the ACA American Counseling Association (1996) * Code of Ethics (2005) - ACA (American Counseling Association) retrieved on the 25th of May at: http://www.counseling.org/Resources/CodeOfEthics/TP/Home/CT2.aspx * Children, Youth and Families Act 2005 – Children’s Court of Victoria retrieved on the 25th of May at: http://www.childrenscourt.vic.gov.au/CA256CA800011129/page/Resources-Papers-New%20Act?OpenDocument * Child Wellbeing and Safety Act 2005 – Department of Justice Victoria, Australia retrieved on the 25th of May 2012 at: http://www.justice.vic.gov.au/workingwithchildren/home/protecting+our+children/child+safety/wwcc+-+child+wellbeing+and+safety+act+2005 * Mandatory Reporting of Child Abuse - AIFS (Australian Institute of Family Studies) retrieved on the 25th of May at: http://www.aifs.gov.au/nch/pubs/sheets/rs3/rs3.html * Family violence orders to protect children - Victoria Legal Aid retrieved on the 25th of May 2012 at: http://www.legalaid.vic.gov.au/1828.htm * Marriage and Family Therapy – A Practise-oriented Approach; Linda Metcalf; 2011