The case of Karen's privacy
In professional counseling, there are limitations to confidentiality and counselors must inform clients when confidentiality breach happens. Disclosure of confidential information happens only with consent, legal or ethical justification. For example, disclosure is required in order to protect clients or others from serious harm such as end-of-life decision or life-threatening diseases. Confidential information may be required to be be shared among team members, third-party payers (with consent), parents or legal guardians. In addition, it is unacceptable to keep secrets from spouse in some cultures. Counselors need to protect privacy boundaries to their best capability. Records must be created, stored, protected, disclosed, transferred and terminated lawfully. Clients may not have access to their own records if having access will harm their own safety. Those are some important points regarding privacy as stated in the ACA ethical standards casebook (Herlihy & Corey, 2014).Ethical decisions should also be based on six moral principles of: 1- Autonomy (independent, self-determination) 2- Non-maleficence (no harm) 3- Beneficence (for the good of the individual/society) 4- Justice 5- Fidelity (honest promise, honor commitments) 6- Veracity (truthful). Several ethical models to consider are the Kitchener’s model, the Practitioner’s Guide to Ethical Decision-Making model, the Social Constructivist model, the Feminist model, the transcultural integrative model, and other specialized models. This brief blog post will discuss the application of those ethic models.
Karen is a second-year student in a master’s counseling program. She spends 5 to 10 hours per week as a supervised practicum student at a local counseling agency. She is having mental and financial issues relating to her mother’s cancer, finance obligations, school and practicum works. She mentioned a possibility of postponing her graduate studies until her mother’s condition gets better to her graduate advisor - Luellen. In a meeting held each semester, Luellen informed the faculty of Karen's situation, leading to Karen being denied internship in the next semester. Karen gets very upset. The challenge here is how could this case be handled differently with better outcomes? If I were Luellen, I would have used the Social Constructivist model with specific steps to be discussed below.
First, I will obtain necessary information from Karen, her field supervisor, and the school in order to understand the specifics of Karen's situation, Karen's practicum performance, internship statistics, course statistics, school regulations and the risk appetite of the faculty board. There are many relationships to be considered such as the one between the school and Karen (academic performance), the potential company and Karen (internship), Karen and her mother (personal relationship with some financial burden since her mother is under treatments), Karen and her current field supervisor (practicum relationship), Luellen and the school (faculty performance relationship), and last but not least, the relationship between Luellen and Karen (academic counseling/supervising relationship).
The second step will involve assessing the nature of the relationships and how they may be impacted. The most important relationship is the one between Karen and her mother. It is important to know where the treatment will go and what level of emotional as well as financial care Karen need to provide to her mother. Breast cancer can be cured or can escalate to other types of cancer depending on how early it was diagnosed. As an academic advisor, Luellen’s most concern should be about the relationship of Karen and the school’s program – the academic relationship. Luellen needs to make sure Karen can maintain an acceptable academic performance in this tough time. It can be overwhelming to consider all the relationships at once.
As part of the third step, Luellen may consult experts in a manner that will not violate Karen’s privacy. One possibility involves Luellen asking school experts on similar cases in the past together with the success rates of students who were in similar situations. Another possibility is asking for the student review board’s risk appetite in dealing with students facing hardship and their expectations out of academic counselors and the general philosophy/best practice of counseling.
The fourth step involves negotiations between Luellen and Karen. Luellen can let Karen talk about how Karen thinks her mother’s situation will be and what level of mental and financial efforts she would need to invest into taking care of her mother. Luellen can lay out what she and the experts know about the cases similar to Karen’s, the expectations of the board, the potential impacts on the relationships between the school’s reputations and the companies/agencies, etc. It is also important to let Karen know about the boundaries and legal obligations especially when there is a supervisory agreement between Karen and Luellen. The internship may come with monetary rewards that will help Karen with reducing coffee shop working hours while helping her with academic performances. A consensus should be reached by the end of this phase and be honestly and fully presented to the board for a final decision, which may or may not follow Luellen and Karen's original consensus.
The strengths of this model can be grounded in the relational views of reality. We cannot view and judge the situation from the school’s or the academic counselor’s perspectives alone. Karen, being a graduate student, deserves a good spot in this process and should be treated as a professional. This model actually helps Karen see through the potential issues within her reality (situation) with helps from her advisor, Luellen. During the quest for a consensus, it is healthy for both Karen and Luellen to discuss the various dimensions affecting various stake holders. I really believe this model is ideal for academic counseling of which purpose is not only about helping students solve problems but also about educating them and reminding them of a bigger picture. The model is practical and agreeable. An experienced counselor may still be able to reach a consensus with a student who holds his/her opinions strongly. One potential weakness is the whole process can be time consuming depending on how complicated the situation is, how many stake holders are involved, how fast it is to obtain expert-reviewed information, and the character of the student.
References
Herlihy, B., & Corey, G. (2014). ACA Ethical standards casebook (7th ed.). Alexandria, VA, USA: American Counseling Association.Haley-Banez, L., Brown, S., & Molina, B. (1999). Association for specialists in group work principles for diversity-competent group workers. Journal for Specialists in Group Work, 24(1), 7-14. doi:10.1080/01933929908411415
Carolyn D’Avanzo’s Mosby’s Pocket Guide to Cultural Health Assessment (2008, St. Louis, MO: Mosby Elesevier)
Thomas, R., & Pender, D. (2008). Association for specialists in group work: Best practice guidelines 2007 revisions. Journal for Specialists in Group Work, 33(2), 111-117. doi:10.1080/01933920801971184
