Breach of Confidentiality
Definition and Explanation
A breach of confidentiality is a major ethical issue in counseling with critical implications for all parties involved. Confidentiality is a concept often associated with the privacy of client data, which means that a counselor has both a legal and ethical obligation to keep all data and communication with the client confidential (McVeigh & Heward-Belle, 2020; Lamont-Mills et al., 2018). According to Halovic (2019), confidentiality is critical for client safety since a breach can cause significant harm depending on the extent of the breach. An example of a confidentiality breach can be illustrated using Maria’s story. Maria attends a private counseling session in her local community to discuss her feelings following an abortion and she does not want anyone else to know. On arrival she sees a client leaving the counselors office through the back door. As she enters the counselor’s room, she notices that her file revealing her name is on the desk alongside other clients’ case notes waiting to be entered onto the computer. The counselor looks flustered and tired and is apologizing for her actions and Maria feels very upset.
Even though the case above indicates an unintentional breach of confidentiality, it is important to understand that the consequences for the client will remain the same. In Mariaâs case, abortion is a highly sensitive issue that needs to be concealed to protect the client. If information about it leaks, Maria’s relationships with friends and relatives could be ruined considering how divisive the topic of abortion is. It can be argued that the councilor has failed to assure Maria the confidentiality she deserves. Leaving notes with names uncovered in a room where there are other clients can be labeled as a reckless and negligent act. As will be discussed in the sections that follow, the councilor can be held liable for all the damages suffered by Maria.
Professional and Legal Implications
Confidentiality in counseling has been subjected to various legislations that vary from state to state. Breaching confidentiality exposes the practitioner to legal issues, including lawsuits where clients claim emotional or financial damages. Having broken the law, the counselor also faces a situation where they could lose licensing and, consequently, lose their jobs. Practitioners have both a legal and ethical duty to protect their clients, which explains why lawsuits are a serious threat (McVeigh & Heward-Belle, 2020). In the National Career Development Association (NACDA), section B focuses on confidentiality where career professionals are obligated to both communicate the boundaries of and maintain confidentiality (NCDA, 2017). Similar provisions are offered by the American Counseling Associationâs 2014 code of ethics, where Section A.7.b., requires practitioners to observe confidentiality. From a professional perspective, breaching confidentiality can destroy trust and question the ability of the counselor to offer practical and emotional support (Bakshi & Goss, 2019). Additionally, breaching confidentiality will affect the behavior of clients seeking counseling services (Sefotho & Seema, 2020). For example, Maria in the case scenario above may never seek counseling again for fear of exposure.
Impact on Client, Councilor, and Counselling Relationship
In addition to the legal and professional implications, breaching confidentiality has its effects on the client, counselor, and the counseling relationship. Exposure of sensitive client information to third parties may cause significant harm to the client. For instance, if the information leaked that Maria has had an abortion, her relatives and other people close to her may become judgmental, which ruins their relationships. Maria may become stigmatized and socially isolated, which only makes her problems worse. The councilor may lose a license if found guilty of negligence in the breach of confidentiality. A career can be lost or damaged, a consequence that the counselors face throughout their careers. Professionalism is lost, which can also lead to damaging the credibility of a practitioner should other people learn of such an event.
The counseling relationship may also be damaged by a breach of confidentiality. As mentioned earlier, trust in a counselor may be lost, which would result in the clients canceling their services, which is indeed within their rights. Society could perceive counseling differently where fear of similar incidences would result in fewer people seeking these services as explained by Sefotho and Seema (2020). It is important to acknowledge that the impacts on society depend on how widespread the confidentiality breaches are and how many incidences get the attention of the media. Clients who suffer from the breaches may act as a warning to other seeking counseling and the entire image of the counseling profession becomes tainted.
Boundary Violation
Definition and Explanation
Boundaries in counseling exist to protect the patients and safeguard the legitimacy of the practice. According to Black (2017), the counselors are in a position of power, which means that the client-counselor relationship automatically becomes a fiduciary. In other words, counselors act in the best interest of the clients. ACA highlights various requirements for maintaining boundaries, which include the previous relationships at a non-professional level (Berg et al., 2018). Two types of boundary violations can occur, namely sexual and non-sexual (D’Souza & De Sousa, 2017). In some cases, boundary extensions may be required, which must be discussed, documented, and consented to by the client.
An illustration of boundary violation can be given by considering the case of Cathy, a 33-year-old-woman. She attended psychotherapy to discuss how her separation from her partner is making her feel very lonely and sad. The therapist named Paul is 45 years old and is very well kept and is single. The therapist straight away discovers that he is sexually attracted to Cathy and flirts with her during the session. After a few sessions he invites her out for a coffee, they talk on the phone out of sessions about their life. After four sessions he invites her to his home for dinner and they have sex. The details of this case show a sexual violation, which is graver and more detrimental to the counseling practice. The reasoning is that many patients experience harm from boundary violations, especially sexual boundary violations where vulnerabilities of patients are exploited (Hook & Devereux, 2018a; Hook & Devereux, 2018b). Counselors would be breaching boundaries by having such relations with their clients.
Professional and Legal Implications
The code of ethics often offers practice guidelines for practitioners. However, such scholars as Corey (2017) believe that ethical practice is more than following a set of rules. Legal implications in such issues as boundary violations may mean that practitioners hardly offer more than fulfilling legal minimums for fear of litigations, which is one of the main legal implications. Legal sanctions, especially where patients feel victimized are a real consequence for counselors who violate boundaries. However, it is important to acknowledge that sexual boundary violations in counseling do not carry the same weight as physical assault. While many cases may not bear legal liability for the practitioner, the institutions may terminate the counseling and require that both the counselor and the client see the supervisor (Gobbard, 2016). Additionally, the patient may be transferred to a different counselor after the termination of the previous arrangement. This way, the organizations protect themselves from potential legal liability should the violation result in a lawsuit.
The professionalism of the counselors can be questioned as legitimacy and credibility are ruined. According to Alpert and Steinberg (2017), some people may question whether the sexual feelings of counselors are abnormal and how much of these feelings are shared with the clients. In this case, breaking these relations can be detrimental to both the patient and the practitioner. Tensions can emerge between the two, which undermines the capacity of the counselor to continue offering the services. Should such behavior become extreme, it can be argued that practitioners will ruin their profession since they cannot build extended professional relationships with their clients. Continuous violation of boundaries can also affect the licensing and the careers may be effectively ruined.
Impact on Client, Councilor, and Counselling Relationship
Boundary violations can be extremely harmful to the clients, especially those who have their vulnerabilities exploited. As mentioned earlier, counselors are in a position of power, which means that violations of boundaries can be interpreted as an abuse of power (Williams & O’Connor, 2019). The counselor becomes an abuser who pursues selfish interests as opposed to fulfilling the fiduciary duty to the client. For example, the practitioners may make sessions unnecessarily longer and make pointless appointments even when the goals of treatment have been achieved. In this scenario, the client ends up suffering financially since the sessions have to be paid. Additionally, more of their time is wasted through prolonged sessions. Should the sexual relationship end, the emotional damage done to the client can be extreme, which would require further counseling. Therefore, the client becomes the ultimate victim in the case of boundary violation.
Litigations and the resulting legal liabilities can cause an end of a counselor’s career depending on the degree of violation. Licensing may be lost alongside the credibility of the practitioner and that of the organization. Such violations can become a matter of public knowledge, which harms the image of the entire practice in the eyes of the public. Therefore, many clients will become reluctant to seek counseling services for fear of being exploited by rogue counselors. The rationale is that many victims of violations are extremely vulnerable and their decisions are not well-informed. A false sense of security or solace could lead to mistakes, which could cause further hurt the client more once they become sobber. Tainting the image of the practice can be detrimental to the whole society as the intention of people to seek the services decline.
Client Rights to Access Records
Definition and Explanation
Counseling practitioners often keep records of the sessions, which is often standard practice. According to Bhaskaran and Seshadri (2016), the notes may contain the key themes, private data, detailed accounts of the sessions, the practitioner’s hypotheses and judgments, or even information about other people in the client’s life. Regardless of what is contained in the notes, the clients often have a right to access them, something which raises problems with practitioners who often find it difficult. Refusing to grant clients access to the notes can be considered a violation of their rights, which can present many legal issues as stipulated in the Health Insurance Portability and Accountability Act (HIPAA) (Neukrug & Fawcett, 2016). A sample case scenario of this violation can be illustrated using the case of Helen, a divorced lady seeing a counselor discuss her emotions and issues relating to child custody.
Helen is recently divorced and is dealing with a custody issue pending in court. She finds the pressure to be extreme and feels emotionally affected. She sees a counselor, Maureen, about the problem where she mostly talks about her ex-husband. Additionally, she expressed problems managing their childâs behavior. With the custody case pending, she fears that the court could subpoena her notes and asks Maureen not to provide the notes or testify against her in court. Additionally, she requests the session notes, for which Maureen denies claiming that she does not release clinical notes to her patients. From this case, it can be argued that Maureen violates Helen’s rights to access the records.
Professional and Legal Implications
Client records remain a sensitive issue since ethical and legal problems tend to arise. As per ACA guidelines, counselors are obligated to provide reasonable access to copies and records of sessions when requested by the clients. The term reasonable can seem controversial since it can be interpreted in many ways. For example, it can be interpreted to imply âwatered downâ notes that have been simplified for the client (Chimowitz et al., 2020). Alternatively, it might mean the original notes or the hypotheses and judgments made by the client. Even with the legal requirement, it is important to understand that the right to the notes cannot be considered absolute. In other words, such clients as Helen are facing major emotional and psychological issues and the original counselor notes may make it worse for the client after learning the truth about herself. This is indeed an argument that can be presented in the course or licensing board since the practitioners have a fiduciary duty to the clients, which includes protecting them from any form of harm. Professionally, a fall-out with clients is a possibility, which means a counselor can easily lose clientele.
Impact on Client, Councilor, and Counselling Relationship
A violation of the client’s rights to access counseling records can leave them frustrated and dissatisfied with the service. Some scholars believe that accessing the notes helps improve satisfaction, reinforces the client-practitioner relationship, and helps improve acceptance among the clients (O’Neil et al., 2019; Smith et al., 2021). In addition to being dissatisfied, the counseling relationship is damaged since the patients will no longer trust the practitioner. Additionally, both the staff and the organizations could face litigations and subpoenas, which could result in a bad reputation. For independent practitioners, litigations and lawsuits could also damage their careers and credibility. Licensing of counselors is often a major threat to practitioners, some of whom remain inclined to fulfilling the legal minimums. Considering the legal implications and interpretation problems, a practitioner needs to make sure the ACA code is followed, alongside all obligations under the HIPAA.
References
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