Confidentialityis a primary factor of consideration in counseling and therapy. Theethical provisions governing therapists require them to treat anyinformation derived from their clients with utmost confidence toavoid it landing it the wrong hands. The rationale for this is thatnot all people have interests in the well-being of an individual.Some may want the information for personal use in research or even toridicule a patient (Sullivan et al., 2002).Whatever ensues in thetherapy room remains there. The assurance of non-disclosure ofinformation instigates the clients to open up to the therapists, andthis is crucial in determining the outcomes of the process. It wouldbe unwise to work with an uncomfortable client since they will bemaking surprise confessions every time, and it would be difficult forthe professionals to have a one-time comprehensive approach to theirproblem.
Accordingto Donner et al. (2008) the American Psychological Association insection 4.01 prohibits professionals to disclose their clients’information to other parties. Other than sharing the information withother parties in parallel practice for the good of the client and thepublic, the law might require the information to facilitate the dueprocess. For example, adolescents who get on the wrong side with thelaw may be required by the court to provide information about theirbehavioral background. The counselor may attest in court on suchincidences. Parents might also be involved in children’s therapysince they are the technical custodian of the children (Pipes et al.,2008). The insurer might also require the opinions of psychologistsand the presentation of their clients’ information to facilitatethe compensation process. A good example is the case of terrorism acton the World Trade Center where many people suffered mentalillnesses. The therapists had to contravene the ethics and presentthe information to the insurance firms for compensation purposes.
Amajor dilemma that therapists encounter is dealing with adolescents.Clients from this group are not of legal age, and they rely on theirparents (Sullivan et al., 2002).On the other hand, they have to enjoyall the privileges given to clients and to ensure positive outcomesfrom the process (Pipes et al., 2008). Confidentiality is, therefore,paramount when it comes involving adolescents in therapy. Zora’scase presents such a dilemma. She is a multi-ethnic adolescent who isat loggerheads with her parents. She is abusing marijuana, Percocet,and Oxycontin. She is also pregnant, and she does not know whether toabort or to give birth. She falls in the hands of a Caucasianpsychologist who seeks help from a peer evaluator who happens to beher mother’s friend.
Confidentialityis of utmost importance in this case since the adolescent is at riskof ruining her relationship with her parents and lose herself todrugs. The first ethical contravention that appears, in this case, isthe prejudiced attitude of the Catholic psychologist who does notfathom the idea of Zora considering abortion. Any efforts to counselher would, therefore, be biased. To open up to her, the professionalshould not show any signs of conclusive views. A study conducted bySullivan et al. (2002) on 200 pediatric psychologists found out thatmost of them perceive adolescents between the ages of 14 to 15 yearsare considered able to make informed decisions just like adults afteraccessing the right information (Sullivan et al., 2002).The otherpeer evaluator who accesses the information knows her parents toowell and she is surprised that Zora is pregnant and in drugs. Sheconsiders the options of telling Zora’s parents about theirdaughter’s condition and the effect of her actions on Zora’ssituation.
Thereis a possibility of cultural conflict between the Caucasianpsychologists and Zora. There is a high possibility that the two donot relate comfortably concerning Zora’s parents strict oppositionagainst her relationship with a Caucasian boyfriend. There may beaspects of contempt borrowed from the cultural background that mightinterfere with the process. Although psychologists have to beculturally competent, the traces of the ingrained feelings ofcultural differences might persist. Involving an African Americancounselor puts her in the right context since the counselorunderstands her family background.
However,the confidentiality of the information is at risk since it is now inthe custody of two parties. Sullivan et al. (2002) sought the opinionof 200 psychologists and found out that counselors may shareinformation about clients’ situation but only for the purposes fthe therapy (Sullivan et al., 2002). The information should not besubject to any other application that may hinder the therapy process.The African American psychologist is a close family friend, and shemight pre-empt the efforts of her colleague. The feeling of havingher friend’s daughter at the risk of drugs and aborting withoutthem having any information may compel her to inform them. On thesame note, there is a possibility of Zora knowing the relationshipbetween her and her parents. The knowledge of her situation coming tolight of her mother’s friend may make her recoil and withhold anyother information, and this might affect the outcomes of the therapy.
First,confidentiality is imperative for the counselor to observe since Zoraneeds to forge a rapport between her and the professional. It is onlypossible if she can trust the counselor with all the information shegives. The factors contributing to her situation are what her parentswere opposing. The absence of a third party in this process wouldallow any non-judgmental approaches (Sullivan et al., 2002).An earlydisclosure of information to her parents might interfere with theprocess since her deviant behavior led to her pregnant situation andabuse of drugs. Whenever there is a conflict between an adolescentand their parents the psychologists should place their attention inthe best interest of the adolescent. Sometimes, parents can also bethe cause of the conflict and psychologists cannot sideline thisfact.
Disclosingthe information might ruin the relationship between Zora and herpsychologist. Zora might not be comfortable with the idea of herparents knowing about what transpired from her deviant behavior. Itmay lead to missing out on the therapy and may fail to confide in heranymore.
Anotherfactor that requires utmost confidentiality is Zora’s undecidedstate of whether to procure an abortion of delivering the child. Thecounselor should provide the right information and the effects ofeither option (Fisher, 2008). Disclosure of the information to herparents might be biased. As mentioned, at her age, she can makeinformed decisions with some guidance. If she considers abortion, andthen the situation may warrant the counselor to involve her parentssince they have a right to know about the health of their children.It would be ethically unfulfilling to perform the abortion with theoblivion of the parents on the matter.
However,there is an ethical dilemma of disclosing Zora’s abuse of drugs.Fisher (2008) provides information that it is common forpsychologists to share information when they encounter ethicaldilemmas. The severity of the risk involved warrants the psychologistto disclose some information about the situation at the rightjuncture. Since she is abusing three different drugs, she is at riskof becoming dependent. Abusing marijuana doubles as a severe tendencyand keeping the parents in the dark may be unethical. AdolescentCounselor group behaviors into different groups based on theirseverity and they use different approaches to them.
Ibelieve that the situation presented by Zora cannot be subject tototal confidentiality without the involvement of a third party. Theimperative approach is to have the African American cease fromsharing any information with the parents if not for the purpose ofthe therapy (Donner et al., 2008). The abuse of marijuana may havedetrimental effects on her life, and it would be a considerable moveto have the parents participate in the recovery process. If sheprefers to have an abortion, the parents have to be aware of theprocess since it is a major reproductive health process. On the otherhand, if she considers giving birth, her parents would be the firstsupportive party. Therefore, the counselor should involve them at theright time and try to create a supportive relationship between them.
Inconclusion, confidentiality of the information that clients give totheir counselor assists in designing an approach that best solvestheir problems. They should, therefore, assure them of this ethicalattribute to allow them open up to the last detail (Fisher, 2008).Counselors should avoid disclosing the information irresponsiblyunless for the purposes of the therapy or legal purposes. However,they should assess the severity of the client’s behavior and thelikelihood of having effects on other parties. Adolescent Counselingpresents a dilemma to many psychologists in determining what todisclose to the parents and at what juncture. Determining theseverity of the behaviors can help to settle on the idea of whetherto involve the parents actively or passively.
Donner,M. B., VandeCreek, L., Gonsiorek, J. C., & Fisher, C. B. (2008).Balancing confidentiality: Protecting privacy and protecting thepublic. Professionalpsychology: Research and practice,39(3),369a.
Fisher,C. B. (2008). The APA Ethics Code and the need for balancedconfidentiality and disclosure decisions in psychotherapy.ProfessionalPsychology: Research and Practice, 39(3), 375-376.
Fisher,M. A. (2008). Protecting confidentiality rights: The need for anethical practice model. AmericanPsychologist,63(1),1.
Pipes,R. B., Blevins, T., & Kluck, A. (2008). Confidentiality, ethics,and informed consent.American Psychologist, 63(7), 623-624.
Sullivan,J. R., Ramirez, E., Rae, W. A., Razo, N. R., & George, C. A.(2002). Factors contributing to breaking confidentiality withadolescent clients: A survey of pediatric psychologists. ProfessionalPsychology: Research and Practice,33(4),396.