Robin was admitted to an intensive residential facility for drug addiction. The Health Insurance Portability and Accountability Act, a federal statute, requires counselors to give clients access to their records. Five moral principles are viewed as the foundation of ethics in counseling: autonomy, nonmaleficence, beneficence, justice, and fidelity. Ethical decision-making models include the following common steps: identify the problem, consult the ACA Code of Ethics, consequences of actions, and course of action.
Keywords: ethics, release of records, moral principles
Ethical Decision-Making in Counseling Addicts
Ethics is the foundation of the mental health profession. Regardless of the specific work environment, counselors encounter ethical dilemmas every day. Ethical decision-making can be a complicated process. A lot of ethical questions and dilemmas rarely have a single correct answer (Remley & Herlihy, 2014). The Code of Ethics are an excellent tool to utilize but cannot completely resolve ethical issues. To assist mental health professionals’ ethical decision-making models were constructed. Most models include the following common steps: identify the problem, consult the ACA Code of Ethics, consequences of actions, and course of action. Counselors must be able to reason ethically through stressful situations and determine the most appropriate course of action that ultimately is in the best interest of the client (Levitt & Moorehead, 2013). Identify the Problem
Robin is a client at a residential facility for drug addiction. She has been administered three assessments during therapy that include the Beck Depression Inventory, the Minnesota Multiphasic Personality Inventory, and the Substance Abuse Subtle Screening Inventory. The Beck Depression Inventory is a 21-item self-report scale used to determine the severity and intensity level of the symptoms of depression (Farinde, 2013). The Minnesota Multiphasic Personality Inventory is a psychological examination that measures personality traits and psychopathology. It is mainly intended to examine individuals who are suspected of having mental health or other clinical issues (Austin, 1994). The Substance Abuse Subtle Screening Inventory is a short psychological evaluation that is available in two distinct forms. One for adults and the other is for children. The Adult SASSI helps recognize people who have a high probability of having a substance dependence disorder. The Adolescent SASSI is designed to detect individuals who have an increased chance of having both a substance abuse and substance dependence problem (Miller, 1999). Robin was denied her client records and any explanation of her assessment results by her therapist upon her request. Apply the ACA Code of Ethics
Prior to any type of test assessment clients have the right to decide whether or not to participate and to be informed of the nature and purpose of the test and how the results will be utilized (ACA Code E.3.a). Counselors need to respect that clients have the right to receive feedback from the results, the inferred analysis, and the foundation for any conclusions and recommendations made by the counselor (ACA Code E.1.b). If a client request access to their records a counselors will provide assistance in clarifying those counseling documents (ACA Code B.6.e). However, a counselor should consider the client’s welfare when determining who receives the results of a test assessment and refrain from making a diagnosis if it could bring harm to the client (ACA Code E.3.b & E.5.d). If a client could experience harm by reviewing counseling records, practitioners may limit the client’s access. Documentation of the request of the records and refusal should be noted in the file (ACA Code B.6.d). Determine the nature and dimensions of the dilemma
Robin was entered into a rehabilitation facility for drug abuse. It is unclear whether or not it was a voluntary commitment. The principle of respect for autonomy would support conceding to Robin’s request of showing her the results of her test assessments. However, given her drug addiction she may not have the ability to make judicious decisions. I believe that when Robin is outside of the facility seeking treatment, autonomy will be more of a focus. Nonmaleficence is a factor and a principle that does apply to this specific situation (Remley & Herlihy, 2014). Robin has requested her records and has been denied. She is confused and does not know why she was given the different assessments or what they mean. Denying her request could potentially harm her. On the other hand, beneficence reflects the counselor’s responsibility to promote mental health and the wellness of the client. Giving Robin the results at this time could worsen her drug addiction impending a diagnosis with a potential stigma. Robin has been advised by her therapist that she is not allowed to see the results of her examinations or any part of their records, so justice does not factor into this situation.
Not showing records to clients’ sounds like a policy within the facility and unbiased treatment of all clients. Fidelity is related to maintaining trust in the counseling relationship. During informed consent, a discussion should have taken place in the test assessments and whether or not results would be discussed. Fidelity would apply in this situation if the client does not trust the counselor and if the counselor did not honor the commitment of disclosing the results (Neukrug, 2014). I feel that both beneficence and nonmaleficence are equally weighted in this situation. The regulations in the state of Virginia require only that a counselor needs to be able to explain how services provided to the client were for therapeutic or diagnostic purposes (Virginia Board of Counseling, 18VAC115-20-130). Generate potential courses of action
The therapist could continue to neglect Robin’s request by prohibiting her to see her results. The counselor could respect Robin’s wishes and allow her to view her records. The facility/counselor could disclose the results to a family member or guardian. Have a consultation with the facility as her counselor and advise them the best decision for the preservation of the counseling relationship is to break policy and release the records to Robin. It might be appropriate for the counselor to let Robin see her records but omit material that could be possibly detrimental. Robin and her counselor could have an open discussion and explain why it is best for Robin not to view her records. Keep a careful balance, honoring the client’s request of disclosing the reason for the test assessments and the facilities policy of not showing the Robin her records. Consider the potential consequences of all options and determine a course of action
If Robin is not allowed to view her results or records, she may become upset and refuse to continue treatment in the facility. Leaving the facility could lead her to continue her drug addiction. Also, Robin could file suit against the counselor. The Health Insurance Portability and Accountability Act, a federal statute, requires counselors to give clients access to their records. However, subpoena of test records is one of the most controversial and difficult issues concerning the release of records because the release of test data involves copyrights laws (Remley & Herlihy, 2014). On the other spectrum, Robin views her records. Some of the practitioner’s annotations could seem inaccurate or ambiguous if taken out of context. Robin could be harmed by the misunderstanding of technical professional information within her records. She may not know how to deal with the information and could cause additional emotional stress. By the counselor releasing her records and results to Robin, the facility could find the counselor in violation of policy and be fired or reprimanded.
Unless Robin is not capable of making her own decisions, releasing her records to family could be in violation of confidentiality unless it was predetermined with written consent by Robin for the release of information. Also, releasing the information to relatives could be detrimental to Robin if it were something in the records she did not want anyone to know. By taking Robin’s request to the facility, the counselor is possibly relinquishing any responsibility in the counseling relationship and letting the employer dictate the course of therapy. The counselor is reducing their chance of having a lawsuit brought against them specifically but also bringing harm to Robin because the focus is on the well-being of the counselor. Allowing Robin to see her records with the damaging material omitted might seem appropriate for the practitioner because the revelation of such material would serve no useful purpose and could increase emotional distress without an immediate constructive purpose.
However, missing information could be confusing to the client and could have repercussions for the counselor with the employer. The practitioner could have an open discussion with Robin explaining why it is not a good time for her to view those results. It would allow Robin to trust the counselor thus preserving and nurturing the counseling relationship which is of primary importance. Unfortunately, Robin could still request to see her records. Lastly, the counselor could honor Robin’s request of explaining the tests that were given and the results. A face-to-face conversation with Robin regarding the test results allows the counselor to expand on any infallible information and educate Robin on the limitations of tests. A dialog with Robin can shed light on any unclear or unexpected test results. This discussion does not violate policy explicitly and allows Robin to know her results (Remley & Herlihy, 2014). Evaluate the selected course of action
A decision about the best course of action is one that honors honesty, benefits the client, does no harm and can be justified by the profession (Van Hoose & Paradise, 1979). In Robin’s situation, there are a lot of factors to take into consideration and in my opinion and the decision I would make is to combine the different courses of action. Immediately after Robin’s request I would have advised her of the policies of the facility. I believe it is good practice to be open and allow the client in the decision-making process. Additionally, I would notify her I would discuss the matter with my employer. I would then consult with my supervisor to address the concerns about withholding the information from Robin and to receive unbiased feedback. At that time, I believe my employer could agree that Robin has the right to review her records and be adequately informed of any test assessments that were given.
I would then have a face-to-face sit down with Robin to review her records to offer elaboration, explain technical terms, and deal with any feelings she might present during the disclosure of the information. I would be careful only to present the material that benefits Robin and would do no further harm. I believe in Robin’s case, withholding the information was doing more harm to her than explaining the results. The results could help her understand her drug addiction. In my personal experience working with addicts, sometimes there is confusion as to why they abuse substances and usually is the result of an underlying issue they are not aware of. Knowing that reason can lead to successful rehabilitation. I believe I would treat further clients with the same regard, and I would advise other counselors to do the same. As a profession, to give this much consideration and thought to a client is something to be proud of, and I would be ecstatic with the community knowing what that entailed.
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