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Ethics & Behavior

ISSN: 1050-8422 (Print) 1532-7019 (Online) Journal homepage: https://www.tandfonline.com/loi/hebh20

Confidentiality of Adolescent Risk-Taking


Behaviors: A Survey of Turkish School Counselors

Rahsan Sivis-Cetinkaya

To cite this article: Rahsan Sivis-Cetinkaya (2018): Confidentiality of Adolescent Risk-


Taking Behaviors: A Survey of Turkish School Counselors, Ethics & Behavior, DOI:
10.1080/10508422.2018.1469089

To link to this article: https://doi.org/10.1080/10508422.2018.1469089

Accepted author version posted online: 27


Apr 2018.
Published online: 21 May 2018.

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ETHICS & BEHAVIOR, 00(00), 1–14
Copyright © 2018 Taylor & Francis Group, LLC
ISSN: 1050-8422 print / 1532-7019 online
DOI: https://doi.org/10.1080/10508422.2018.1469089

Confidentiality of Adolescent Risk-Taking Behaviors: A


Survey of Turkish School Counselors
Rahsan Sivis-Cetinkaya
Department of Guidance and Counseling
Uludag University

The present study investigated school counselors’ ratings of the importance of factors in deciding to
report adolescent risk-taking behaviors to parents. Turkish school counselors (N = 346) were surveyed.
Differences based on gender, years of experience, level of education, attendance of a counseling ethics
course, and geographic region were investigated. Mann-Whitney U and Kruskal Wallis tests were used in
data analysis. Protecting the student was the highest rated factor. Women and those who took an ethics
course rated protecting the student higher than others. Implications for counseling ethics training are
discussed, and recommendations for future research are outlined.
Keywords: school counseling, counseling ethics, confidentiality, adolescent risk-taking behaviors

Confidentiality is a key principle of the helping relationship for mental health professions, wherein
clients have confidence that the information they provide will be kept confidential by mental health
professionals. Nonetheless, limitations do apply to confidentiality, and mental health professionals
are required to breach confidentiality in certain situations. The ethics codes for prominent organiza-
tions of mental health professionals in the West all emphasize a duty to protect clients or identifiable
others from serious harm or danger and recognize limits to confidentiality when the law requires
disclosure (American Counseling Association [ACA, 2014]; American Psychiatric Association,
2013; American Psychological Association, 2017; Australian Psychological Society, 2007; British
Association for Counselling and Psychotherapy, 2016; British Psychological Society, 2009;
Canadian Counselling & Psychotherapy Association, 2014). Some codes also emphasize the
importance of discussing with all clients (including, as much as possible, people who are legally
incapable of consenting) all relevant limits to confidentiality as part of the informed consent and
assent process (e.g., American Psychological Association, 2017).
The ethics codes for Turkish mental health professionals have similar requirements regarding
confidentiality. For instance, ethical codes for Turkish psychologists (Turkish Psychological
Association, 2004) stipulate breach of confidentiality for legal requirements, in cases involving
harm toward the client or others, and in any instance of child abuse. Likewise, the Turkish Guidance
and Counseling Association (TGCA; 2006) code of ethics requires counselors to breach confidenti-
ality when there are legal requirements to do so or when there is clear danger or harm toward the

Correspondence should be addressed to Rahsan Sivis-Cetinkaya, Faculty of Education, Guidance & Counseling,
Uludag University, Gorukle 16059, Turkey. E-mail: rahsansivis@yahoo.com
2 SIVIS-CETINKAYA

client or others. In a similar vein, the ethics codes for Turkish psychiatrists (Psychiatric Association
of Turkey, 2002) demand breach of confidentiality when patients pose a physical, mental, or
economic harm toward themselves or others or when the law requires a breach of confidentiality.
Breaching confidentiality is particularly complicated for those mental health professionals such
as school counselors, who work with minors. School counselors work with minors on a daily basis
and are ethically responsible to both students and their parents. To date, the ACA (2014) requires
counselors to both protect the confidentiality of information received in counseling relationships
with minor clients and respect parents’ legal rights to such information. Similarly, the American
School Counselor Association (ASCA, 2016) necessitates that school counselors be responsible to
both students and their parents and that school counselors be required to balance minors’ ethical
rights to confidentiality and parents’ legal rights to information regarding their children. The
ASCA (2016) code of ethics requires that school counselors inform parents when there is risk of
serious and foreseeable harm to self or others.
Keeping minor clients’ information confidential can be particularly challenging in situations
involving adolescent risk-taking behaviors. Adolescents, persons 10–19 years of age, as defined by
the World Health Organization (2018), are developmentally prone to engage in risk-taking behaviors
during this transitional stage (Fingerman, Berg, Smith, & Antonucci, 2011; O’Donohue, Benuto,
& Tolle, 2014). Risk-taking behaviors are defined as behaviors that one knowingly chooses that bear
uncertain and mostly negative consequences, such as smoking, alcohol consumption, substance abuse,
reckless driving, self-mutilation, suicidal ideation or attempt, engagement in risky sexual behaviors,
and performance of criminal acts (Carroll, Houghton, Durkin, & Hattie, 2009; Levesque, 2014).
Several authors (Glosoff & Pate, 2002; Schneider Corey & Corey, 2007; Studer, 2015) agree that
adolescent clients usually disclose information regarding such risk-taking behaviors during counseling
sessions, and school counselors are frequently faced with the dilemma of whether to breach
confidentiality.
Despite the reporting of students’ risk-taking behaviors to parents being frequently cited as a
prevalent dilemma experienced by school counselors (Jungers & Gregoire, 2013; Kolbert, Williams,
Morgan, Crothers, & Hughes, 2016; Stone & Dahir, 2015), empirical research addressing this
phenomenon is rather limited. The bulk of research regarding this issue has been conducted with
samples of psychologists working in school settings or other mental health professionals who counsel
adolescents (Duncan, Hall, & Knowles, 2015; Goesling, Potts, & Handelsman, 2000; Mendes,
Nascimento, Abreu-Lima, & Almeida, 2016; Rae, Sullivan, Razo, & Alba, 2002; Rodriguez, Fang,
Gao, Robins, & Rosenthal, 2016; Tryon, 2000). Some qualitative studies (Har & Jusoh, 2015;
Trice-Black, Riechel, & Shillingford, 2013) with small sample sizes have investigated how school
counselors deal with the issue of confidentiality with school administrators. Only a handful of empirical
studies in the international counseling ethics literature have specifically addressed school counselors’
reporting of students’ risk-taking behaviors to parents. Our current understanding of how school
counselors decide whether to report adolescent risk-taking behaviors to parents is limited.
In an early study conducted with 627 school counselors, Isaacs and Stone (1999) found that
participants considered breaching minor clients’ confidentiality in cases of suicide risk, violence
victimization, substance abuse, theft, depression, and abortion. Bodenhorn (2006) found in a
survey study of 92 school counselors that the most common and challenging ethical dilemmas
concerned finding a balance between keeping information about adolescents’ risk-taking beha-
viors confidential and parents’ legal rights to such information. In another survey study with a
sample of 195 school counselors, Lazovsky (2008) found that counselors mostly breached
CONFIDENTIALITY OF ADOLESCENT RISK-TAKING BEHAVIORS 3

confidentiality in cases involving risk-taking behaviors. In a phenomenological study, Atanasov


(2016) interviewed 10 high school counselors who worked with adolescents who abused drugs.
Participants cited drug use severity, frequency, and context as determinants in deciding to breach
confidentiality. Similarly, in a recent vignette study conducted by Llyod-Hazlett, Moyer, and
Sullivan (2017), the results from a sample of 208 prospective counselors showed that the
participants were more likely to report student risk-taking behavior to parents with increased
duration, intensity, and frequency of the behavior or when the behavior involved self-harm. In
another qualitative study, Jenkins and Palmer (2012) interviewed a small sample of six school
counselors and found that participants mostly maintained confidentiality regarding students’
risk-taking behaviors in order to not interrupt the counseling process.
In a landmark study, Sullivan and Moyer (2008) specifically examined factors influencing school
counselors’ decision to report student risk-taking behaviors to parents. Survey results from a sample
of 200 school counselors revealed that the apparent seriousness of the risk-taking behavior received
the highest rating as an extremely important factor by 80% of the participants, followed by protecting
the student (79.5%), and intensity of the risk-taking behavior (72.5%). Gender (60%) and age (24%)
of the student were rated as extremely unimportant in this study. This rare study provides insight into
school counselors’ ethical reasoning and their judgments, such as identifying their prioritization of
certain factors in deciding to report students’ risk-taking behaviors to parents.
The counseling ethics literature suggests that in general there are differences among counselors with
regard to ethical reasoning. Gender differences have been observed in several studies (Gibson & Pope,
1993; Neukrug & Milliken, 2011; Nigro & Uhlemann, 2004; Sivis-Cetinkaya, 2015a), with women
being more likely to comply with the ethics of their professions compared to their male counterparts.
Significant differences (Downs, 2003; Sivis-Cetinkaya, 2015a) in the ethical judgment of counselors
regarding confidentiality have also been observed among counselors who took counseling ethics as a
course compared to those who did not, with those who took an ethics course being more likely to abide
by the ethics of their profession. Counselors’ level of education in connection to their ethical judgments
was also investigated in a limited number of studies, with results suggesting that participants with
graduate degrees were more likely to comply with the ethics of their profession than those with
undergraduate degrees (Gibson & Pope, 1993; Neukrug & Milliken, 2011; Sivis-Cetinkaya, 2015a).
The role of years of experience in counselors’ ethical reasoning seems yet to be addressed in counseling
research.
In Turkey, all undergraduate counseling-related programs are titled Guidance and Psychological
Counseling (GPC), and most—if not all—graduates work as counselors in school settings. The Turkish
Council of Higher Education (2007) requires that all GPC undergraduate programs offer an obligatory
counseling ethics course entitled Ethical and Legal Issues in Counseling. In addition to their ethical
obligations, Turkish school counselors have legal and institutional obligations concerning breach of
confidentiality. Legally, Turkish Criminal Law (2004) mandates every citizen to report child sexual
abuse, and those employed at government institutions (including school counselors) have increased
liability. Turkish Criminal Law (2004) defines possession and trade of illegal drugs as a crime;
therefore, reporting such crime is also mandatory for all citizens. The same law demands parental
consent in cases involving minors’ reproductive rights, such as abortion. In terms of institutional
legislations, the Ministry of National Education Disciplinary Regulations for Students (2007) entails
expulsion from school in cases of possession and abuse of illegal drugs, gang membership, and theft.
Smoking and possession of tobacco products or gambling is punishable by written condemnation,
whereas being involved in violent acts and causing personal injury requires short-term expulsion from
4 SIVIS-CETINKAYA

school. According to the Ministry of National Education Disciplinary Regulations for Students (2007),
all school staff, including school counselors, have a duty to ensure that students abide by these
regulations.
Despite having been introduced into the field of counseling in Turkey over a decade ago,
empirical research regarding counseling ethics in Turkey is extremely scarce. Empirical studies
regarding confidentiality in school counseling practices is even scarcer. In a critical incidents study,
Sivis-Cetinkaya (2015b) found that the majority of dilemmas experienced by counselors were
related to confidentiality (56.4%) in school settings, with 35% related to adolescent risk-taking
behaviors. In another rare study with a Turkish sample, Kolay-Akfert (2012) found that the most
cited category of ethical dilemmas by counselors concerned confidentiality (72%), 39% of which
were experienced by school counselors regarding adolescent risk-taking behaviors. Even a very
limited number of studies show that Turkish school counselors struggle with issues regarding
confidentiality surrounding adolescent risk-taking behaviors. Thus, it seems worthwhile to gain
insight into factors influencing Turkish school counselors’ decision to report adolescent risk-taking
behaviors to parents.
The purpose of this study was to examine Turkish school counselors’ ratings of the importance of
certain factors in deciding to breach confidentiality and report adolescent risk-taking behaviors to
parents. To do this, the present study translated Sullivan and Moyer’s (2008) survey instrument into
Turkish. Examining Turkish school counselors’ prioritization of certain factors that play into their
decision to report adolescent risk-taking behaviors to parents could make several contributions to the
research and practice of counseling ethics. First, findings can be informative for the development of a
more culturally relevant, research-based code of counseling ethics in Turkey. Drawing commonalities
and differences between the findings of the original Sullivan and Moyer survey study and this study
using the same survey can help researchers understand the transculturality of specific factors across
different nations, such as the United States and Turkey. Examining which factors influence school
counselors’ decisions to breach confidentiality seems to be a rather neglected area of research in the
counseling literature. The present study is expected to fill this gap, both in the international and national
counseling ethics literature. Translating the survey into Turkish will also benefit future counseling
ethics research in Turkey, which suffers from a lack of measurement instruments.
The present study aimed to examine Turkish school counselors’ ratings of the importance of
factors when deciding whether to breach confidentiality and report students’ risk-taking behaviors to
parents. For this purpose, the survey instrument from the original study (Sullivan & Moyer, 2008)
was translated into Turkish. Factors receiving the highest and lowest ratings were identified.
Associations between the factors given in the survey and participants’ gender, years of experience
working with adolescents, level of education, whether they had taken counseling ethics as a course
during their education, and geographic region of work setting were also investigated.
The research questions investigated in this study were as follows:
RQ1: Which factors were mostly rated as extremely important and extremely unimportant?
RQ2: Is there a significant difference between participants’ ratings of the items with respect to gender?
RQ3: Is there a significant association between participants’ ratings of the items and their years of
experience working with adolescents?
RQ4: Is there a significant association between participants’ ratings of the items and their level of
education?
CONFIDENTIALITY OF ADOLESCENT RISK-TAKING BEHAVIORS 5

RQ5: Is there a significant difference between participants’ ratings of the items with respect to
whether they had taken counseling ethics as a course during their education?

RQ6: Is there a significant difference between participants’ ratings of the items with respect to
geographic region of their work setting?
RQ7: What are some other additional factors cited by participants as extremely important?

METHOD

Participants

Participants comprised a convenience sample of 346 Turkish school counselors currently working in
school settings all over the seven regions of Turkey. Participants responded to an online survey
instrument, and due to the online nature of the data collection, the sample was limited to only those
school counselors who had Internet access. Participants included 233 women (67.3%) and 113 men
(32.7%). The proportion of male and female participants in this study are similar to the gender
distribution portrayed by the membership statistics of the TGCA (2013), with men making up 39%
and women 61% of total membership. Table 1 provides a summary of participants’ demographic

TABLE 1
Participants’ Demographic Characteristics

Characteristics n % of Responses

Gender
Male 113 32.7
Female 233 67.3
Age
20–29 198 57.2
30–39 103 29.8
40–49 37 10.7
50+ 8 2.3
Years of experience
Less than 1 year 51 14.7
1–5 years 138 39.9
5–10 years 80 23.1
More than 10 years 77 22.3
Geographic region
Marmara 117 33.8
Mediterranean 50 14.5
Aegean 46 13.3
Black Sea 32 9.2
Eastern Anatolia 19 5.5
South Eastern Anatolia 34 9.8
Level of education
Undergraduate 282 81.5
Graduate 64 18.5
Total responses 346 100

Note. Percentages that do not add up to exactly 100 are due to rounding.
6 SIVIS-CETINKAYA

characteristics, such as gender, age, years of experience working with adolescents, geographic region
of work setting, and level of education.

Instruments

A translation of the survey instrument developed by Sullivan and Moyer (2008) was used to collect
data. The survey instrument was translated into Turkish by the researcher with the author’s permission
(J. R. Sullivan, personal communication, November 7, 2017). Five doctoral students with a good
command of English reviewed the translated survey items for expert judgment. They compared the
original and Turkish forms of the survey in terms of clarity, language equivalence, and cultural
relevance. The survey instrument was pilot tested for comprehension with 15 master’s students who
were all school counselors. Wording of the survey items were refined based on feedback from pilot
testing. The researcher chose to forego back-translation, as several researchers (Epstein, Osborne,
Elsworth, Beaton, & Guillemin, 2015; Epstein, Santo, & Guillemin, 2015; Mohler, Dorer, Jong, & Hu,
2016) suggest evaluating the quality of the translation directly instead of indirectly through a
back-translation. Cronbach’s alpha for the survey instrument in the present study was .75.
Each item asked respondents to rate the importance of a given factor when determining whether
to breach confidentiality to report adolescent risk-taking behaviors to parents. The 15-item survey
used a 5-point scale in determining one’s rating of the importance of a factor: 1 (extremely
unimportant), 2 (somewhat unimportant), 3 (neutral), 4 (somewhat important), and 5 (extremely
important). An open-ended optional item asked respondents to identify Other (if any) factors they
perceived as extremely important. There was also a personal information section that required
participants to provide demographic data, including gender, age, years of experience working with
adolescents, geographic region of work setting, level of education, and whether they had taken
counseling ethics as a course during their education.

Procedures

The researcher used an online survey form in Google Documents to collect data over the course of 1
month. The survey link was circulated widely on social media by a network of fellow counselor
educators and school counselors from different regions of Turkey. Potential participants were invited to
respond to the online survey on Facebook, WhatsApp groups, e-mail lists, and by word of mouth. The
survey was featured on a number of Facebook pages (such as Guidance and Counseling Careers,
School Guidance and Counseling Services, Guidance and Counseling Platform). Closed Facebook
groups (such as School Counselors, Psychological Counselors and a number of regional groups of
TGCA) were also used to recruit potential participants. Informed consent to participate in the research
was received online. Participants were informed that no discomfort was expected regarding survey
questions and that their responses would be kept confidential and would be used only for scientific
purposes. The researcher’s e-mail address was provided for further queries. The completion of the
online survey took approximately 5 min.

Data Analysis

Data were analyzed using SPSS, version 23. Descriptive statistics of frequencies and percentages of
item ratings were calculated. Each survey item was treated as a different variable with the survey
CONFIDENTIALITY OF ADOLESCENT RISK-TAKING BEHAVIORS 7

developer’s approval (J. R. Sullivan, personal communication, November 7, 2017), as it was deemed
more informative to do so. Nonparametric tests were used in the data analysis because items were
rated on an ordinal scale and data were ranked (Greene & D’Olieira, 2005; Nusbaum, 2015;
Privitera, 2014). Mann-Whitney U and Kruskal Wallis tests were used for group comparisons.
Eta-squared values were calculated to identify effect sizes for significant results from group
comparisons. Cronbach’s alpha was used to test the survey instrument’s internal reliability. The
alpha value for statistical analyses was .05. Additional factors provided by the participants in
response to the open-ended Other item were analyzed by the researcher.

RESULTS

Most and Least Important Factors

Of the 15 survey items, “Protecting the adolescent” received the highest rating (n = 310, 89.6%) as
extremely important, followed by “Upholding the law” (n = 213, 61.6%). “Not disrupting the
process of counseling” ranked third (n = 196, 56.6%), followed by “Apparent seriousness of the
risk-taking behavior” (n = 184, 53.2%). “Gender of the student” (n = 27, 7.8%) ranked first as
extremely unimportant. “Potential of risk-taking behavior to stop without telling parents” (n = 129,
37.3%) was the item most commonly rated as neutral. “Complying with school district policies”
(n = 97, 28%) ranked second in this category, followed by “Likelihood that student will continue
counseling after breaking confidentiality” (n = 95, 27.5%). Table 2 provides a summary of the
percentages of item ratings.

TABLE 2
Percentages of Item Ratings

% Responses

Items 5 4 3 2 1

1. Apparent seriousness of the risk-taking behavior 53.2 31.2 11.3 3.8 .6


2. The negative effects of reporting on the family 24.6 37.3 23.7 12.4 2.0
3. Confidence that risky behavior has actually occurred 51.7 27.7 11.6 6.9 2.0
4. Upholding the law 61.6 23.1 13.0 1.7 .6
5. Complying with school district policies 15.3 21.4 28.0 20.2 15.0
6. Protecting the adolescent 89.6 7.5 2.3 .3 .3
7. Avoiding legal problems for the adolescent 37.9 24.3 25.1 9.2 3.5
8. Not disrupting the process of counseling 56.6 22.8 15.0 4.0 1.4
9. Potential for risk-taking behavior to stop without telling parents 11.3 20.2 37.3 19.4 11.8
10. Likelihood that student will continue counseling after breaking confidentiality 28.9 24.6 27.5 15.0 4.0
11. Frequency of risk-taking behavior 42.5 32.4 14.2 8.4 2.6
12. Intensity of risk-taking behavior 48.0 32.1 11.0 7.2 1.7
13. Duration risk-taking behavior 44.5 32.9 12.7 8.1 1.7
14. Gender of the student 7.8 10.7 19.7 21.7 40.2
15. Age of the student 23.4 24.0 20.2 12.1 20.2

Note. N = 346. Rating scale: 5 (extremely important), 4 (somewhat important), 3 (neutral), 2 (somewhat unim-
portant), 1 (extremely unimportant). Percentages that do not add up to exactly 100 are due to rounding.
8 SIVIS-CETINKAYA

Group Differences Regarding Item Ratings

Gender

Results revealed that there were statistically significant gender differences with respect to ratings
of certain items. Female participants were more likely to rate “Complying with school district
policies” (M rank = 184.29, U = 10649.5, p = .003) and “Avoiding legal problems for the adolescent”
(M rank = 185.19, U = 10443.0, p = .001) highly than their male counterparts (M ranks = 151.24 and
149.42, respectively). Both of these differences were significant, with small effect sizes (η2 = .025
and η2 = .030, respectively).

Years of Experience

Participants were categorized based on their years of experience working with adolescents into
four groups: less than 1 year (14.7%, n = 51), 1–5 years (39.9%, n = 138), 5–10 years (23.1%,
n = 80), and more than 10 years (22.3%, n = 77). The results from Kruskal Wallis test showed that
there were statistically significant differences between ratings of the following items with respect
to years of experience: “Complying with school district policies,” “Potential for risk-taking
behavior to stop without telling parents,” “Likelihood that student will continue counseling after
breaking confidentiality,” “Frequency of risk-taking behavior,” and “Duration of risk-taking
behavior.” Table 3 provides a summary of chi-square values, significance levels, and effect sizes
regarding ratings of these significant items.
Post hoc analyses showed that participants with less than 1 year of experience and those with
more than 10 years of experience were more likely than other groups to rate “Complying with
school district policies” highly. Participants with less than 1 year of experience were also more
likely than other groups to rate “Frequency of risk-taking behavior” and “Duration of risk-taking
behavior” highly.

Level of Education

There were 282 (81.5%) participants with undergraduate GPC degrees and 64 (18.5%)
participants with graduate GPC degrees. Participants with an undergraduate GPC degree were

TABLE 3
Significant Items as a Function of Years of Experience

Items χ2 p η2

Complying with school district policies 14.488 .002 .042


Potential for risk-taking behavior to stop without telling parents 8.381 .039 .024
Likelihood that student will continue counseling after breaking confidentiality 12.633 .006 .036
Frequency of risk-taking behavior 9.093 .028 .026
Duration of risk-taking behavior 9.058 .029 .026

Note. N = 346, p < .05 (chi-square values, significance levels, and effect sizes of significant items with respect to
years of experience).
CONFIDENTIALITY OF ADOLESCENT RISK-TAKING BEHAVIORS 9

more likely to rate “Age of the student” highly (M rank = 178.47) than those with a graduate
GPC degree (M rank = 151.61), with a small effect size (U = 7623.000, p = .047, η2 = .011).

Taking Counseling Ethics as a Course

There were 312 (90.2%) participants who took counseling ethics as a course during their
education and 34 (9.8%) who did not. The results revealed that those who took counseling ethics
as a course were more likely to rate “Protecting the adolescent” highly (M rank = 175.42) than those
who did not (M rank = 155.91), with a small effect size (U = 4706. 000, p = .041, η2 = .012).

Geographic Region of Work Setting

The sample was composed of participants from all seven regions of Turkey: 117 from
Marmara (33.8%), 50 from Mediterranean (14.5%), 46 from Aegean (13.3%), 48 from Middle
Anatolia (13.9%), 32 from Black Sea (9.2%), 19 from Eastern Anatolia (5.5%), and 34 from
South-Eastern Anatolia (9.8%). The results showed that there were no statistically significant
differences between ratings of the items with respect to geographic region of work setting
(p ≥ .05 for all items).

Additional Factors Provided by the Participants

Few participants (n = 10, 2.9%) provided qualitative responses to the optional Other item, which
asked for additional factors that participants deemed as extremely important. Family’s potential
reaction (n = 6, 60%) was a leading factor cited by these participants, followed by the cultural
context (n = 2, 20%) in which the behavior occurred and the potential modeling effect of the
behavior on peers (n = 2, 20%).

DISCUSSION

The present study aimed to examine Turkish school counselors’ ratings of certain factors in deciding
whether to report adolescents’ risk-taking behaviors to parents. Factors with the highest and lowest
ratings were identified. Additional factors perceived as extremely important by the participants were
also identified. The role of demographic variables, such as gender, years of experience, level of
education, taking ethics as a course, and geographic region, was also investigated. The results
revealed that “Protecting the adolescent” and “Apparent seriousness of the risk-taking behavior”
were among the top four factors predominantly rated as extremely important. “Gender of the
student” ranked first as extremely unimportant. “Likelihood that student will continue counseling
after breaking confidentiality” was the most controversial factor in this study. Family’s potential
reaction ranked first among additional factors cited by the participants.
The results revealed that there were significant group differences between participants’ ratings of
specific items. Female participants were more likely than their male counterparts to rate “Complying
with school district policies” and “Avoiding legal problems for the adolescent” highly. Both the most
and least experienced participants were more likely than other groups to rate “Complying with
school district policies” highly. The least experienced participants were also more likely to rate
10 SIVIS-CETINKAYA

“Frequency of risk-taking behavior” and “Duration of risk-taking behavior” highly compared to


other groups. Participants with an undergraduate degree were more likely to rate “Age of the student”
highly than those with a graduate degree. Participants who took an ethics course were more likely to
rate “Protecting the adolescent” highly than those who did not.
Findings are in line with the original Sullivan and Moyer (2008) study, which found that
“Protecting the adolescent” and “Apparent seriousness of the risk-taking behavior” were among
the top four factors predominantly rated as extremely important. These factors seem closely related
to the professional ethics codes (ACA, 2014; ASCA, 2016; British Association for Counselling
and Psychotherapy, 2016; TGCA, 2006) requiring counselors to protect clients from serious and
foreseeable harm. Apparently, school counselors prioritize protecting their adolescent clients
(rated highest in this study and second in Sullivan and Moyer’s, 2008, study) over other factors
in their risk assessments. In line with previous research (Sullivan & Moyer, 2008) that used the
same survey, “Gender of the student” ranked first as extremely unimportant in this study. These
findings suggests a transculturality of the protection of the adolescent client as a priority for school
counselors in determining whether to report risk-taking behaviors to parents, and gender of the
student did not matter for the counselors in these studies. A gender bias among a Middle Eastern
sample of school counselors, such as the present study sample, could presumably be expected
(e.g., being more inclined to report risk-taking behavior to parents if the student was female).
However, similar to findings from a Western sample (Sullivan & Moyer, 2008), the results showed
that participants in this study did not perceive gender as an important factor in determining their
decisions to breach confidentiality.
“Likelihood that student will continue counseling after breaking confidentiality” was the most
controversial factor in this study. This finding could be attributed to school counselors’ struggle
with balancing the legal rights of parents to information about their children and minor clients’
ethical rights to confidentiality (ACA, 2014; ASCA, 2016). The ASCA (2016) further cautioned
that, after a risk assessment, even when the risk is low, it is too risky not to report to parents.
This finding may have implications for counseling ethics education. Prospective counselors
could be trained on conducting a risk assessment regarding breach of confidentiality to report
risk-taking behaviors to parents.
An additional open-ended item in the survey asked participants to cite other factors that they
perceived as extremely important, and participants in this study cited the family’s potential
reaction as an extremely important additional factor. Similarly, participants in the original
Sullivan and Moyer (2008) study cited a family-related factor among additional important
factors. It could be speculated that school counselors in both samples were aware of the risks
involved with reporting to parents in some families, with the potential for corporal punishment
or even more severe reactions that might be harmful to the adolescent.
The results revealed significant gender differences for the ratings of some items. Female participants
in this study were more likely to rate “Complying with school district policies” and “Avoiding legal
problems for the adolescent” highly than their male counterparts. These findings are in line with
previous research (Gibson & Pope, 1993; Neukrug & Milliken, 2011; Nigro & Uhlemann, 2004;
Sivis-Cetinkaya, 2015a) citing gender differences in ethical reasoning of counselors in general. As in
the aforementioned studies in which female participants were more likely to be in compliance with the
ethical requirements of their professions, female school counselors in this study could be more likely to
abide by the rules and regulations of their institutions than their male counterparts. In addition, female
participants’ higher ratings of “Avoiding legal problems for the adolescent” could be attributed to the
CONFIDENTIALITY OF ADOLESCENT RISK-TAKING BEHAVIORS 11

often speculated (Gibson & Pope, 1993; Neukrug & Milliken, 2011) relational, empathetic, and caring
nature of female moral/ethical reasoning.
Participants’ ratings of some items were also different with respect to their years of experience.
Both the most and least experienced participants in this study were more likely than other groups to
rate “Complying with school district policies” highly. This finding could be attributed to the
tendency of seasoned counselors to be more traditional and likely to abide by the policies of
supervisors or institutions in authority. The least experienced school counselors, a relatively naive
group, might have tended to avoid making decisions that could potentially conflict with supervisors
or institutions in authority in their initial years of employment. In addition, the least experienced
participants were more likely to rate “Frequency of risk-taking behavior” and “Duration of
risk-taking behavior” highly compared to other groups. This might be an effort to base their decisions
and risk assessments on concrete, quantifiable, objective criteria, thereby easing the difficulty of the
decision-making process.
Similar to previous studies (Downs, 2003; Sivis-Cetinkaya, 2015a), there were differences
between the ratings of participants who took an ethics course and those who did not. Participants
who took an ethics course were more likely to rate “Protecting the adolescent” highly than those
who did not. As counseling ethics courses generally emphasize a duty to protect the client (and
identifiable others) from harm, counselors know as a basic principle that the client’s protection
should be a priority in risk assessments. Those who graduated before the Turkish Council of
Higher Education (2007) made Ethical and Legal Issues in Counseling a required course in the
Psychological Counseling and Guidance curriculum were deprived of a chance to take this course
and may lack this basic understanding that others who took the course have.
In line with previous research, the results revealed that participants with graduate and undergraduate
degrees differed in their ethical reasoning (Gibson & Pope, 1993; Neukrug & Milliken, 2011;
Sivis-Cetinkaya, 2015a). Participants with an undergraduate degree were more likely to rate “Age of
the student” highly than those with a graduate degree. As most situations regarding adolescent
risk-taking behaviors could involve the law, and the law has certain age limits for some risk-taking
behaviors (such as minors’ sexual activity or criminal acts), participants with an undergraduate degree
could be more likely to base their decision to report risk-taking behaviors to parents solely on the law
rather than conducting a complex, multidimensional risk assessment.
Results of this study are informative for the pedagogy and practice of counseling ethics. In the
training of prospective school counselors, special emphasis on confidentiality regarding adolescents’
risk-taking behavior could be given. Ethical decision-making models applied to ethically dilemmatic
situations regarding adolescent risk-taking behavior could be taught in more elaboration.
Experiential modes of learning could be used, such as movies or interviews with colleagues. The
provision of continuing education programs in the form of in-service training geared toward new
school counselors and those who did not take an ethics course during their education could be
beneficial. Findings from this study can form a basis for a research-based code of counseling ethics in
Turkey. The current TGCA (2006) code on limits to confidentiality provides little elaboration for
school counselors working with minors. Codes that address confidentiality regarding adolescent
risk-taking behaviors seem vital.
The results of this study should be interpreted with caution, as certain limitations apply. First, due
to the online data collection, the sample was exclusive to school counselors who had Internet access.
In addition, potential participants were largely recruited via social media. All school counselors have
Internet connections in their offices in Turkey. Smartphones and social media use are also prevalent
12 SIVIS-CETINKAYA

among Turkish people. However, the fraction of the study population without smartphones, social
media accounts, or Internet connections in their offices presumably were not included in the study
sample. Therefore, the results of the present study are specific to the study sample and may not be
generalizable to all Turkish school counselors. Second, the results presented in this study are limited
to the factors identified by the survey items and did not employ additional quantitative and
qualitative data collection methods. There may be other important factors that school counselors
consider in deciding whether to report adolescents’ risk-taking behaviors to parents. Type of school
or type of risk-taking behavior might also play a role in their decision making, which this study did
not take into account.
Further research might triangulate surveys with additional data collection methods, such as
interviews. Case studies with purposive samples of school counselors working with at-risk
adolescents could be conducted to illustrate their decision-making process regarding specific
risk-taking behaviors. Other qualitative methods such as a critical incidents technique might be
recommended to further explore what type of ethical dilemmas regarding confidentiality and
adolescent risk-taking behaviors school counselors experience, what they do in those situations,
and how the incidents conclude for all parties involved (the counselor, the student, the parents, and
the family). All in all, more research needs to be conducted to improve our understanding of this
phenomenon among school counselors.

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