SAINT MARY’S UNIVERSITY

Weekly Journal on Legal and Ethical Issues

MAED-GC 206
JOMAR BUMIDANG Week 3

Part III Navigating Key Concepts: Confidentiality and Informed Consent

5 Exercising Discretion: Case Study: A Dangerous Client

A. Questions for Review and Reflection

1. Why should client confidentiality be treated by therapists as an essential part of the
therapist-client relationship?
Client’s confidentiality should be treated by therapist as an essential part of the therapist-client
relationship to maintain the trust which the clients has entrusted to the therapist- through trust,
the client would be able to reveal freely his thoughts and ideas which would be helpful in the
making of a successful assessment.

2. What ethic codes mentioned in this chapter treat harm to self or others as possible
exceptions to therapist- client confidentiality? Do these codes of ethics require disclosure
in such cases? Explain.
The ethics code in this chapter that treat harm to self or others as possible exceptions to
therapist- client confidentiality is confidentiality and non-maleficence. Sometime a disclosure of
this ethic code is needed specially when there is a presence of harm to the client and or of to the
third party.

3. Briefly describe the facts in the 1976 California Supreme Court case Tarasoff v. the
Regents of the University of California. What landmark conclusion did the court reach?

4. What is the difference between the duty to protect and the duty to warn?
The difference between the two is that duty to protect is a broader one compared to duty to
warn. Duty to warn is only a state to inform other or any other third party of what possible harm
to occur while duty to protect is to promote the safety and welfare of other.

4. In the case of Arty, suppose that Dr. Morgan practices in New Jersey where there is a
duty to warn and/or protect if the client communicates a threat of serious physical harm
to him- or herself or to an identifiable third party, and it would be reasonable for a
therapist to believe that the client will carry out the threat (N.J. Rev. Stat. 2A:62A-16). If
you were in Morgan’s position, would you believe you had a duty to warn or protect? If
not, why not? If so, given the significant number of stakeholders, to whom would this
duty be owed? On what basis would you make this determination?
5.
If I were in Morgan’s position, I would still believe that I have the duty to warn and protect
those identifiable third party considering that there is a number of stakeholders that might be
harmed and affected during the the possibility of harm.
 6. What if the applicable state law was that of Florida where there is no duty to warn or
protect and the therapist is protected civilly and criminally whether or not disclosure is
made when the decision is made in good faith? Would this law affect the manner in
which you handled the ethical decision whether or not to disclose? Explain.
No, I would still stick to my decision which is to disclose because it already involves the
possibility of harm, I don’t afford to stand and wait that something bad will happen to the
stakeholder and to my client.

7. What if Arty did not have a history of any violent actions or a mental illness that
disposed him toward violence? Would this affect your decision if you were Morgan?
Explain. What if he did have such a history or such an illness?
No, because with or without a violent history, we still do not know what is running in his
thought, what if this will be his first time to commit a violent action or crime. If ever that he has
history or such an illness, then this would make the possibility more likely to happen.

8. How might Morgan lessen the probability that Arty might follow through on his
threat?
To lessen the probability, Morgan may inform the authority to monitor the behavior of Arty for
prevention purposes or he may also help Arty in finding new job.

9. What exceptions to client confidentiality do state laws commonly recognize?

The exception to client confidentiality that the state laws commonly recognize is the disclosure of
information that would put the welfare of the client or any third party into risk.

10. What is privileged communication, and what is the difference between legally
recognized client confidentiality and privileged communication?
Privilege communication is an interaction between a therapist/counselor and a client which the
law recognizes a private, protected relationship. Confidentiality is the duty of a therapist or
counselor not to disclose information while privilege communication is defined in terms of a
client’s privilege not to have their counselor disclose information about them in a legal setting.

11. Is privileged communication absolute or does it have exceptions? Explain.

Privileged communication is not absolute for it has exception such as in instances that harm- or
the threat of harm- to people is involved
.
12. What was the significance of the legal case of Jaffee v. Redmond?
The significance of the legal case of Jaffe v. Redmond is that it le the establishment of privilege
communication in the federal court.

13. How does the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
protect client confidentiality?
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) protect client
confidentiality by not disclosing any pertaining information without the client’s consent.
However, exceptions in which the client’s authorization is not required include use or disclosure
by the covered entity for its own training programs, to defend itself in a legal action or
proceeding brought by the client, or which is required or permitted by law such as to prevent
probable and imminent harm to the client or another, or to report child abuse.

14. If state laws protecting client confidentiality conflict with HIPPA, which would
apply: the state law in question or HIPPA?
If state laws protecting client confidentiality conflict with HIPPA, the one to be questioned will
be the state Law.

15. According to the professional codes of ethics such as the American Counseling
Association Code of Ethics or the National Association of Social Workers Code of
Ethics, what should a therapist do if a court orders confidential client information?
In this case, the therapist may provide the information but be sure to obtain and to document the
client’s consent. The therapist must explain to the client the purpose for the release of such
information. In case that the client did not agree but a harm is involved, then it is the duty of the
therapist to provide in limit to what is requested by the court.

B. Cases for Analysis

Using concepts discussed in this chapter, discuss and reflect on virtuous practice in the
following scenarios.

1. Sasha is a 58-year-old divorced male who is in therapy with Minerva Gatsby, a

clinical social worker for a community mental health clinic. Sasha has recently
disclosed to Gatsby that he is very low on funds, in danger of losing his home, and
has been contemplating robbing a bank. He states that he does not own a gun and
does not want to “harm anybody” but that he “will pretend” that he has one for
purposes of accomplishing the robbery. How should Gatsby handle this situation?
Gatsby should investigate or ask more Sasha where or whom does she planning to apply
or do the robbery sand what are the things that she wants or that would help him in
order not to continue what she is planning. Through this, Gatsby will have an idea on
what is the next thing to do.

2. Victor Vale is a middle-aged male who is in treatment with Dr. Suzie Sturgeon.
Victor’s primary goal is to learn to lessen his angry outbursts at his wife and
coworkers. Recently, he discovered that a friend of his wife, Arlene, had told his wife
that she saw Victor at a motel with another woman. Victor conceded to Sturgeon that
he is in fact having an extramarital affair, but that he has no intention of leaving his
spouse. He expressed intense anger at Arlene and stated that “she will wish that she
never opened her mouth.” When asked to explain what he meant by this, Victor
replied, “Never mind.” He stated that if Sturgeon brings up this topic again, he will
terminate therapy. What options does Sturgeon have in dealing with this case?
Since Victor is said to be aggressive and has problem in minimizing his anger, with his
statement it is very clear that he putting a threat to the life of Arlene and that he
accidentally said it. For this reason, Sturgeon should have the duty to warn and protect
Arlene as the third party since a possibility of harm might happen.
 3. Rita Blumson, a 75-year-old female has been in therapy for 6 months with Dr. Andrea
Davinci, a psychologist. Last night, Rita confided to Davinci that she is exhausted and
overwhelmed from taking care of her elderly spouse who is suffering from dementia.
She states that she wants “no strings attached to him” any longer and is contemplating
abandoning him at a crowded football stadium without leaving any identification on
him. She has begged Davinci not to tell anyone about her plan. What are Davinci’s
ethical and legal responsibilities?
In this case, since there is a possible danger to the third party, Davinci should be
responsible on disclosing the information to prevent such harm.

6 Being Candid and Honest: Case Study: Withholding Information From a Depressed
Client

1. Why is providing informed client consent to therapy necessary?

Providing informed consent to therapy is necessary to get the trust of the client and
at the same time so for the client not to think and feel that he/she was deceived.

2. In the case of Diana, why was it important for Carla to include exceptions to
confidentiality as part of Diana’s informed consent? Was the information Diana
received about the reporting of physical abuse adequate?
It is important for Carla to include exceptions to confidentiality as part of Diana’s
informed consent to import autonomy on them and to avoid the possibility of
deception.

3. In your estimation, was Carla a candid therapist? Explain.

4. Is informed consent a moment in time or a process? Explain.

Inform consent is a process because it is a part of the counseling procedure. You
will not be able to have a successful termination without giving an informed
consent.
5. Was it appropriate for Carla not to have shared Diana’s diagnosis with her? Explain.
Yes, the action made by Carla is appropriate since her motive is to protect the
information and record of her client and given that there is no former order from the
court.

6. Would Carla ordinarily have had a legal right to see what her diagnosis was? Explain.
Yes because Carla as client has also the legal right to see her diagnosis as her right to
information.

7. What measure might a candid therapist take to ensure that the therapist-client trust is
not weakened after information in the client’s records had been intentionally withheld
from the client?
To ensure that therapist-client trust is not weakened, a candid therapist must not
abandon her client until the issue is not resolved. Instead, he/she will help the client
overcome whatever finding from him/her
 8. In the legal case of Canterbury v. Spence, what precedent (legal rule) did the court
establish with regard to providing a patient informed consent? What possible exception to
informed consent did the court make? What standard did the court adopt for determining
whether particular information should be disclosed to a patient?
9. Based on the standard of disclosure set in Canterbury v. Spence, list 11 sorts of
information that should be provided to a client for the client to give informed consent to
therapy?
10. As discussed in this chapter, some information included in informed consent may
depend on the context or circumstances of therapy. Provide at least one example of your
own, other than the ones provided in the chapter.
11. What conditions are necessary for a client to possess capacity to make decisions
about their treatment?
12. Carla did not disclose Diana’s diagnosis of Borderline Personality Disorder to Diana
because of her state of mind. In your estimation, did Diana have capacity to make her
own treatment decisions? Apply the legal standards discussed in this chapter to respond
to this question. Would it have been appropriate for Diana to have a surrogate to make
her treatment decisions? Explain.
13. What does it mean to be “incompetent”? Is incompetence all or nothing, or can a
person be incompetent in some respects but not in others? Explain. Who has the authority
to render a judgment of incompetence? Who decides whether a client lacks capacity?
14. Do the fact that young children lack capacity to make their own treatment decisions
mean that therapists do not need to get their informed consent? Explain.
15. What information should be addressed with the client in terminating the counseling
relationship? What if the therapist intends to leave the practice?
16. In couples or family counseling, who is the client, in your estimation? What
implications does this have for confidentiality and informed consent?

B. Cases for Analysis

Using concepts discussed in this chapter, discuss and reflect on virtuous practice in the following
situations.

1. Dr. Amelia Armstrong, an 80-year-old retired physician, has been in therapy for issues
related to loneliness after the death of her husband. Her psychologist is 45-year-old Dr.
Calhoun Winters. Armstrong, a prominent former physician in her city, prides herself on
her intellectual acumen and still keeps abreast of trends in her field. Recently, Winters
has begun to strongly suspect that Armstrong has the beginning symptoms of dementia;
however, he wants to rule out any other physical ailments that might be causing her
apparent short-term memory loss. When he broaches the topic of Armstrong’s memory
possibly not being as good as it formerly was (but never mentioning dementia), she
becomes angry and leaves the session early. Winters follows up with a phone call to
Armstrong who admonishes him for being ageist and states that she will not continue
with the sessions unless he “stops this crap.” How should Winters proceed?

In this case, Winter must still try to convince Dr. Amelia and change her type of question or
if not she may do some interview with any family member of Armstrong to ask for their
observations regarding the possible presence of dementia.
2. Fiona, a 36-year-old mother of two, is in counseling with Cheryl Manning, a mental
health counselor. Her sister, Renata, age 40, is also in treatment for similar issues. Both
suffer from flashbacks related to sexual abuse by a close family member who is now
deceased. Fiona believes that this abuse stopped when she was 8 years old when she
“ordered” the perpetrator to “stop.” However, Renata recently disclosed to Manning that
she witnessed her sister being abused on one occasion when Fiona was 12 years old.
Renata has asked that Manning not disclose this information to Fiona because “this will
destroy her.” What should Manning do? Can she justify not disclosing this information to
Fiona and still remain a candid and honest therapist?
If Manning wants do dig deeper on what Fiona experienced when she was 12 years old, then
she may do some questions that would not directly point out what she found out from Renata
and not to totally disclosed the information he found out or whom it came from. This is very
important to uncover such possible passed experience of the client that is still affecting her at
the moment.

3. Brigham Hall, a 25-year-old male, is in treatment with Rona Farmer, a mental health
counselor, in a small town clinical practice. Hall recently discovered that he was adopted
as an infant and is struggling with issues of betrayal and anger. He no longer speaks to
members of his family and states that he “can’t believe that they all lied to me for my
entire life.” He has become estranged even from his friend and has searched extensively
to find his birth mother, albeit unsuccessfully. Both Farmer and Hall have lived in the
same small town since childhood, and Farmer believes that she knows someone who
probably has knowledge of Hall’s parentage, a former county clerk. There are potential
legal, ethical, and therapeutic implications, including privacy issues of Farmer disclosing
the name of this individual. What would you do in this case?
If I were to be in this situation, I will not disclose the information that I knew but what I
would do is to reach out to his Adoptive parents in order that the information should come
from them

4.