Case Study 1- Reflection and Ethics
What would you say to Matt at the beginning of therapy to ensure he provides informed consent? “Matt did you have any questions relating to the paperwork on confidentiality and informed consent that I gave to you and your parents at assessment that you both returned signed at the end of the last session? Do you understand that because you are a minor, that if I am worried about anything I may talk with your parents for their input? Also that if I feel you or someone else may be in immediate risk of harm that it is my ethical and legal obligation to inform the appropriate people? Though I will also inform you of my intent to do so, did you understand all that?
What are the legal and ethical considerations in this vignette? The considerations that I have looked at in this vignette are:
 Limits of Confidentiality,
 Informing the client,
 Clients best interests,
 The ongoing counselling relationship,
 Civil law if I failed to report and something happened,
 Ethics standard A.5.2{c},
 Who needs to be informed,
 Giving client confidentiality in relation to those I consult with,
 Safety issues, and
 My own capacity to manage the risk and monitoring the risk of harm to others.
Would you breach Matt’s confidentiality? Yes and No.
I would discuss the feelings Matt has disclosed to me with his parents and what they feel about the disclosure. I would find out from them as to whether he has access to any firearms or any knowledge of firearms.
I would then discuss the situation with my supervisory colleagues on what would be the best way to monitor Matt’s progress while keeping his name confidential but discussing the situation.
I would then reiterate to Matt what I had said at the beginning of our session about confidentiality and its limits. Then I would continue to monitor hi progress and if the risk perceived increased, I would then inform the appropriate people and authorities.
How would you communicate this to Matt? “Matt in past sessions I have discussed the limits of confidentiality with you, and with the information that you have disclosed today, I feel this is one issue that I need to discuss with my parents and my colleagues. I will keep your name confidential with my colleagues, but I will discuss where we are, at the moment. I understand your anger and frustration with your situation and I feel we need to look at how best to address these feelings you are having. So as not to let the situation get out of control we both need to be mindful of the seriousness of the issue and monitor progress before taking it further.
What other actions might you perform before doing the above, or in conjunction with the above? The following are the actions I would have taken:
 Review the informed consent forms,
 I would consult the legal and ethics codes and regulations and interpret them as they would apply to the situation.
 Would have consulted with other supervisors and professionals available to me,
 I would look at similar case studies to help me clarify my interpretation of the legal and ethical codes and regulations,
 I would talk with Matt’s parents to discuss the issue of firearms and accessibility, and
 I would keep