a counsellors ethical responsibilities in reporting clients

8/3/2019 A Counsellors Ethical Responsibilities in Reporting Clients

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A Counsellors Ethical Responsibilities in Reporting Clients

This essay is a critique of a practice session based upon an ethical issue raised by a

client. The essay will look at my ability to respond to the ethical issue appropriately and

summarise skills used with verbatim examples. In addition, my reflections on the session and

improvements to skills or application of other skills that could have been used and whether

the session was effective along with further reflection on future implications as a professional

counsellor.

Clients Presenting Problem

The client came to me with a presenting problem about her sister who is five months

pregnant and is a recreational user of drugs and alcohol. The client who is unable to have

children has suggested to her sister that if she does not want the child she would be willing to

adopt the baby; her sister has indicated that she would never let that happen. Although the

client is concerned about the welfare of the unborn child, the ethical issue is whether the babyis in danger or not. There is evidence to suggest that pregnant mothers who are recreational

drug and alcohol users do refrain from these activities whilst pregnant, according to West

Australian Drug & Alcohol Office (2008).

One of the biggest hurdles facing counsellors is knowledge or lack of it in this

instance, although I was only aware of the dangers to children from continued drug and

alcohol use during pregnancy and yet unaware if there is a system in place to force an

expectant mother to stop. Research since this session has revealed that although it is

mandatory for health professionals to report incidents of child abuse it is not however

mandatory to report on unborn babies at risk. I believe this is due to the Law in New South

Wales that does not presently recognise the rights of unborn infants; which are not classified

as living human beings until they draw breath at birth. Therefore, it is up to the discretion of


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the health professional to decide if the unborn child is at risk and needs to be reported,

however, there is no legal justification for intervention other than to educate expectant

mothers of the risks of drug and alcohol use. That said NSW Health recommends that health

professionals consider the following benefits to reporting; firstly, reporting enables agencies

and community services to set in motion beneficial services to assist both the mother and the

unborn child. Secondly, allows them to set in motion interventions through enabling

statutory/protection to take affect after the child is born (Childrens Research Center, 2009).

According to statistics provided by Australian Institute of Health and Welfare (AIHW, 2010),

of the 162,259 abuse cases investigated, 34% were substantiated, although this figure is

unacceptably high, it does also indicate that 66% were fortunately false reports.

The ethical issue in this case is whether or not to report based upon this clients

word and knowing her desire to have this baby, who suspects her younger sister is acting in a

manner that will deliberately endanger the life of the unborn baby. Armed with the knowledge

from my own research and having given the client similar research homework I could then

call her to confer and let her know of my findings. If she is still of the belief that her sister is

acting recklessly and endangering the unborn childs life then contacting Community Services

to investigate would be an option worth pursuing.

Because this session related to a third party and not a real problem of the clients, not

that she did not have a genuine problem it was more a matter of a vested interest in the unborn

baby. The session progressed with the client seeking advice on a problem of conscience, her

conundrum, being should she report and risk losing the chance to adopt by alienating her

sister or let nature take its course. Therefore, she sought advice on what to do and as a result, I

did advise her for the most part of the session because I was focussed upon the ethical issue

rather than her as a client. Although I maintained rapport with the client and at times mirrored

her posture, I did at times lose eye contact with her. The reason for this lapse is because


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during the entire session the recording equipment echoed back both our voices and as a result

I found it difficult to concentrate on what she said and equally so hearing my own voice

rebounding off the glass behind me.

Although the client and I formed a mutual bond in that our values were very similar in

respect to the risks facing the unborn baby, as a counsellor I needed to maintain perspective,

the client has an agenda and just because her sister may be showing signs of rebellion does

not mean she would deliberately harm the unborn baby. Therefore, another ethical issue arose

in that I must not act on emotions and be aware that my emotions do not interfere with any

action I decide to take. I would also need to be certain that the sister is putting the child at risk

and my verbalised thoughts of an intervention could help or harm the situation, depending

upon the mental state of the sister. According to Brill & Levine (2002), health care workers

need to be aware that, People can and do change values as they perceive the dichotomy

between what they profess and what they do in terms of implementing values (p. 31).

Additionally a counsellor should according to Stanard & Hazler (1995 ) seek consultation

prior to reporting any information and ensuring all reasonable alternatives have been utilised

and information received is verifiable as well as relevant.

By raising the idea of researching both autonomously and collaboratively, I attempted

to move the client forward toward learning more about the issues of drugs and alcohol abuse

in pregnancy and to seek other avenues of approaching her sister and to reflect upon other

choices such as approaching friends or organisations like Bernardos Homes. Bond (2010)

suggests a client should be steered toward self-talk and to engage in a reflective process to

consider other options and to empower them. Because there was an uneven power distribution

favouring the counsellor, which I felt reluctant and uncomfortable to act upon, the research

homework given to the client helped to redistribute power through the offer to contact the

client later that week to confer on our discoveries. This imbalance is what Solace (1996, p.


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148) described as a conflict between competing interests the clients in possessing the baby

and my own in protecting the baby.

According to Erik Ericksons theory of human development, my client is exhibiting

stages six, seven, & eight, the first of these, intimacy and isolation, the clients sense of loss

with her relationship with her sister and being unable to connect. The second, generativity

versus stagnation, where the clients need to nurture through giving back, by caring for her

sisters unborn child and finally, the clients need for her life to have a purpose and meaning as

fulfilling a self interest in the need to have a child.

Reflecting on the session, what I did miss was an opportunity to address the

aforementioned issues and those she had of feeling guilty for not doing anything to protect the

rights of her sisters unborn baby. The only option I considered was to report her concerns to

Community Services, however, armed with knowledge I did not have at the time, I could have

said, Unfortunately youre not alone, there is little you or I can do in the circumstances as the

Law only allows us to intervene after the baby is born. Although this may have helped

toward suppressing her guilt and normalising her situation, it would however, also have raised

another issue of helplessness, which she expressed later in the session.

When the client said, She just laughs in my face and says, You will never get your

hands on my baby!, I empathised with her situation saying in a concerned tone, Sounds

like she really knows how to pull your heart strings. My sharing her concern by disclosing

my own need to have another child did not upon reviewing the session normalise her feelings

because she unlike myself never had any children and therefore was a good example of why it

is not always practical to self disclose. Bond (2010) would call this crossing a boundary and

irrelevant considering the clients feelings are entirely different to those of the therapist.

Although rapport had been established prior to the session, there was a time when I

found it appropriate to advise the client that I am legally and ethically bound to report any


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instances of child abuse. That if she still wished to speak about her relationship with her sister

and the unborn baby further, and then I may have to report any potential harm she discloses.

Advising the client or warning the client in advance that confidentiality has its limits helps in

the therapeutic alliance between counsellor and client (Kaslow, 1998). However, in hindsight

I realise that reporting the clients sister would help relieve her of any guilt but also aid her in

gaining custody of the baby, a catch 22 situation.

At one stage during the session I began to say, Shes not going to give you the child

anyway, the sentence went unfinished because the client interrupted by saying, Well she

says that but, um she may change her mind, what I did not get to finish saying was, What

will you do if that happens? The intention as suggested by Kay & Tasman, (2006) was to get

her to think about alternatives, other avenues she may have considered or express her feelings

if she could not adopt the baby.

I also asked the client, What would you like to be able to do with your sister? she

replied, I would like her to look after her to child... allow me to help look after it. I

empathised with the client at this stage regarding her feelings for her sister and frustration she

was feeling, she interrupted to say her sister is unwell and may not really mean to act out the

way she does. It was after asking whether she has confronted her sister that she stated, She

lies low I said, So she avoids you? to which she repeated my words, which made me feel

that we were in contact with each other.

My initial thoughts of an intervention arose but changed as I believed that further

investigation was needed and set the client a task of researching organisations and services as

well as mutual friends of her sister. Closing off the session with an assurance that I would

keep in touch, and follow up with her then and review the options available with her.


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Conclusion

What this session has taught me is that where ethical issues arise, those issues must be

acted on with careful consideration and based upon fact rather than hearsay. The word of a

client cannot be discarded even though there may be a conflict of interest and the client may

be attempting to use common moral values empowering a therapist to act on their behalf

against someone else. Although I am not under any obligation to report this instance, I think

that the clients needs must be attended too in a way that her perceptions of her sisters

reaction are normal for cases of sibling rivalry. Additionally, whether she was always like this

and the clients sister sees her as an interfering and judgmental person trying to control her

life. In addition, ascertain whether her sister is just deliberately bating her for a reaction,

which may be the case.

Because I was focussed upon the subjective element of the ethical issue rather than the

whole picture, the clients feelings of guilt and loss and based upon Ericksons stages of

developmental theory, I could have challenged her more on those areas. Other skills I need to

work on are paraphrasing and self-disclosing appropriately. I did feel that my posture was

neutral and I that I maintained an air of congruence throughout.


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References

AIHW (2010). Child welfare series number 47, Child protection Australia 200809.Retrieved July 25, 2010 from http://www.aihw.gov.au/publications/cws/35/10859.pdf

Brill, N. & Levine, J. (2002) Working with people, the helping process (7thed.). Boston: Allyn & Bacon, pp 19-37.

Bond, T. (2010). Standards and ethics for counselling in action. London: SAGE PublicationsLtd.

Childrens Research Center (2009) . New South Wales mandatory reporter guide . RetrievedJuly 25, 2010 fromhttp://www.community.nsw.gov.au/kts/guidelines/documents/mandatory_reporter_guide.pdf .

Kaslow, F. (1998) Ethical problems in mental health practice. Journal of Family Psychotherapy , 9:2, 41-54.

Kay, J., & Tasman, A. (2006). Essentials of Psychiatry . West Sussex: John Wiley & SonsLtd.

Solas, J. (1996) The limits of empowerment in human service work . Australian Journal of Social Issues, 31:2, 147-156.

Stanard, R. & Hazler, R. (1995) Legal and ethical implications of HIV andduty to warn for counselors: Does Tarasoff Apply? Journal of Counseling and Development , 73:4, 397-400.

West Australian Drug & Alcohol Office (2008). Policy framework for reducing the impact of parental drug and alcohol use on pregnancy, newborns and infants. Retrieved July21, 2010 fromhttp://www.dao.health.wa.gov.au/Publications/tabid/99/DMXModule/427/Default.aspx?EntryId=1052&Command=Core.Download.
http://www.aihw.gov.au/publications/cws/35/10859.pdfhttp://www.community.nsw.gov.au/kts/guidelines/documents/mandatory_reporter_gui%09de.pdfhttp://www.community.nsw.gov.au/kts/guidelines/documents/mandatory_reporter_gui%09de.pdfhttp://www.community.nsw.gov.au/kts/guidelines/documents/mandatory_reporter_gui%09de.pdfhttp://www.dao.health.wa.gov.au/Publications/tabid/99/DMXModule/427/Default.asphttp://www.community.nsw.gov.au/kts/guidelines/documents/mandatory_reporter_gui%09de.pdfhttp://www.community.nsw.gov.au/kts/guidelines/documents/mandatory_reporter_gui%09de.pdfhttp://www.dao.health.wa.gov.au/Publications/tabid/99/DMXModule/427/Default.asphttp://www.aihw.gov.au/publications/cws/35/10859.pdf

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