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Maintaining client confidentiality might be assumed in counseling; however, in actual practice, providing confidentiality may be more challenging than it initially appears. Certain restrictions apply to maintaining confidentiality in specific cases. For example, counselors working with a group, families, or minors cannot assure their clients’ absolute confidentiality. Understanding when confidentiality applies in the counseling profession is a challenging yet essential requirement for delivering ethical counseling services. These challenges could range from the straightforward (e.g., office administration issues such as case notes and client files, sharing information with other behavioral health professionals) to the more complicated (e.g., mandated reporting, court ordered disclosure, responding to subpoenas, exceptions to confidentiality).

For this Discussion, review the media, Clinical Mental Health Counseling: Confidentiality, and consider the ethical decision-making model for addressing challenges to confidentiality. Use the Case Study Analysis Worksheet located in the Learning Resources for week two. Review the confidentiality issues in the ACA Ethical Standards Casebook and consider how to address challenges in adhering to critical elements in counseling practice.

Post by Day 3 any insights gained about confidentiality or the challenges to confidentiality based upon the Faculty Interviews. Then, provide a brief description of two key confidentiality issues from this week’s case studies in the ACA Ethical Standards Casebook. Explain why you consider these issues to be critical elements in a counseling practice. Then, explain two challenges you might face as you adhere to these elements in day-to-day practice and explain how you might address them.

case study

Karen is a second-year student in her master’s counseling program. She is enrolled in two academic courses and her practicum, which entails a field placement. As a practicum student, she spends 5 to 10 hours per week at a local counseling agency where she observes her site supervisor and coun- sels two to three clients per week. She meets with her university and site supervisors on a weekly basis for an hour of individual supervision. Luel- len, her university supervisor, is a part-time faculty member and adjunct instructor in the master’s program. One week, during a regularly scheduled supervision session with Luel- len, Karen discloses that she is “struggling to keep her head above water” while trying to balance the responsibilities of graduate school, her family obligations, and her part-time job. Luellen asks her to say more about her struggle. Karen explains that she works part time at a local coffee shop during the evenings, and this is making it difficult for her to do a good job on her school assignments. Lately, she has needed to pick up more shifts at the coffee shop because her roommate moved out unexpectedly, leaving Karen responsible for all of the bills. In addition, Karen’s mom was recently diagnosed with breast cancer. Although treatment seems to be going well and her mom has encouraged her not to worry and to “focus on school and building a life,” Karen says she is distracted by her mother’s illness. She worries that she is not spending enough time at home, which is 2 hours away from where she is living and attending grad school. Karen reports that she tries to talk to her mom on a daily basis and has been spending weekends at her parents’ house. Karen and Luellen spend about half of their supervision hour discuss- ing Karen’s situation and brainstorming possible solutions, such as Karen approaching her adviser about the possibility of changing her enrollment status from full time to part time, seeking individual counseling, or post- poning her graduate studies until her mother’s health is more stable. During the remainder of the supervision session, Karen and Luellen discuss ways that Karen’s personal situation may be affecting her clients at her practicum site. Karen reports being distracted to the point of some- times “zoning out” during counseling sessions. She also mentions that her site supervisor has observed that Karen’s appearance is occasionally di- sheveled, making comments like, “Did you forget to brush your hair this morning?” At the end of the supervision meeting, Karen acknowledges that external factors are having an impact on her work with clients. The next week, the counselor education faculty members gather for their student review and retention meeting. At this meeting, which is held once each semester, decisions are made regarding students’ applications to en- ter or continue their field experiences. Karen’s application to proceed from practicum to internship is among the stack to be reviewed. When Karen’s application is brought forward, Luellen brings up the conversation she had with Karen. Luellen expresses her concern that Karen may not be ready for a full-time internship experience at this point, citing examples from their su- pervision meeting as reasons for her concern. The faculty decides to inform Karen that her application to enroll in internship the next semester will not be approved at this time because of concerns about her practicum perfor- mance. When Karen receives a letter from her adviser notifying her of this decision, Karen feels betrayed by her supervisor and is angry that content from their supervision session was shared without her permission.

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