Confidentiality: The Case Of Sally: Ethical Decision-Making Model

By using The Case of Sally for this case study, I will work through the ethical decision making model to decide the best course of action. The Case of Sally can be found in Issues and Ethics in the Helping Professions (8th edition), chapter 6 Confidentiality: Ethical and Legal Issues (p. 255). The therapist is having difficulty in determining if she has the ethical and legal responsibility to breach confidentiality. This case involves a 12-year-old girl named Sally, who experienced a brief encounter of sexual fondling by her intoxicated father. The father has no previous history of molesting his daughter. He has agreed to seek substance abuse counseling as a result of his inability to recollect the fondling incident. The family is

adamant that the therapist not report the sexual encounter to social services. The family believes they are dealing with the incident together by discussing their feelings with the therapist and beginning to heal from their pain.
My initial reaction to this case is to report the incident to social services.

As the counselor, I am supposed to protect those who have been harmed and those who are currently experiencing harm. While the family insists this sort of thing has never happened, there is no guarantee that it won’t happen again in the future. Not only do I feel it is my moral responsibility to have the child’s best interest, it is also my legal responsibility. If the father were to relapse and molest his daughter while intoxicated again, it would crush me as the counselor knowing that I didn’t do anything to stop the molestation from happening again. It could also have legal and ethical ramifications for me, resulting in the possibility of a malpractice suit and/or have my license to counsel revoked. I would attempt to involve the family in my decision to report the abuse by letting them know it is my legal responsibility to report the incident in the state of Missouri. I would also try to have the family make the report themselves, during our family therapy session. If the family was not willing to make the call to social services themselves, then I would be forced to report the abuse myself. I believe it would be my moral, ethical, and legal obligation to report the sexual abuse of the 12-year-old girl to social

services.
When working through an ethical dilemma, it is important to follow the steps for making an appropriate ethical decision. The ethical decision making model that will be used to decide the best course of action comes from our book Issues and Ethics in the Helping Professions, written by Corey, G. Corey, M.S. and Callanan, P. The ethical decision making model consists of 7 steps for deciding the best course of action to be taken. The ethical decision making model begins with identifying the problem or dilemma, moving into identifying the potential issues involved, reviewing relevant ethics cods, knowing the state laws and regulations, obtaining consultation, considering all possible and probably courses of action, and finally ending with making a decision on the best course of action (p. 24-26).
The dilemma for the therapist in this case is a combination of ethical, legal, and moral responsibilities. From the ethical stance, the therapist has the duty to protect the client’s, which in this case are all three family members. However, harm to the minor has been caused by one of the family members, and the possibility of future harm is not out of the realm of possibility. From a legal standpoint, the therapist is allowed to breach confidentiality because there is a minor involved, which falls under Missouri’s Statue of confidentiality exceptions. The moral dilemma for the therapist is the fact that the abuse only happened once, and that maybe the father didn’t intentionally fondle his daughter. Maybe the fondling only happened because he was intoxicated and didn’t realize what he was doing, in addition to the fact he claims to have no recollection of the incident. The counselor is not sure if she should risk ruining the father’s reputation and losing the family as clients, since the family seems to be handling the situation and have requested that the counselor not report the incident to social services. It is important for the counselor to identify the potential issues involved before considering any possible courses of action.
The counselor must take into consideration the six moral principles to help guide her decision-making. The six moral principles consist of: autonomy, nonmaleficence, beneficence, justice, fidelity, and veracity. The purpose of these six moral principles is to support the client and to make sure the counselor is acting in the best interest of the client when making an ethical decision.
When looking at the six moral principles, it is important for the counselor to first consider how autonomy will play a role in her decision making process. “Autonomy refers to the promotion of self-determination, or the freedom of clients to be self-governing within their social and cultural framework” (Corey, Corey, Callanan, 2011). The counselor has the ethical responsibility to support her client’s decisions in regards to therapy goals and how the client wishes to be helped. In this case, her clients (the family) are asking to be autonomous with their decision on how to resolve the issue and pain caused by the sexual fondling of the 12-year-old daughter. The clients wish to handle the incident between the father and the daughter on their own through therapy. They believe they are working through the pain that has been caused together as a family. The therapist in this case is responsible for encouraging the family to grow and develop together. However, there is a minor involved and the therapist has the duty to protect the minor. Which could result in the family no longer having their therapy requests fulfilled because of the legal responsibility the therapist has to report the abuse to social services.
Next the therapist must look at the importance of nonmaleficence to guide her thinking. “Nonmaleficence means avoiding doing harm, which includes refraining from actions that risk hurting clients” (Cory, Cory, and Callanan, 2011). In other words, the counselor must do no harm. In this case, the therapists risks harming the therapeutic relationship if she reports the abuse, going against the clients’ wishes. However, even more so, she risks hurting the minor if she does not report the abuse. The therapist has no way of knowing if the father would fondle is daughter again. If she does not report the abuse she would not be acting in the best interest of the minor client, therefore, practicing without nonmaleficence.
Thirdly, the therapist should take beneficence into consideration. “Beneficence refers to doing good for others and to promoting the well-being of clients” (Corey, Corey, and Callanan, 2011). While, the therapist is counseling a family, which means all three family members are her clients, she still must act in the best interest of the child. A child’s well-being trumps the adult’s well-being in all cases. In order for the therapist to practice with beneficence, she must promote the well-being of the child.
After considering how autonomy, nonmaleficence, and beneficence plays a role in the ethical decision making process, the counselor must now look at practicing with justice. Corey, Corey, and Callanan explain “justice means to be fair by giving equally to others and to treat others justly. Practitioners have a responsibility to provide appropriate services to all clients” (p. 21). The counselor in this case is practicing with justice. She is providing family therapy without any judgments about the family’s background in regards to age, sex, race, ethnicity, disability, socioeconomic status, cultural background, religion, or sexual orientation, which are listed under Corey, Corey, and Callanan’s definition of justice (p. 21). The therapist is willing to help this family through their difficult time, she is just having difficulty in making a decision on whether to report the father for sexual abuse or not.
Next the counselor needs to assess if she is practicing with fidelity. “Fidelity means that professionals make realistic commitments and keep these promises. This entails fulfilling one’s responsibilities of trust in a relationship” (Corey, Corey, and Callanan, 2011). The counselor has accomplished building a therapeutic alliance with the family; the family trusts her to help them work through the sexual abuse incident. The counselor is now faced with keeping a promise to help the family without involving social services. This is however, not a realistic commitment the therapist can make because she must act with the best interest of the child. The therapist must provide the family with information on how it is her legal responsibility to report the sexual abuse of a minor. With that, she then must respect the client’s right to choose whether or not to continue therapy with her. The parent’s in this case may feel the therapeutic relationship has been tarnished if the counselor reports the abuse, therefore, they may wish to cease therapy with this counselor.
Lastly, the therapist must act with veracity when working with this family.

“Veracity means truthfulness, which involves the practitioner’s obligation to deal honestly with the clients” (Corey, Corey, and Callanan, 2011). The therapist must make the family aware of her responsibility to protect the minor, as it is her obligation to be honest with the clients. It is unclear if the therapist was truthful with the clients about her obligations to protect minors no matter the circumstance. Based on the trusting relationship already built between the counselor and the family, it seems as though the counselor was practicing with veracity. The family would have most likely not disclosed the sexual abuse of the 12-year-old girl if the therapist had not built a trusting relationship with the family. With that said, the trust will be broken if the therapist reports the sexual abuse to social

services.
There are many things to consider when making an ethical decision. Using these six moral principles can help guide the therapists’ decision. In addition to considering the six moral principles to guide decision-making, the counselor must be aware of the cultural contexts involved in the case. For this particular case, a cultural context that may be important to consider is the idea that the family might believe the welfare of the whole family is a priority, not just the welfare of the child. As the counselor, I could respect the family’s values on wanting the needs of the whole family be top priority, however, it would be my responsibility to put the child first and to make sure her needs are met first.