Confidentiality as an Ethical Dilemma

This article discusses the importance of confidentiality in counseling and the ethical dilemmas that arise when dealing with sensitive information. It explores the case of James Peterson, a firefighter suffering from PTSD, and the application of Corey's eight-step approach to ethical decision-making. The article also discusses the relevant codes of ethics and laws that apply in Samoa.

Running Head: CONFIDENTIALITY AND ITS IMPORTANCE
Confidentiality as an Ethical Dilemma
Student Name
Affiliation

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CONFIDENTIALITY AND ITS IMPORTANCE
Abstract
Counselors during training sessions are bound by ethics to observe confidentiality during the
therapeutic process. This is essential because a lot of personal information is divulged
during the process. To put this into perspective, it is essential to consider a case study
presented by James Peterson who is a fighter but has been diagnosed with chronic post-
traumatic stress disorder. His current state has prevented him from having a happy life and
as such, its negative impacts have spilled over into his health condition, family and social
life. He took a positive step to become part of the community trauma processing group
which consists of other firefighters and police officer suffering from Post-Traumatic Stress
Disorder. During one of the sessions, he opens up and narrates some of the experiences he
goes through on a daily basis especially when performing his duty of saving lives and
property. Therefore, the American Counselling Association’s Code of Ethics 2014 has been
used as well as moral principles, Corey’s eight-step approach, Statutes in Samoa and the Fire
and Emergency Service Act 2007. These are in relation to how one thinks through ethical
dilemma incidences. In the last part, this paper includes a section of self-reflection when
handling situations that create a dilemma.

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Confidentiality as an Ethical Dilemma
Ethical standards dictate that counselors have the duty of maintaining the
confidentiality of clients, informing them limits to confidentiality, duty to protect
communications that are privileged and also to avoid any kind of harm towards the clients
or groups that have presented themselves for counseling, (ACA, 2014). It is also essential
for counselors to inform the clients about confidentiality, the therapeutic process, limits to
observe in relation to confidentiality and also to provide a tangible report which bases on
the existing laws and standards of practice used by the mental health professionals. Also, it
is the counselor’s duty to provide answers to any questions from the clients as well as
addressing concerns being raised during the counseling sessions. Informed consent is one of
the most important element when handling clients. This helps in building confidentiality
because both parties have consented to take part in the counseling session. As such, trust is
built hence a positive state of the therapeutic alliance between a client and a counselor,
(Corey, Corey, Corey, & Callanan, 2015).
During the therapy process, clients reveal a lot of information hence the need for
confidentiality as stated before. In most cases, the issues raised by the clients may clash
with ethical virtues against statutory requirements and mandatory ethics which also may be
against the professional code of ethics. In such situations where values, ethics as well as
laws clash, the mental health practitioner is supposed to handle this with the help of
methodologies used in solving ethical problems. These methodologies must put into
consideration client care and ethical dilemmas in question, (Executive Order, 1955, page no.
11). It becomes harder to handling privacy and confidentiality in group sessions and despite

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this, counselors still have the duty of protecting individual member’s confidentiality as well
as privacy. This also applied to the confidentiality in the entire group. However, the law does
not require group members to observe confidentiality of other members and this is also
hard to be reflected in ethical codes because these codes usually govern confidentiality
between counselors and clients only- not group members. However, there is a need to
inform group members about confidentiality. This is mainly spearheaded by the Association
for Specialists in Group Work, (Mcclanahan, 2014, 32). This is mainly directed at counselors
who are reminded that they are duty-bound to inform or educate group members about
how confidentiality is important, consequences of breaching member confidentially as well
as limits in which communications in a group setting are set. As such, these factors that also
raise the ethical dilemma herein of whether one should report or he or she should not.
The case of James Peterson
James Peterson is a 48-year-old African American who constantly has instances of
flashbacks of his firefighting missions, rescuing accident victims or handling corpses on many
occasions. He has been part of firefighting teams sent to aid in the 2001 September 11
attacks, has been active in rescuing house fire victims as well as helping victims in road
accidents. As such he has had a lot of exposure to trauma for many years. After being
evaluated, he was diagnosed to have Post-Traumatic Stress Disorder which was based on
the DSM-5 criteria. This prompted his admission to a treatment facility where he was
enrolled in a residential treatment program for firefighters- for a period of 6 weeks. He is
also a member of a group of seven firefighters receiving the same treatment. In one of the

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most recent counseling session, James was processing his trauma which made his memory
flood with fresh details. In his description, he recalls how his unit was responding to a fatal
accident that involved school children in a bus that had collided with a fuel tanker. The
scene was horrible with children screaming out of excruciating pain, some with broken
limbs, some already dead and the tanker spilling fuel exposing approximately 70 children to
an explosion. In the process of saving the lives of other children, he notices that one of the
children was in a bad state- all legs were broken and a sharp metal had pierced his eye
straight through the head. The group members are shaken up on hearing Jame’s trauma
amid sobs. What James narrates next sends them into shock. On seeing the critical condition
of the child and knowing that he may live the rest of his life in pain or may have a painful
death, James confesses to having killed the boy by driving a broken metal straight into his
heart- ending his life. The group now realizes that James killed the boy. Now, what next?
Corey’s Eight-Step Model
This is an ethical decision-making model which is helpful in solving problems or
dilemmas that do not have a clear inclination towards Code of Ethics. For this to be achieved
a framework is important so that analysis is made hence the proper making of ethical
decisions, (Mills, 2014, page no. 96). Therefore, these are the steps to be followed using
Corey’s eight-step Mode.

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Step 1: Identifying the Dilemma or the Problem.
James has just admitted that he killed the child so that he could stop his continuous
pain as well as future implications due to the destroyed limbs, eyes and head/brain injury.
The revelation from James now holds moral, legal as well as professional issues to be faced
and determined by the counselor, (Blessing et al., 2018, 9). This clearly indicates a past
homicide and a question is raised as to whether one is mandated to report the individual or
incident. Secondly, was the issue discussed in the group with the presence of informed
consent? Also, is the counselor in any way obligated to report the incident or killing?
Statutes should also be looked into and as such, what do the Samoan Statutes stipulate?
Lastly, what suggestion is provided by the ACA Code of Ethics?, (Nahon & Lander, 2013,
page no. 164)
Step 2: Identification of the Potential Issues involved.
Some of the issues that a counselor has to consider include the legality of the
confusion made by James as well as the requirement for one to report such homicide cases
to the law enforcers. In addition, the counselor has to look into the negative aspects this
may cause to both the client and other members of the group especially when the aspect of
confidentiality is broken in the process. According to Cottone and Tarvydas (2016), the
counselor must strictly put emphasis on the importance of confidentiality and as such, must
apply this aspect to all disclosures in the group. It is therefore important to practice
confidentiality since this will help the group to progress in a positive path that leads to
recovery, (United Sates Government, 2008).

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Another issue to be developed is the existence of moral principles especially when
handling the ethical dilemma. According to Non-maleficence, counselors should be able to
minimized risks that a client may face especially from instances of exploitation, (Corey et al.,
2015)
Trauma processing sessions may also lead to countertransference. The entire
therapeutic process may be affected negatively depending on how the counselor feels after
listening to the confession. This also relates to how he or she feels towards the client. This
leads to the need of having an analysis of the situation that is well informed and deliberate
so that the ethical decision to be made at the end can favor both the client and the
counselor, (Thomas & Pender, 2008, page no. 2).
Step 3: Review the Relevant Ethics and Codes
The American Counselling Association’s Code of Ethics is the main Code of Ethics that
applies in Samoa and the American setting at large. One particular purpose of this code
entails the enablement of counselors in making informed decisions that are arrived at after
thorough evaluation of situations so that the client’s development and growth is promoted,
(ACA, 2014). In this particular scenario, there are sections which apply directly- as seen in
the 2014 ACA Code of Ethics.
i. A.2. a. in Informed consent, responsibilities, and rights of both the client and the
counselor are covered. The main question here is whether there was informed
consent from each and every member of the group.
ii. A. 4.b. this governs personal values. Counselors are required not to impose their
personal values on their clients, (ACA, 2014)

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iii. A.9.b. counselors have the duty of protecting clients especially from emotional,
physical as well as any form of psychological trauma.
iv. B.1.c Confidentiality is key and counselors should respect this by not disclosing any
information unless they have consent from their clients. Consent can also be sought
from legal and ethical justifications.
v. B.2.a. in certain cases, there are legal requirements which come into play. As such, it
is a matter of consideration whether foreseeable harm, as well as legal
requirements, may lead to the breaking of confidentiality.
vi. B.4.a. this section governs group work where limits of confidentiality have to be
determined by the counselor.
vii. C.2. e. In the event that there is a need from consultations from other counselors,
one should still observe the Code of Ethics, especially when handling an ethical
dilemma.
viii. 1.1. a. it is paramount for counselors to know and fully understand the ACA Code of
Ethics because this forms the backbone of their daily profession.
ix. 1.1. b. instances of ethical decision making are governed here. Counselors must use
and also document the processes they use in making ethical decisions, consider laws
that are applicable, consultation with colleagues, as well as the ethical standards
available in their practice especially in the community in relation to how they handle
and resolve ethical dilemmas.
x. Conflicts between laws and ethics are enshrined in section 1.1c. Here counselors
have to make a full commitment to the profession they are in and this includes

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adhering to the counseling ethics and professional standards when resolving
conflicts.it is also essential for a counselor to abide by the laws and regulations
especially when serving the client’s interests.
Fire Fighter Code of Ethics
James is a fire fighter who has been dedicated to his job for more than 20 years.
According to the firefighter code of ethics, all firefighters are sworn in and mandated to
carry out their duties in a respectable manner which reflects integrity and proper ethical
behavior, (Reader, Foulkes & Robinson, 2017, page no. 3). Firefighters also pledge to accept
responsibility for their actions as well as their consequences, act in a fair way, avoid
situations that may affect negatively their credibility before the public, respect others’
welfare and safety, exercise professionalism, and exercise honesty at all times.
Under Section 40 of the Samoa Fire and Emergency Service Act 2007, one may face
disciplinary action if he or she breaches any regulations, get s involved in acts of misconduct.
Recklessly or carelessly handles his duties and also acts in a manner that is disgraceful and
this act or omission may lead to the disapproval of the firefighting entity, (Dawson et al.,
2017, page no. 216).
After considering the provisions above, it is evident that James broke the Code of
Ethics and his allegiance and as such, he should be held liable for his actions. The act if
ending one’s life is unethical and also considered a sin and as such, it is punishable under

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law. This also means that he broke the bonds and ethos of service towards the general
public no matter the condition they are in and as long as they attempt to save lives.
Step 4: Know the Applicable Laws and Regulations.
All counselors in Samoa must be conversant with the regulatory and legal
environment that they mainly practice in. James and the counselor have considerations to
be put in place. Under the Federal LA and Samoan State law, there are no statute limitations
on felonies that are serious like murder, (Dunn, Clark & Pearlman, 2017, page no. 3498). As
stated earlier, firefighters have the duty of saving lives and acting in a humane way hence
upholding what their dignity and that of the institution. Any transgressions are punishable
by law and as such, there is no law that prevents James from being convicted for his crime
especially after personally confessing that he committed it.
Regulations and laws applicable to the counselor.
The confidentiality between clients and counselors is strongly protected by the law
in Samoa. This is mainly seen in the mental health practice Act which states that no mental
health practitioner is supposed to be disclosed any kind of information that he or she
receives while carrying out her duty and also in the course of treatment, (Torous &Roberts,
2017, page no. 438). This can only be divulged when consent has been obtained from the
client. In case there is a group of clients, consent should be received from them inclusively.
On the other hand, privilege and confidentiality do not exist in certain cases where children
or the elderly have faced acts of violence or when there are imminent threats and attacks
against them. This also extends to where the client is prone to self-inflicted injuries. It is also

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essential to protect the clients or take any kind of precaution. In this scenario, it is also
important to put into consideration that the client confessed about his past actions, and as
such, he has no intention whatsoever of doing the same act, (Sachsse et al., 2016, page no.
125).
Step 5: Get a Consultation
In the attempt of making an ethical decision, one proves his or her good-will by
seeking advice or consulting from other colleagues such as supervisors, peers, lawyers, and
similar professionals. In this scenario, it is wise to seek consultation from a trusted lawyer or
supervisor as well as the Professional Standards Department of the ACA, (Gelpi, 2017, page
no. 117). An important element to factor in is morality with the consideration of personal
values, law, ethics, and beliefs.
Step 6: Consider Probable and Possible courses of Action
Putting everything in context is essential when developing the course of action to be
taken, (Corey, 2015).
Action 1. The crime can be reported to the Law Enforcement. In this case, the counselor
sees the need for justice to be done, (Dudley et al., 2011, page no. 202). This makes the
counselor have a moral code and as such, the client’s wellbeing is not placed first, followed
by ethical practice and morals. In this case, James will not receive the required treatment
and other members in the group may become silent and suffer from it instead of sharing
their own details.

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Action 2: Members should be reminded that anything said in the group must always remain
in the group. In that regard, the move made by James in processing his state of trauma
helped him in moving onto the next step.
Action 3: the group members should be involved in the determination of how
confidentiality is valuable especially when a confession is made, (Yoneda et al., 2016, page
no. 1650). By collaborating and discussing, the members will see the importance of helping
each other as they move forward in trying to treat their stress conditions, (Butz, 1985, page
no. 84).
Step 7: List the consequences of different decisions
The cause of actions explained above has their own risks and benefits for the clients
and the counselor. Action 1 is seen as being disruptive especially to the therapeutic process
because James will be arrested and the entire healing process will be curtailed. Also, other
group members will have the fear of opening up and expressing their trauma. On the other
hand, the family of the child that James killed will also be affected. However, the aspect of
reporting the crime emanates from the counselor's morals, ethics, and beliefs, (Glosoff &
Pate, 2002, page no. 21). The action taken herein goes against the Code of Ethics, Section
A.4. b of the ACA. It states that counselors should not impose their beliefs and values to
their clients. Also, the confidentiality in the group will be broken.
Action two promotes confidentiality within the group under the support of Section
B.1.c and Section B.4. a, which stand for respect to confidentiality and limits to
confidentiality in a group respectively. Confidence is an aspect which should be agreed on

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and maintained in the group at all times. His action of revealing his actions was driven by
the knowledge that the group members will not disclose his actions, (Angoti et al., 2009,
page no. 2263).
Action 3 gives power to the whole group by enabling them to discuss the issue of
confidentiality. As such, more dialogue in the group is realized hence the understanding of
how confidentiality is important, (Hardon et al., 2012, 26). For the members to successfully
treat their conditions, they have to share their experiences with the knowledge that all
information is confidential. In the end, the counselor and the group members will be
confident about each other hence positivity and success in the treatment process,.
Step 8: Select what the Best Course of Action may be
After a thorough research and consultation process, the best course of action that
can apply to James’s situation is Action 3. The aspect of confidentially is thoroughly stressed
in action 3. Also, all group members have the opportunity of processing their personal
feelings in a clear and safe therapeutic environment, (Weniger et al., 2013, page no. 117).
Most importantly, this kind of environment focuses on the well-being of all members.
However, countertransference should be avoided by the therapist so that he or she should
solely focus on providing psychological treatment as opposed to feeling pitiful to the clients.
As a leader, the counselor should also ensure that any issues arising are worked upon
together so that there is better interaction. After consultation with professionals, what
came out clearly is the need for self-care when avoiding countertransference and handling
moral clashes.

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Self-Reflection
While handling this scenario at the start, I thought that I had a perfect solution to the
situation. Reporting the incident was seemingly the best solution to it. From this, it is
evident that the remedy was based on morals, personal beliefs and from the responsibilities
of how firefighters should be loyal and committed to their work of saving a life. The act of
ending another person’s life is unimaginable despite the severity of the injuries. However, a
better understanding of the American Counselling Association’s Code of Ethics 2014
enlightened my thoughts. The most important information was how confidentiality plays a
key role in a psychologists or counselor’s life. By reporting an incident to the authorities,
one’s life is worsened because the client may not receive the desired treatment for stress
disorders. Similarly, fear will be instilled on other group members who will end up “dying”
with their problems instead of expressing them. Therefore, I have learned that personal
thoughts and values should not be imposed in clients and the right thing to do is to adhere
to the Code of Ethics and professional conduct when dealing with clients and situations of a
dilemma.

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References
American Counseling Association. (2014). ACA Code of Ethics. Alexandria, VA: Author. 12
Cottone, R. R., & Tarvydas, V. (2016). Ethics and decision making in counseling and
psychotherapy (4th ed.). New York, NY: Springer Publishing. 34
Corey, G., Corey, M. S., Corey, C., & Callanan, P. (2015). Issues and ethics in the helping
professions (9th ed.). Stamford, CT: Cengage Learning. 10-48
Executive Order No. 10631, 3 C. F. R. 266 (1955). Retrieved from
https://www.archives.gov/federal-register/codification/executive-order/
10631.html. 11
McClanahan, K.K. (2014, July 21). Can confidentiality be maintained in group therapy?
The National Psychologist. Retrieved from
http://nationalpsychologist.com/2014/07/can-confidentiality-be-maintained-in-
group- therapy/102566.html 32
Mills, J. (2014). Psychotherapist-Patient privilege, recordkeeping, and maintaining
psychotherapy case notes in professional practice: The need for ethical policy
Reform. Canadian Journal of Counseling and Psychotherapy, 48(4), 96-113
Nahon, D., & Lander, N. R. (2013). Working with men in groups from an integrity model
perspective. Journal Of Men’s Studies, 21(2), 162-177.

16
CONFIDENTIALITY AND ITS IMPORTANCE
United States Government. (2016). Manual for courts-martial United States. Retrieved
fromjcs.defense.gov/Portal/99/Documents/MCM2016.pdf?ver=2016-12-08-
181411-957.
Thomas, R. V., & Pender, D. A. (2008). Association for specialists in group work: Best
practice guidelines 2007 revision. The Journal For Specialists In Group
Work, 33(2), 111-117.
Reader, D., Foulkes, H., & Robinson, C. (2017). Investigating barriers to mental health
care experienced by the Deaf community in North Wales. Mental Health
Nursing, 37(3).
Dawson, S., Gerace, A., Muir-Cochrane, E., O'Kane, D., Henderson, J., Lawn, S., & Fuller,
J. (2017). Carers' experiences of accessing and navigating mental health care for
older people in a rural area in Australia. Aging & mental health, 21(2), 216-223.
Dunn, H. K., Clark, M. A., & Pearlman, D. N. (2017). The relationship between sexual
history, bullying victimization, and poor mental health outcomes among
heterosexual and sexual minority high school students: A feminist
perspective. Journal of interpersonal violence, 32(22), 3497-3519.
Torous, J., & Roberts, L. W. (2017). Needed innovation in digital health and smartphone
applications for mental health: transparency and trust. JAMA psychiatry, 74(5),
437-438.
Gelpi, A. (2017). Rethinking super-confidentiality in the age of disclosure: The ethical and
social implications of privacy protections in mental health data. Ethics, Medicine
and Public Health, 3(1), 116-123.
Butz, R. A. (1985). Reporting child abuse and confidentiality in counseling. Social
Casework, 66(2), 83-90.

17
CONFIDENTIALITY AND ITS IMPORTANCE
Glosoff, H. L., & Pate, R. H. (2002). Privacy and confidentiality in school
counseling. Professional School Counseling, 6, 20-27.
Angotti, N., Bula, A., Gaydosh, L., Kimchi, E. Z., Thornton, R. L., & Yeatman, S. E. (2009).
Increasing the acceptability of HIV counseling and testing with three C's:
convenience, confidentiality and credibility. Social science & medicine, 68(12),
2263-2270.
Hardon, A., Vernooij, E., Bongololo-Mbera, G., Cherutich, P., Desclaux, A., Kyaddondo,
D., ... & Obermeyer, C. (2012). Women's views on consent, counseling and
confidentiality in PMTCT: a mixed-methods study in four African countries. BMC
Public health, 12(1), 26.
Weniger, G., Siemerkus, J., Barke, A., Lange, C., Ruhleder, M., Sachsse, U., ... & Irle, E.
(2013). Egocentric virtual maze learning in adult survivors of childhood abuse
with dissociative disorders: evidence from functional magnetic resonance
imaging. Psychiatry Research: Neuroimaging, 212(2), 116-124.
Sachsse, U., Vogel, C., & Leichsenring, F. (2016). Results of psychodynamically oriented
trauma–focused inpatient treatment for women with complex posttraumatic
stress disorder (PTSD) and borderline personality disorder (BPD). Bulletin of the
Menninger Clinic, 70(2), 125-144.
Dudley, W. C., Whitney, R., Faasisila, J., Fonolua, S., Jowitt, A., & Chan-Kau, M. (2011).
Learning from the victims: new physical and social science information about
tsunamis from victims of the September 29, 2009 event in Samoa and American
Samoa. Earth-science reviews, 107(1-2), 201-206.

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CONFIDENTIALITY AND ITS IMPORTANCE
Yoneda, A., Whealin, J. M., & Tsai, J. (2016). PTSD in Asian American and Pacific Islander
Veterans: Prevalence, Context, and Implications for Practice. Comprehensive
Guide to Post-Traumatic Stress Disorders, 1649-1667.
Blessing, E., Maron-Katz, A., de los Angeles, C., Abu-Amara, D., Li, M., Qian, M., ... &
Marmar, C. (2018). F25. PTSD is Associated With Reduced Anterior and Posterior
Hippocampal Connectivity in Combat Veterans. Biological Psychiatry, 83(9), S246-
S247.