Confidentiality in Counseling: Protecting Privacy and Ensuring Informed Consent

This article discusses the importance of confidentiality in counseling and the need to protect privacy and ensure informed consent. It explores a case study of a client with anxiety, depression, and post-traumatic stress disorder, providing insights into the client's demographic information, presenting problem, mental status exam, and diagnosis. The article also discusses the treatment plan, evidence-based treatments, ethical issues, multicultural factors, assessment tools, referrals, and prognosis.

Confidentiality
I started by exchanging pleasantries, then I introduced myself, I cleared my position by
telling her that I am an intern at Liberty University. After it, I told the client about my
intentions to record a video. I told her that informed consent is necessary to protect her right
to privacy. I further told her about the ethics of the research where every subject has a right to
protect her identity and it is purely her choice and discretion to participate in the video
recording, her identity will be protected throughout and it will not be used commercially. She
agreed to the terms and conditions.
Demographic Information
Jane Doe is a 27-year-old African American female. She belongs to a disturbed and estranged
family. She is suffering from the pangs of separation; her intimate partner in the previous
relationship was abusive and violent in nature. In her present status, her life revolves around
her four-year-old son. She is a loner by nature this is why she doesn’t have a strong
social support system guarding her. Financially, she is passing through a rough patch because
her ex-husband is not supporting the upbringing of her son. The history of her mental illness
started with the attacks of mild depression. Her financial instability can be contributed as a
major reason behind regular attacks of depression and anxiety. The episodes of depression
and anxiety become severe when she is required to accompany her son to supervised visits
with his father.
Presenting Problem
During her first visit she told me that she is surprised that why she has been referred to
someone who offers psychological counseling, she mentioned about certain physiological
symptoms like chest congestion and headaches. She also suspected that she is suffering from
low Blood Pressure; however, she failed in presenting any corroborative statement in this

regard. After launching an ice-breaking session with her, I figured out certain symptoms of
post-traumatic disorders. Her past bad experiences were catching up with her all the time and
making her pessimistic. In the true spirit of a counselor when I said that she should stop
thinking negatively and focus more on the events that are under her locus of control then she
revealed about her constant worries related to the lack of a social support system because her
kid is very young. Financial worries were also troubling her.
Mental status exam
While having a friendly chat on an interpersonal level she also talked about her disturbed
state of mind during the four hours of supervised visit. This statement gave me a reason to
diagnose her with mild depressive disorder, with a single event causing episodes repetitively.
The pangs of the separation were also visible in her personality because she was suffering
from low self-esteem and she was not comfortable with her body. This low self-esteem
clubbed together with her isolation from the society gave me an idea that either she is on a
borderline or she has already become a victim of generalized anxiety disorder.
After reaching a level where I can say that I am familiarized with her, I started noticing her
more minutely. Psychotic thoughts were not present. Her cognitive features were sharp
enough to respond to the environment and social conditions. Her orientation with time place
and the person was right and her abstract reasoning was in place. Emotionally she was stable
and selection of the words was apt for the occasion.
The history associated with the presenting problem
Her childhood was normal, it was a fairy tale romance that she had with her ex-husband,
however, and her separation from her ex-husband was the darkest chapter of her life.
Biopsychosocial history

The biopsychosocial history of Jane can be considered as blank because she came out of a
well-nurtured family and walked out with her ex-husband. It was a disturbed marriage right
from the word go, and when she separated from her husband, she was all alone in a new city
because her parents estranged her. She never joined any social circles that can influence her
for anything good or bad.
Addiction Screening/ Risk Factors
Jane is a teetotaller with no history of alcohol abuse or smoking habits. The absence of
psychotic behavior in her gives us an idea that she cannot pay any harm to anyone. She never
manifested any suicidal tendencies and this gives us an idea that she will not pay any harm to
herself as well.
Diagnosis
After fully evaluating Jane during our first session I have diagnosed her with the following:
300.02 (F41.1): Generalized anxiety disorder.
296.21 (F32.0) Major Depressive Disorder, mild, single episode
307.50 (F50.9) Post Traumatic Stress Disorder
Problem List:
1. Anxiety related to frustration, worry, and depression
2. Binge eating and comforting herself with food.
Medications:
1. Wellbutrin
2. Zoloft
Case Conceptualization Summary Statement

While writing a Case Conceptualization Summary Statement an expert first presents the
conditions associated with the findings of a clinician and discuss the social aspects,
psychosocial aspects and biological traits of the subject. In general, this discussion revolves
around the self-presentation of the subject, predisposition, habit to perpetuate and
precipitation. This discussion helps a reader in understanding a pattern associated with
various factors of the case (Berman, 2018).
When we put the case of Jane on the same scale, we find that prima facie her symptoms give
us an indication about the presence of anxiety, low self-esteem and lack of confidence. Her
presentation prior to the ice breaking session gives us this idea. The disturbance in her family
life and her isolation from the society forced her to think negative about life this absence of a
social circle can also be termed as a strong reason behind her depression that can be
considered as the root cause of major conditions that she is facing now (Ehde, Dillworth &
Turner, 2014). Her condition perpetuated because of the cycling nature of her life, the
repetition of supervised visits can be termed as a major reason behind her Post-traumatic
stress disorder (Trauer, 2015).
Theoretical Orientation and Research/Evidence-based treatment
Cognitive behavioral therapy can be an answer to Jane’s problem, the scope of CBT is not
confined to counseling alone, and the list of associated goals can help an expert to fix the
right course of action. In the case of Jane, she can become a part of various social circles and
observe other individuals how they are coping with the difficulties of life. The role of
associated goals in a CBT is of utmost importance because it can guide an expert in
administering other behavioral interventions (Ehde, Dillworth & Turner, 2014).
We can also understand it with the help of two M’s. The first M is related to the modeling,
where a subject can pick some role models from the social circles where she is moving.

These role models can motivate her or demotivate her. After the selection of the role models
the second M comes in existence, this second M is molding. A subject can mold herself in
accordance with the behavioral interventions that she received with the help of counseling
and behavioral interventions. (Ehde, Dillworth & Turner, 2014). The personal mind makeup
of the patient can play a major role, in the case of Jane we can see that the absence of
psychotic behavior and suicidal tendencies are a positive point.
Treatment Plan/Research/Evidence-Based Treatments
Smart Goals
S Specific Medication to handle the anxiety
disorder
M Measurable To keep a check on the anxiety
levels during her four hours long
"Supervised visits."
A Attainable To introduce her to certain social
groups where she can share some
time with like-minded people
facing similar kind of problems
R Relevance At her age, she is still forming a
world view and gaining bittersweet
experiences from life. A social
circle where she can have some
pleasant experiences is a relevant
intervention because of her age.
T Timely The treatment of post-traumatic
stress disorder has a higher success
ratio if the subject is relatively
young.
Intervention
Constant counseling and inception of a social group can be used to as CBT treatment with
associated goals. She can also take the service of a life coach or a self-help coach to come out
of the problem of low self-esteem. Life is a hard teacher; the bitter experiences of life can

also be treated as the learning experience of life. The intensity of the episodes of anxiety is
episodic and occurs on certain specific occasion. These specific occasions can be treated as
the key result area for the treatment of the subject. (Dunlop, 2016).
The use of strong medication is not required because her physiological condition is stable.
However, sometimes she can take the support of some medicines that can calm her nerves
(Lyman, 2014).
Ethical Issues
The issue that will be primarily considered is the privacy or confidentiality of the patient. I
will try to protect her past details and will talk to her if she wants to communicate so that her
privacy could be maintained. Further, her documents and statements will also be kept
securely.
Multi-cultural Factors
She is well placed in her society, whatever grudges she has from life are all personal grudges.
The influences based on culture, ethnicity, and gender are not present in her. Her struggles
are personal. Since she is suffering from low self-esteem, she acknowledges the society,
however, she is suffering from an inferiority complex and this is the area where I would like
work while counseling her.
Assessment
The administration of the patient health Questionnaire (PHQ-9) and MINIDEP assessment
tool will be used on the merits of the episodes (Rathore et al., 2014). The Geriatric depression
skill GDS based empirical tests will be done where we will try to quantify the depression
during various episodes. In the advanced stages of the treatment participate in three
generation genograms or a feeling wheel can also be administered; the variety of the tests

helps us in keeping control over various variables (Seo & Park, 2015). During the initial run,
a bi-weekly test will be performed, the most severe part of the week is the part when she goes
out for the supervised visit, a test right after the supervised visit and in normal conditions will
give us an idea about her anxiety levels. This empirical data will help us in finding out the
efficacy of our treatment.
Referrals
The primary physician recommended her to get psychiatric help. It can be a referral point for
me. However, since her physical condition is stable and she is not suffering from any major
ailment, as a referral we can consult him during crunch situations. Interaction with the social
groups where she is moving as a part of the treatment are the areas where we need to focus
more. These are the places where we can collect notes about her behavior patterns and overall
wellbeing while handling the condition of depression and post-traumatic stress disorder.
Prognosis
The prognosis of Jane is based on the success of the behavioral interventions that we are
planning with her. It is very important to check and balance her motivational levels from time
to time. Depression can become a tendency; problems like PTDS can erupt out during tough
times and emotional breakdowns of the subject. This is why it is important to keep a check
on the orientation of the person after short intervals initially and long intervals after the
successful completion of the treatment.
References

Berman, P. S. (2018). Case conceptualization and treatment planning: Integrating theory
with clinical practice. Sage publications.
Dunlop, J. (2015). Meditation, stress relief, and well-being. Radiologic technology, 86(5),
535-555.
Ehde, D. M., Dillworth, T. M., & Turner, J. A. (2014). Cognitive-behavioral therapy for
individuals with chronic pain: efficacy, innovations, and directions for
research. American Psychologist, 69(2), 153.
Lyman, D. R., Braude, L., George, P., Dougherty, R. H., Daniels, A. S., Ghose, S. S., &
Delphin-Rittmon, M. E. (2014). Consumer and family psychoeducation: assessing the
evidence. Psychiatric Services, 65(4), 416-428.
Seo, J. G., & Park, S. P. (2015). Validation of the Patient Health Questionnaire-9 (PHQ-9)
and PHQ-2 in patients with migraine. The journal of headache and pain, 16(1), 65.
Trauer, J. M., Qian, M. Y., Doyle, J. S., Rajaratnam, S. M., & Cunnington, D. (2015).
Cognitive behavioral therapy for chronic insomnia: a systematic review and meta-
analysis. Annals of internal medicine, 163(3), 191-204.