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Clinical Supervision: Models, Role, Legal & Ethical, Cultural Competency, & Transference
In this section, we will examine three concepts of ethically consulting colleagues regarding a client’s confidentiality boundaries. These three concepts of ethically consulting colleagues are client’s best interests, conflicts of interest, and proper consultation procedure.
3 Concepts of Ethically Counseling Colleagues
Concept #1 - Client’s Best Interests
However, if a client is a self-harming risk or if your supervisee cannot come to a decision in order to benefit the client, bringing in a third party, if he or she was not in a supervised situation, may be the best option for the client’s health. I stated to my supervisee, Janelle, "When I need to make a decision about disclosing vital case information to a colleague, I weigh the negative and positives consequences." Here is an example of a client Janelle was treating.
Case Study Regarding Client’s Best Interests
Because Jared was 18, he was considered independent of his parents, even though he had not graduated from high school yet. Clearly, you can see my dilemma. Because he had not given me explicit authorization to disclose his information to his parents, I faced the decision of choosing between honoring his request, or seeking out his parents’ help.
In this case, because the situation was of a delicate nature, I decided to consult my colleague, Joe, who had come across a similar case in his own work. Joe stated, "Because Jared poses a threat to himself and if you feel that he is incapable of keeping himself from harm, it is ethically appropriate for you to tell his parents, or at least encourage him to do it himself. However, you must accept the possible consequences of a strained client-therapist relationship."
After consulting with Joe, I decided to inform Jared’s parents. They agreed to monitor Jared and take the proper precautions in preventing him from harming himself. Although the future sessions between Jared and I were strained for a few weeks after, they still yielded results and Jared found a second support system in his parents.
Concept #2 - Conflicts of Interest, Presented to the Supervisee
For instance, some conflicts of interest include a client who knows the colleague personally, professionally, or through a family member. Also, I believe if a fellow colleague has certain prejudices that may apply to the client, this could most definitely affect his or her judgment.
Case Study Regarding Conflicts of Interest
She took her question to a colleague, Marion, and asked her for her opinion. Marion responded, "That sicko is around children! He shouldn’t be out of prison!" Puzzled by Marion’s strong reaction to her client, Charlene was even more surprised when Marion called the police and reported that Michael had molested the daughter, even though there was no such complaint from the mother or daughter. Later, Charlene discovered that Marion had been molested as a child.
Marion’s opinion about Michael resulted from bitterness about her own trauma as a child. Had Charlene known of Marion’s possible conflict of interest, it would not have been ethically appropriate to ask her questions about a pedophile.
Exercise for the Supervisee
Concept #3 - Proper Consultation Procedure, Presented to the Supervisee
Because of this, many healthcare workers worry about malpractice lawsuits and clients fear losing their jobs or other loved ones becoming aware of their mental health problems. To avoid this, I find that it relieves my mind to be up to date on the proper consultation procedure in order to ensure that I have not disclosed too much information. My number one rule: disclose the least amount of information necessary to achieve effective advice. To do this, I sometimes make a checklist of details I will disclose and details I should avoid in order to preserve the confidentiality boundary.
Case Study Regarding Proper Consultation Procedure
Before my consultation with Jeff, I made a mental checklist of the information I deemed appropriate to share, and information I deemed should be left out of our conversation. The details I decided to share with him included: her diagnosis, symptoms, age, and time-frame of the disorder. The details that I decided to leave out of the conversation included: her name, family situation, and economic class. If Jeff needed more information, then I would decide during the consultation whether or not to divulge it.
Exercise for the Supervisee
In this section, we discussed three concepts of consulting colleagues in relation to a client’s confidentiality. These three concepts of consulting colleagues are client’s best interests, conflicts of interest, and proper consultation procedure.
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