Introduction
Counseling is a significant collective aspect, especially in the present world where pressures of work, career, and family tend to take a toll on most people. In fact, most organizations today employ a counseling psychologist to attend to the emotional and mental needs of their employees as a step toward maintaining maximum productivity. Youth Off the Streets is an organization dedicated to the well-being of youths living in the streets due to their lack of alternative accommodation. The central role of the organization is to attend to the immediate need of these youths, which is accommodation, and to provide counseling where necessary.
This paper presents an exploration of my experience as a counselor with this particular organization. My counseling session involved a female youth named Mary, and the ethical dilemma that confronted me during the process was the issue of maintaining the confidentiality of Mary’s personal information.
Background of the Case
Apparently, Mary, a Hispanic young lady, had been committed to a counseling session after showing signs of emotional or mental disturbance, a condition that was severely affecting her social life and health. As an organization dedicated to the wellbeing of young people living in the streets, Youth off the Streets mandated me to attend to the emotional and mental concerns of Mary through a counseling session. Mary was a decent young woman, who had been forced to adapt to a life of cruelty by her present circumstances. According to her colleagues, she had become involved with a group of other youths engaging in criminal behavior, specifically small-time robberies like pick-pocketing, which accelerated her apparent emotional and mental disturbances. For example, she would cry a lot when lonely and become violent toward other people with little or no provocation. Furthermore, during the counseling session, Mary disclosed to me that she had been sexually molested as a child by a close relative. Additionally, life on the streets had compelled her to start using drugs, which is the main reason she had become involved with criminal elements. As such, my counseling session with her was meant to find out the exact cause(s) of her developing negative behavior and devise a solution for the same.
In my counseling session with Mary, I attended to the issues bedeviling Mary through various approaches during which I encountered the ethical dilemma of the necessity of disclosing Mary’s personal information.
Firstly, I considered my ethical sensitivity with regard to Mary’s developing behavior. Ethical decisions made by counselors rest on their ability to recognize situations presenting ethical dilemmas in their work. Various research works have unveiled that most of them lack the capacity to identify ethical dilemmas once they occur (Fleck-Henderson, 1995, p. 2862B; Neukrug, Milliken, & Walden, 2001, p. 63; Welfel, 2010, p. 27; Pope & Vasquez, 2011, p. 7). In this regard, it is very clear that developing and demonstrating ethical sensitivity is a skill that counselors must possess; thus, the professionals must continuously attune their minds in a manner that allows them to notice situations presenting ethical dilemmas. This is opposed to them simply assuming that they will recognize such situations when they happen. Consequently, without ethical sensitivity, counselors risk arriving at unethical conclusions in their sessions and hence putting the well-being of their clients in jeopardy.
On a personal scale, developing ethical sensitivity is a life-long process. It requires me to have a clear knowledge and understanding of how my work is affected and influenced by my background as well as my personal ethical and moral values. The Transcultural Integrative Decision-Making Model developed by Garcia, Cartwright, Winston, and Borzuchowska (2003, p. 268) facilitated my understanding and awareness of my emotional and attitude-oriented reactions toward Mary, who is a young woman of a different cultural orientation from my own. The model also improved my comprehension of concepts, such as acculturation and role socialization. Consequently, to demonstrate ethical sensitivity, I normally cultivate this important aspect of my work by committing to continuous education, self-reflection, supervision, and consultation with other counseling professionals. This helps me to understand how personal and professional experiences of most counselors help to shape the core of their ethical sensitivity and identity.
Secondly, I made a deliberate effort to identify the facts as well as all entities that stood to be affected by my work with Mary. To ensure that my counseling session with Mary would be effective, I took an initiative of finding the relevant facts about her and her developing attitudes as well as all the stakeholders whose lives or activities could be upset in the process. The identification and organization of all the information gathered about a case is one of the foundational works that counselors undertake in a counseling session (Kitchener, 1984, p. 44). This information includes all the social and cultural dimensions of a particular case (Cohen & Cohen, 1999, p. 11). In my case with Mary, I first of all determined whether I had all the information I needed about the case and where I found that I lacked vital information I took the initiative of finding it. I understood that without carefully considering all the facts to the case, my reasoning throughout the counseling session would be undermined, leading to an unethical and unsatisfactory conclusion (Welfel, 2010, p. 27).
In this process, I subscribed to the wisdom of Treppa (1998) that ethical dilemmas do not arise separately from the rest of reality (p. 32). I knew that I had to understand myself and Mary within the entirety of both our cultural contexts. Thus, apart from being essential for effective therapy, socio-cultural sensitivity is also a moral foundation in mental health services as well as responsible decision-making. In looking for the facts of the case, I critically examined my overall multicultural counseling competency to determine which skills, attitudes, and knowledge I needed to develop (Arredondo et al., 1996, p. 7; Garcia, Cartwright, Winston, & Borzuchowska 2003, p. 269; Leuwerke, 2005, p. 23). Additionally, I needed to evaluate the quantity and quality of all the information I gathered about Mary with regard to her socio-cultural context and her overall worldview. I understood that if I needed more information, I had to get it from Mary through other avenues in a manner that did not compromise her confidentiality (Welfel, 2010, p. 28). Most importantly, I had to find out whether Mary had previous experiences with individualized or institutionalized prejudice or oppression that might affect our relationship during the counseling session (Chung & Bemak, 2002, p. 155).
With this information in mind, I needed to also ascertain my level of rapport with Mary and consider what I needed to do to win her trust (Sue & Sue, 2003, p. 17). To ensure that I completely understood her experiences, I had to identify what I was yet to learn by exploring several scenarios. Firstly, I had to determine how sure I was about her involvement with drugs and criminal activity. Secondly, I had to consider all the relevant legal and ethical requirements involved in cases where Mary disclosed childhood abuse as well as possible involvement with drug addiction and criminal gangs. Lastly, I had to consider the current emotional and mental state of Mary as well as her wishes with regard to the confidentiality of her disclosures. Another important consideration I had to note was how the contextual and gender differences between Mary and me would impact the decision-making process. Furthermore, I had to interrogate in what ways Mary and I were similar and how such similarity would or could influence the process. For example, I had to consider how our being close in age would impact the counseling process (Hillerbrand & Stone, 1986, p. 419).
With regard to my counseling session with Mary, I had to be sensitive on how our counseling session and the eventual decisions made would affect others (Welfel, 2010). Specifically, I had to consider all the entities involved in the present situation concerning Mary (Garcia, Cartwright, Winston, & Borzuchowska 2003, p. 271). In this case, an entity was any party connected to Mary that could either be harmed or helped by my actions and decisions as her counselor (Garcia, Cartwright, Winston, & Borzuchowska 2003, p. 271; Treppa, 1998, p. 34). In the present case, the entities included myself as the counselor, Mary as the client, Youth Off the Streets as my employer, and Mary’s friends and others who had been or were being rehabilitated from the streets and who, like Mary, had sensitive personal information.
Thirdly, I had to identify issues that were central to the dilemma and the available options before me. From all the information I gathered about Mary, I was able to focus on the fundamental issues of the ethical dilemma. I had to ensure that all the cultural information was incorporated into my considerations of the predicament. In this regard, I had to make a quick reference to the ACA codes in order to make sure that I did not break Mary’s confidentiality to disclose her childhood abuse considering that there was no looming risk of such abuse occurring in the present (ACA, 2005, p. 2). As such, the central dilemma, in this case, was whether or not I needed to disclose Mary’s drug addiction and likely involvement with criminal elements. As I worked through this dilemma, I discovered that the central issue contributing to this dilemma was whether or not I was legally mandated to disclose such information. Furthermore, given the cultural differences between Mary and me, the other factor contributing to the dilemma was the question of whether or not our values regarding confidentiality conflicted and also if they also contradicted those of the counseling profession (Constantine, Hage, Kindaichi, & Bryant, 2007, p. 25; Fisher, 2008, p. 3).
Conclusion
Indeed, considering the pressures and challenges of the modern world, counseling is an important component in today’s society. As people continue to confront social, economic, and family problems, the possibility of emotional and mental breakdown is greater than ever. In Mary’s case, for example, the pressures of living in the streets as a young woman from a minority culture took a toll on her emotional and mental wellbeing. It is these pressures that drove her to engage in drugs as well as participate in criminal activities. As Mary’s counselor, I was faced with the ethical dilemma of sharing her disclosure with the relevant authorities, especially her childhood abuse, present drug problem, and possible involvement with members of criminal gangs. My experience with Mary is evidence of how counselors are continuously confronted with ethical dilemmas, especially those involving the privacy and confidentiality of the personal information of their clients.
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