Step 1: Identify the dilemma
James is a community counseling student and an intern at a local university. Recently, he began working with Lisa a 21-year-old female who presented symptoms associated with depression. Lisa disclosed experiencing physical abuse from her mother’s partner. As a result, she drugged him, and he later died. The decision to diagnose her or not is a dilemma. Lisa has told her counselor something that she had never disclosed to anyone. Referring her to another counselor would make her uncomfortable, and she could decide to give up on counseling.
Step 2: identify the potential issues involved
There are three issues involved. First, a legal matter because the counselor has to make a decision to either disclose or not the crime committed. Secondly, a moral issue is also involved. This issue is because the counselor feels morally responsible for not reporting the murder incident. Thirdly, an ethical issue because the counselor has to make a decision if to or not disclose the crime committed by his client. In all the issues involved the rights of the client must be protected and the welfare of the counselor should not be affected by the decision made.
Step 3: Review the relevant ethical codes
There are ethical codes guiding this dilemma. An example is the ACA code of ethics. According to code B.2.a, there are several situations in which the client’s trust can be broken. In order for James to obtain consultation on the matter he should refer to his advisor or the membership he belongs to.
Step 4: Know the applicable laws and regulations
The case presents laws relating to penal and criminal laws. The evident legal issue emanates from the argument that murder was possibly committed. Any case of murder is a legal issue that is handled by the judicial systems, police system, and the other law enforcers. Similarly, James must adhere to organizational policies relating to situations of dilemmas in work place such as involving the supervisors. James should follow organizational policies and not let Lisa go through any harm whether physical or emotional.
Step 5 Obtain consultation
James must seek consultation from the superiors. A good decision must be made on whether or not James should continue therapy lessons with Lisa or refer her to another person. He should be guided about the right decisions to make. James is likely to ask questions relating to protect the client. He must also consult to ensure that the case ends well for both the client and him. Information that he gets from the supervisors should be documented after consultation.
Step 6 Consider possible and probable courses of action
One course of action is to diagnose the patient. This will entail full counseling, emotional support and therapeutic processes. Another course of action is report the murder case to the authorities. This case has criminal element since legal action could be taken against the client.
Step 7 Enumerate the consequences of various decisions
If he diagnoses the patient, and he recovers, his services will be deemed good. If it backfires, he may be charged for professional misconduct. He may also get client’s referrals if he succeeds and win the trust of the client. If this fails, his career may deem. Reporting the matter to the police will lead to arrest and charging of the client. It will also lead to loss of trust.
Step 8 Decide on what appears to be the best course of action
The best course of action is to diagnose the patient. James could be able to handle the situation despite him being an intern. The fact that he has already handled previous issues in Lisa’s life means that he can handle even the current case.
Cultural competence dilemma
Step 1: Identify the dilemma
James’s competence is in question. James is an intern and therefore he may not have experience in dealing with depression issues. The dilemma related to the given case is the cultural competence. Cultural competence dilemma not only relate to race and social construction but also include various aspects of group differences relating to gender, sex, creed, age, and skills.
Step 2: identify the potential issues involved
Being an intern, cultural competence dilemma occur because of his perceived little knowledge about the complication of the patient’s personal and social identity formations and way of life. The issue is whether James is qualified or not and whether the low qualifications can enable him to mastery of James’ social and cultural background. Being an intern, as per the prevailing work culture, clients may think that the counselor is not qualified.
Step 3: Review the relevant ethical codes
Step 4 know the applicable laws and regulations
In this situation, there are applicable rules and regulations for both the decision and cultural dilemma. The Texas Board Rules states that the counselors experience, education, and training should not be made falsely. The rules also state that the counselors should provide limits of confidentiality. In this case it applies to James sharing information with his supervisors. In the therapy institutions, the client should always be protected.
Step 5 Obtain consultation
James should obtain consultation. As an intern, he may not have enough experience on how to deal with depression. This consultation should be from professionals who are knowledgeable about the ethical issues. In this case, James should consult his supervisors. They are knowledgeable, and since they have already completed their course, then they have more experience. James expects to be given a solution to the dilemmas. This information includes the guidelines he obtains. From the consultations, the client has the right to know about James competence that is in question.
Step 6 Consider possible and probable courses of action
There are several possible and probable courses of action. While determining the course of action, the counselor should consider different consequences and the client’s welfare if he decides to continue or discontinue the relationship. One of the probable courses is for the counselor not informs the authorities on what the client disclosed. Another probable course of action is for Lisa to be referred to another counselor that would not be very favorable to her. Another course would be for James to continue counseling Lisa. This action would be considered because Lisa trusted James to the extent of telling him about the horrific time in her life and had not previously shared it with anyone. James should involve the client in determining the decision. She should know that he is an intern but willing to help her through her situation. Sharing the information and revelation of the status help the patient to make sound choices and avoid any professional misrepresentation
Step 7 Enumerate the consequences of various decisions
If Lisa is referred to another counselor, she could end up being broken and feel uncomfortable. She may decide to live with her issues and not be able to trust anyone again. This course of action would also make her lose faith in all counselors and believe that they are of no help that is not true. If they continue the counseling sessions then, Lisa will be able to go through her problems with the right advice. She will be guided step by step until she overcomes her depression that is causing her emotional and physical stress. Of course in whatever decision to be made the client must be fully involved.
Step 8 Decide on what appears to be the best course of action
The best course of action in this case is for the relationship to continue. However, James should get advice from his supervisors on how to handle the situation. James agrees to his client being a part of the decision makers. James is willing to follow up and determine the outcome and see if further action is necessary.
