Confidentiality for Substance Abuse Counselors
Confidentiality for Substance Abuse Counselors
In today’s world, counseling profession has grown to be one of the most important professions in the world due to the many difficulties that people go through in their everyday life. However, this profession may at times lead to conflicts of interest and even serious legal implications as it usually involves the disclosure of personal and confidential information by the client to the counselor. While the law may set forth some regulations on how professional counselors should conduct themselves in the workplace, this duty is usually left to the professional associations. Although the issue of confidentiality in counseling may appear straightforward, it may at times be confusing if there are no guiding principles or a code of conduct. In fact, some professionals find it hard to balance between the requirements of the law and maintaining client’s confidentiality. In this respect, the law may at times require the disclosure of some information by the counselor if they feel that there is risk to life. This may in turn lead to an ethical dilemma, leaving the counselor anxious and uncertain as to what their course of action should be (Bond & Sandhu, 2008).
The American Counseling Association (ACA) is one of the professional bodies that are involved in setting standards and codes of ethics for their members. In 2014, the association formulated the 2014 ACA Code of Ethics to replace the 2005 edition. This paper will try to evaluate the issue of confidentiality among substance abuse counselors while using the 2014 ACA Code of Ethics as a reference. In particular, the paper will try and assess the situations in which these counselors may be involved in breach of the confidentiality terms as well as the methods that they can use in avoiding the same. Moreover, a literature review on this issue will be conducted to evaluate the dynamics surrounding it. In addition to this, I will conduct a personal reflection about my learning and insights regarding my professional development and ethics. This will be through the evaluation of my strength areas as well as the areas in ethics that I need to improve.
Confidentiality among Substance Abuse Counselors
The exploration of the ethical issues surrounding substance abuse counselors is very important as it has resulted in lawsuits in the past. In this respect, some counselors do not fully understand the disclosures of information that require prior authorization from the client and those that do not. As such, they end up disclosing confidential information to third parties without the consent of their clients, who then file lawsuits. It is therefore very important that chemical dependency counselors have a full understanding of what is expected of them under the legal and ethical guidelines in order to avoid getting into trouble (Manhal-Baugus, 1996). Since drug abuse counselors often handle information that can be illegal or which presents a risk to life, understanding the exceptions under which they are allowed to disclose confidential information to third parties is very important as it can save them from legal battles. In particular, since such cases can lead to the cancellation of the operating license of these professionals, it is in their best interest that they understand their ethical and legal requirements.
The 2014 ACA Code of Ethics
The 2014 ACA Code of Ethics presents an ethical guideline address the confidentiality issues that are presented by the advancement and adoption of new technologies as well as other traditional ethical dilemmas that face professional counselors in conducting their duties. In particular, the new edition outlines the ethical issues surrounding the use of social media with clients to communicate as well as maintaining confidentiality of the information raised through this channel. In Section B of the 2014 edition, the precautions and principles that counselors should apply while addressing confidentiality and privacy are well outlined, with the focus being on the ethical mistakes that counselors do as well as exception to such ethical issues. In particular, the code of conducts prohibits professional counselors from disclosing clients’ confidential information to third parties and only to do so after receiving authorization from the clients. In addition, they are advised to explain the limitations of confidentiality to the clients throughout the counseling process. Counselors are also advised to use social media and other electronic mediums of transmitting confidential client information wisely, as they are not foolproof and may therefore lead to breach of confidentiality (ACA, 2014).
While addressing the legal implications of the ethical guidelines provided, the ACA Code of Ethics emphasizes that counselors should act in the best interest of their clients while abiding to the national laws. In particular, they are urged to consult with others in the case that they get caught up in ethical dilemmas. Ethical decision-making is also insisted under these guidelines, which place the interest of the clients first (ACA, 2014).
According to a study by Bokhari et al. (2014), while most counselors were aware of their duty to secure confidential information disclosed by their clients, the legal and ethical understanding had very little contribution to the practicing of confidentiality among counselors. In this respect, most counselors rely on the agreements made between them and their clients as well as consents from clients in determining the information that they disclose to third parties. However, argue the authors, given the increased importance of counseling in different settings such as schools on drug abuse alongside other matters, it is of importance that counselors have an in-depth understanding of their legal and ethical obligations while conducting themselves. While insisting on the need to have such an understanding, the authors posit that failure to disclose certain types of information such as child abuse can result in legal prosecution. In addition, failure to understand the ethical obligations that one should have as a counselor may lead to adverse consequences such as increased suicide cases among students who had shown the symptoms on the same (Bokhari, et al., 2014).
While addressing counselors in the school context, Moyer & Sulllivan (2008) established that the tendency to break confidentiality was largely influenced by the perception of the counselor on the dangerousness of the behaviors they were counseling their students on. When counselors were involved in counseling students on drug and substance abuse, the perceived danger that the drugs in question posed were the greatest influencer as to whether the counselors disclosed this information to third parties, especially parents/guardians, or not. For instance, drugs such as cocaine were perceived to be more dangerous than cigarette smoking and therefore led to higher cases of breaking confidentiality among the counselors (Moyer & Sullivan, 2008).
This phenomenon can best be explained by the ethical dilemma that counselors dealing with children have to face while trying to balance between the ethical code of conduct and the law (Lazovsky, 2008). Particularly, while the ASCA (2004) ethical code insists on the maintenance of confidentiality by school counselors, it at the same time requires them to respect the rights of parents/guardians of taking care of their children. In addition, parents are legally entitled to the information that is discussed during the counseling sessions, thereby granting them legal rights to confidential information of students equal to the ethical right of students to privacy. This places the counselors at a dilemma, as they must balance between their obligation to inform parents on student affairs and the possibility of betraying the trust of students (Moyer & Sullivan, 2008).
Given these dynamics, the authors advise that school counselors should undergo training regularly in order to familiarize themselves with the ethical codes of conduct and other policies governing school counseling in order to be in a position to address the ethical dilemmas. In addition, they insist on the need of counselors to self-reflect on the influence that their own experiences, spiritual beliefs, morals and values have on their perception on how dangerous student activities are. This would help them to avoid imposing their own values and beliefs on their clients. Consistent with the ACA Code of Conduct, the authors advise on the need of counselors to consult from their colleagues in case they are faced with these ethical dilemmas. Lastly, school counselors are advised to take into account both the legal and ethical principles that guide their practices and then strike a balance between them before deciding on the best courses of action (Moyer & Sullivan, 2008).
Closely related to this, Moyer, Sullivan & Growcock (2012) address the ethical dilemmas that face school counselors while deciding on whether to inform the school administrators on students involved in risk-taking behaviors such as drug abuse. The authors established that there was a lack of agreement as to when it was necessary to break confidentiality and report these behaviors to the administrators. However, some consistency in breaking confidentiality was noted in the case that there were written laws or policies prohibiting the behavior in question. In particular, the opinions of counselors did not vary significantly on the ethicality of reporting drug abuse among students to the counselors due to the existence of the No Child Left Behind Act of 2001. In this respect, the counselors who were surveyed perceived it ethical to break confidentiality and report to administrators in all the cases that the students were involved in drug abuse. In the absence of such precedents, the counselors were more likely to base their decisions on the ethicality of breaking confidentiality on the school-specific policies that were in place (Moyer, Sullivan, & Growcock, 2012).
Given the dilemmas that the counselors are faced with, the authors recommend open communication between them and the administrators aimed at aligning the expectations of the school administrators with the importance of confidentiality between the counselors and the students. In addition, counselors should take an active role in the formulation of policies in the school aimed at avoiding the ethical dilemmas that they face while trying to balance between the maintenance of confidentiality and adhering to the set policies at the school. Lastly, the authors advise that counselors should be aware of the consequences of their actions before they can decide on whether to break confidentiality (Moyer, Sullivan, & Growcock, 2012).
The situation faced by school counselors in other countries is not different as was established by Jenkins & Palmer (2012) while addressing school counselors in the UK setting. In this respect, most of the counselors reported lack of awareness of the policies that guide information sharing and confidentiality. The main dilemma arises due to the fact that confidentiality in the school setting can be viewed both as a benefit and a source of difficulty. In this respect, most counselors are faced with the dilemma of school administrators and parents demanding for information on students and the need to maintain confidentiality for the benefit of the counseling process (Jenkins & Palmer, 2012).
Manhal-Baugus (1996) largely focuses on the need of chemical dependency counselors to understand the legal and ethical issues that should guide their conduct on confidentiality. Although there is a universal expectation among clients that the information shared with the counselors will be kept confidential, there exist exceptions that allow the breach of confidentiality under the law. However, disclosure of information that violates such exceptions can result in legal penalties. In particular, the author relies on the Code of Federal Regulations, 1994, and the Confidentiality of Alcohol and Drug Abuse Records, 1987, in explaining the confidentiality requirements and exceptions. Under these laws, the disclosure of client information without their written consent presents a breach of confidentiality that can result in fines (Manhal-Baugus, 1996).
However, confidentiality may be breached in several cases. First, the counselors legally bound to breach confidentiality if they acquire information on child neglect or abuse by their clients. In addition, counselors have a duty to warn in case their clients pose a threat to other people. Third party payers such as insurance companies also have the right to confidential information as does auditors and researchers for as long as the safeguards under the law are met. Chemical dependency counselors dealing with inmates also have the obligation to disclose confidential information to the prison authorities as they act as the agents between the prison system and the client-inmates. Other than the legal obligations that these counselors have, they also have an ethical obligation to disclose confidential information if they feel that the client has become a danger to himself/herself or to others. This is an exception from the ethical standards that guide the counseling profession, as it requires them to keep their communication and relationship with clients confidential while safeguarding this confidentiality at all times (Manhal-Baugus, 1996). This implies that chemical dependency professionals must be fully informed of the existing legal provisions guiding their conduct as well as their ethical obligations.
In my career field, ethical conduct comes as one of the competencies that one must possess. Having aspired to become a professional counselor for adolescents, understanding the ethical dynamics surrounding this field are very important for my career development. From class lessons and research, I have established that one of the main obstacles facing professional counselors pertains to the legal and ethical dilemmas that they face. Personally, I am well versed on the ethical requirements that one ought to have while approaching counseling. In this respect, I understand that one ought to maintain a confidential relationship with their clients while acting in their best interest at all times. In addition, having familiarized myself with several codes of ethics that have been set by different associations such as the 2014 ACA Code of Ethics, I have been able to point out the different actions that can amount to breach of confidentiality as well as the ethical obligations of counselors.
However, I am not fully aware of the current laws that guide the conduct of professional adolescent counselors. In this respect, it is my understanding that one of the dilemmas that faces counselors in carrying out their duties is trying to balance between the legal requirements and their ethical standards. Particularly, the codes of conduct provided by different bodies may at times conflict with the law, thereby requiring a counselor to make a judgment decision as to the best course of action. However, without a clear understanding of the existing laws, it would be impossible to maintain a balance between the legal and the ethical requirements. Moreover, dealing with minors presents extra hurdles as third parties are at times legally entitled to confidential information provided by the minor to the counselor. As such, I should have a clear understanding of the legal duties and rights of third parties such as parents/guardians and school administrators. This is therefore one of the areas that I should seek to improve on while on my career development path. This would ensure that I abide by the law while carrying my duties as a counselor.
Lastly, I feel that I need to conduct a self reflection on my beliefs, values and assumption and the influence that they may have on my ethical conduct. This issue arises as I have never taken the time to consider the impact that my spirituality and personal values have on my decision making. Since it is my understanding that professional counselors should steer clear of imposing their values and beliefs on their clients, I understand that failure to have a clear understanding of oneself may lead to one imposing their values, beliefs and assumptions on their clients unintentionally. I therefore plan on embarking on a self-awareness mission whereby I will be evaluating the impact that my values have on my decisions and conduct. This will assist me in challenging my perceptions and tendencies that may lead to the imposition of my personal values on others.
The counseling profession is one the professions that are increasingly becoming important in the world today. However, counselors (drug abuse counselors in particular) are faced with dilemmas while conducting their duties due to a lack of understanding of their ethical and legal obligations. This problem is escalated by the fact that the law may at times contradict with codes of conduct that guide counselors thereby putting them in a dilemma as to what the best course of action is. In particular, the issue of confidentiality poses many dilemmas to counselors while deciding on what information they should disclose to third parties and at what instances. Counselors dealing with minors are largely affected by such problems as the law may provide third parties with the right to confidential information shared by the minors. It is therefore important that every counselor is well informed on their legal and ethical duties in order to function efficiently. I therefore plan on acquiring these skills as part of my career development plan in becoming a counselor for adolescents.
ACA. (2014). 2014 ACA Code of Ethics. Alexandria, VA: American Counseling Association.
Bokhari, M., Saadan, R., Pilus, A. M., Hassan, S. N., Jano, Z., Ishak, N. M., et al. (2014). Contribution of Awareness and Understanding in Legal and Ethics towards the Practice of Confidentiality amongst Counselors. Asian Social Science, 10 (16), 144-151.
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Moyer, M. S., Sullivan, J. R., & Growcock, D. (2012). When is it Ethical to Inform Administrators about Student Risk-Taking Behaviors? Perceptions of School Counselors. Professional School Counseling, 15 (3), 98-109.
Moyer, M., & Sullivan, J. (2008). Student Risk-Taking Behaviors: When Do School Counselors Break Confidentiality? Professional School Counseling, 11 (4), 236-245.