Tuesday, August 4, 2009

Counselor Safety in Private Practice

Counselor Safety in Private Practice

Confidentiality and the rights of clients remain the responsibility of clinicians. According to the Composite Board Rules 135-7-.01, a licensee’s primary responsibility is to the client. As such, clinicians serve as the vanguard of the rights and confidentiality of their clients. Clinicians follow the basic tenet of do no harm. Yet this basic tenet can create the potential for a clinician to encounter ethical dilemmas regarding safety and disclosure of confidential information.

Consider the following case: A male schedules his first appointment with a female clinician to receive counseling for his sexual behavior. During the first session, he exposed himself to the counselor after becoming aroused as he described his recent sexual activity. The counselor immediately terminated the session and requested the male leave her office. The counselor was unable to convince him to leave of his own volition and she contacted building security to escort the male from the building. The counselor filed a report with building security and local police, but remained concerned regarding her duty to warn should this male schedule with other female counselors and his behavior escalate to physical harm. What are the responsibilities of the counselor? Does “duty to warn” apply in this situation?

The most common example stems from Tarasoff v. Regents of the University of California in which it was determined counselors have the duty to protect third parties against whom a client may have made a threat and requires breach of confidentiality. This ruling has sparked great interest outside of California, and while enacted in several states it has not been implemented as law in Georgia. Therefore, counselors become legally and ethically bound to the laws and rules enacted by the Georgia Composite Board regulating the counseling profession.

According to rule 135-7-.03, subsection (2)4, confidentiality may be breached, “where there is clear and imminent danger to the client or others, in which case the licensee shall take whatever reasonable steps are necessary to protect those at risk including, but not limited to, warning any identified victims and informing the responsible authorities.” In this case, the counselor assumed the necessary responsibility to ensure her own safety and notified the appropriate legal authorities.

In this instance, the individual can be considered a criminal instead of a client allowing for the clinician to disclose identifying information of the male to police in order to facilitate their investigation. Yet the dissemination of his identifying information via mass communication with colleagues creates the risk for libel and the potential for distortion of facts. Vague examples of safety concerns may be discussed with clinicians in order to foster the development of safety plans. Clinicians should also contact their professional association to obtain additional support and guidance in developing safety plans and navigating the legal recourse for similar situations.

The Ethics Chair for LPCA’s Board of Directors, David Lane, will provide a follow up article to this email notification in the September edition of the LPCA newsletter to further discuss safety planning for clinicians. If you have additional questions or wish to comment on this email blast, please contact LPCA staff at (404) 370-0200 or LPCA@mindspring.com.

By Nicole Urbanek, License-Eligible, lpcaoffice@mindspring.com
LPCA Office Manger