Counselling Dilemma: Two Separate Clients Crossing Paths
You have been retained by a company to counsel a member of staff who is currently on stress leave from her job. During the first session with this person you discover that her immediate supervisor is a private client who has been coming to you for counselling for some time. The staff member tells you that this supervisor is the main cause of the problems which have led to her being on stress leave.
As the counsellor, what would you do next?
Recognising this situation as one which has implications for the well-being of each client involves a process known as moral sensitivity (Welfel, 1998).
In weighing up the need for moral action in this case, a counsellor will need to consider the possible consequences arising from the situation and is also likely to seek guidance on the matter from a supervisor or formal ethical guidelines.
One such avenue is the Code of Ethics provided by the Australian Psychological Society, a guide to applying the principles of professional conduct.
Although having no guidelines which relate directly to this situation, general principles indicate that we must be cognisant of the reasonably foreseeable consequences of our actions (1a) and that the welfare of clients shall take precedence over the interests of the organisation employing us (III).
There is a potential for harm to one or both clients in this situation. This may take the form of a breach of confidentiality, for example if the counsellor inadvertently mentions information to one client that has been revealed to him/her by the other. There is also the possibility for loss of trust should one or both clients discover they are seeing the same counsellor.
A counsellor accepting this moral responsibility will need to consider and evaluate all the possible responses to the dilemma posed, a practice referred to as moral reasoning (Welfel, 1998).
There are two primary courses of action a counsellor in this situation could consider:
How do we choose which course of action to take? There is no legal mandate in this situation hence this becomes a question of ethics. In deciding on a suitable course of action, several points need to be taken into consideration.
If continuing to see both clients:
If deciding not to see the new client:
In answering these points, both practical and ethical issues arise. One area which will influence the course of action taken is the counsellor?s level of experience. A beginning counsellor may decide, after assessing the client and conferring with a supervisor, to refer the client to a colleague on the basis of not being the most suitable or qualified person to meet the client?s needs.
This would allow the counsellor an alternative to breaching the original client?s right to privacy when explaining the situation to the new client.
A more experienced counsellor may decide they are able to maintain professional boundaries while seeing both clients, believing he/she can refrain from revealing information to one client given to the counsellor by the other.
This would necessitate regular support via supervision to keep a clear view of the situation, along with the need for tactful scheduling of appointments.
This however does not address the potential negative consequences should one or both clients discover they are confiding in the same person. This brings us to another area influencing the eventual course of action, the potential reaction from the client(s).
The counsellor and supervisor may make a prima facie assessment of the potential for harm based on each client?s temperament as noted by the counsellor to date. A client showing a tendency towards suspicion or anger, or one with trust issues, will be more vulnerable in this situation than a more laid-back client.
One last point for the counsellor to consider is the actual issue mentioned by the new client. Is her assertion that her supervisor is the main cause of her stress a clue to a more general interpersonal problem (i.e. blaming others) than a specific difficulty between the two?
This may or may not be the case, but it would mean the focus of counselling would be more on addressing irrational thoughts and skill deficits than dealing specifically with the situation at work. In this case, the potential conflict facing a counsellor seeing both clients is minimised.
This case would create problems with confidentiality. The Counsellor would be aware of information about the client?s situation due to previous discussions with the client?s supervisor. If either client became aware of the counsellor seeing both of them, then the clients would correctly assume that the counsellor had been discussing their case with the person they are in conflict with.
This could result in a loss of trust and a breakdown in rapport. The aggrieved client may seek legal redress for the suspected breach in confidentiality. The Counsellor would need to advise the client that they are unable to provide counselling and refer the client.
The client would need an explanation that did not uncover the name of their co-worker who is already attending counselling.
This dilemma is quite complicated.
Possibilities upon possibilities, scenarios upon scenarios came storming into my head in order to find the best solution in order to avoid any problems for the client ? counselor relationship.
This is when the Ethical Decision Making Flowchart (on pg. 6 of THE PROFESSIONAL COUNSELLOR, Issue 01, 2011), was very helpful. When I reached to the (3) tests to the action decided upon, it became clear to me that the action that I would take would be to refer the new client to another counselor.
This action I would:
a) recommend to another counselor (Universsality)
b) be happy to have this action reported by the media (Publicity)
c) treat others the same in a similar situation (Justice)
1) is for the best interest of the new client
2) is to safeguard the therapeutic relationship with the private client
3) will prevent the counselor from unnecessary stress and anxiety