Question

Marcie is a new client and a 22-year-old female who works as a receptionist in a doctor's office. She has just revealed to you during the intake session that she has recently lost interest in most activities, has been sleeping a great deal yet feels tired all the time, and sometimes wishes she could cease to exist. She mentioned feeling as though she has been "on an emotional roller coaster" during the past year, throughout her on-again/off-again relationship with a 35-year-old married man. The last breakup with him seemed final, and Marcie has felt herself sinking deeper and deeper into depression ever since. When probed further about suicidal ideations, Marcie admitted that she has considered killing herself, although she is uncertain whether or not she would actually do it. She said that she is currently in possession of a gun that her friend allowed her to keep in her home following a rash of burglaries in the neighborhood, but she does not know whether she would actually use it.

You have consulted with your supervisor, who has agreed that Marcie should be referred immediately for a psychiatric evaluation and has instructed you to arrange for Marcie to go directly from your office to a nearby hospital. Marcie told you that her mother accompanied her and is in the waiting room, but she has emphatically stated that she does not want her mother to know what is going on with her. How should this delicate situation be handled? Why? What are three ethical and/or legal concerns about this case?

Answer 1

• Up to this point the counselor has handled the situation appropriately, she recognized the suffering that Marcie was having, and the concern for inflicting harm to herself. She got an assessment of the patient and received advice from her supervisor who also thought that Marcie could benefit from a psychiatric evaluation. In such a situation,the counselor needs to be empathetic and understand Marcie's condition. If she is not comfortable talking in front of her mother,then that should be allowed.
• Client confidentiality is very important and an ethical concern as well. But since this a delicate situation,her family needs to know about her condition because in this condition she needs her family support.
• Licensed counselors can break this ethical code under special circumstances.The most common includes when a client is a threat to himself/herself or others, in which case a therapist must notify the person in danger or notify someone who can keep the client safe.
• Also,because hospitalization is required therefore,the counselor needs to reveal details about the treatment as well limited to only diagnosis and any medications required.
• Since it involves gun too therefore legal concerns are there as well and the family needs to be informed about it. If discussing the whole situation with Marcies helps,then it would be easier to hancdle the case but if not then without her consent the mother would have to be informed in order to protect her.