Introduction
This essay explores critical issues in counselling professional practice through a case study of a client who presented with explicit suicidal intentions during a session. As a counselling student reflecting on this scenario, I will examine the ethical dilemmas surrounding the decision to breach confidentiality by contacting emergency services, the client’s GP, and their mother. The discussion will focus on the ethical frameworks guiding such decisions, the legal and professional obligations of counsellors, and the impact of these situations on counsellor wellbeing. This analysis aims to provide a balanced understanding of the complexities involved, drawing on academic literature and professional guidelines to evaluate the actions taken and their broader implications for practice.
Ethical Dilemmas in Breaching Confidentiality
Confidentiality is a cornerstone of therapeutic practice, fostering trust between counsellor and client. According to the British Association for Counselling and Psychotherapy (BACP), maintaining confidentiality is an ethical imperative unless there are compelling reasons to disclose information, such as a risk of serious harm (BACP, 2018). In the case study, the client’s explicit intention to commit suicide presented a clear and immediate risk, necessitating a breach of confidentiality. This decision, while necessary, raises significant ethical concerns about the balance between client autonomy and the duty of care.
The principle of beneficence, which underpins the counsellor’s responsibility to act in the client’s best interest, often conflicts with respect for autonomy in such scenarios (Beauchamp and Childress, 2013). By involving emergency services, the GP, and the client’s mother, I prioritised the duty to protect life over the client’s right to privacy. However, this action arguably undermined the therapeutic alliance, as the client may perceive it as a betrayal of trust. Bond (2015) highlights that while breaches of confidentiality are sometimes unavoidable, they must be handled with transparency and sensitivity to mitigate damage to the therapeutic relationship. In this instance, discussing the need to involve others with the client, where possible, could have softened the impact, though the urgency of the situation limited such opportunities.
Legal and Professional Obligations
From a legal and professional standpoint, counsellors in the UK are bound by frameworks that permit breaches of confidentiality under specific circumstances. The BACP Ethical Framework explicitly states that confidentiality may be broken when there is a risk of serious harm to the client or others (BACP, 2018). Furthermore, the Mental Capacity Act 2005 provides a legal basis for intervening when a person’s capacity to make decisions is compromised, as may be the case during a severe mental health crisis (UK Government, 2005). In this scenario, the decision to contact emergency services and the GP aligns with these guidelines, as the client’s suicidal intent posed an immediate threat to their safety.
Notably, involving the client’s mother introduces additional complexity, as this action extends beyond standard protocol and may not be explicitly covered by legal or professional guidelines unless prior consent was obtained. Jenkins (2017) cautions that involving family members without clear justification or client agreement can complicate ethical boundaries and potentially exacerbate the client’s distress. Reflecting on this, I acknowledge that this step may have been driven by an instinct to ensure additional support but lacked a robust ethical rationale. A more measured approach, such as consulting a supervisor before involving family, might have ensured adherence to best practice.
Impact on Counsellor Wellbeing
Beyond the client-focused aspects of this case, the emotional toll on the counsellor must also be considered. Managing a suicidal crisis is inherently stressful, often triggering feelings of anxiety, self-doubt, and emotional exhaustion (Rossouw, 2015). In this instance, the urgency of the situation and the weight of deciding to breach confidentiality placed significant pressure on my emotional resources. Furthermore, the fear of potential backlash from the client or family members added to the strain, highlighting the importance of self-care and supervision in counselling practice.
The BACP Ethical Framework underscores the need for counsellors to monitor their wellbeing and seek support to maintain competence (BACP, 2018). Indeed, regular supervision provides a critical space to process such intense experiences and reflect on decision-making. Research by Wheeler and Richards (2007) suggests that counsellors who engage in reflective practice and prioritise self-care are better equipped to handle ethical dilemmas without compromising their mental health. In retrospect, I recognise the value of debriefing with a supervisor immediately after the incident to unpack my emotional response and evaluate the appropriateness of my actions.
Critical Reflection on Decision-Making
Reflecting critically on this case, I can identify both strengths and limitations in my approach. On one hand, the swift decision to contact emergency services and the GP was grounded in a clear understanding of my duty of care and aligned with professional guidelines. The priority to safeguard the client’s life was non-negotiable, and this action likely prevented a tragic outcome. On the other hand, involving the client’s mother raises questions about proportionality and necessity. While my intention was to build a support network around the client, this decision may have overstepped ethical boundaries and could have been handled differently, perhaps by seeking guidance from a supervisor or exploring alternative support options.
Moreover, I must consider the longer-term implications for the therapeutic relationship. Breaching confidentiality, even for valid reasons, can erode trust, and rebuilding this trust requires careful communication and empathy (Bond, 2015). If faced with a similar situation in the future, I would aim to involve the client in the decision-making process where feasible, explaining my obligations and the reasons for any disclosures. This approach, though challenging in an acute crisis, could help preserve some degree of autonomy for the client.
Conclusion
In conclusion, this case study of a client presenting with suicidal intent illustrates the complex ethical, legal, and personal challenges inherent in counselling practice. The decision to breach confidentiality by involving emergency services and the GP was justified by the duty of care and supported by professional guidelines, though the involvement of the client’s mother highlights a need for greater caution and reflection. This scenario also underscores the profound impact of such crises on counsellor wellbeing, emphasising the importance of supervision and self-care. Ultimately, this analysis reveals the delicate balance counsellors must strike between protecting clients and respecting their autonomy, a balance that requires ongoing critical reflection and adherence to ethical principles. The implications for practice are clear: counsellors must be equipped with robust training, supervisory support, and a deep understanding of ethical frameworks to navigate such dilemmas effectively.
References
- Beauchamp, T. L. and Childress, J. F. (2013) Principles of Biomedical Ethics. 7th ed. Oxford: Oxford University Press.
- Bond, T. (2015) Standards and Ethics for Counselling in Action. 4th ed. London: SAGE Publications.
- British Association for Counselling and Psychotherapy (BACP) (2018) Ethical Framework for the Counselling Professions. Lutterworth: BACP.
- Jenkins, P. (2017) Professional Practice in Counselling and Psychotherapy: Ethics and the Law. London: SAGE Publications.
- Rossouw, P. (2015) ‘The emotional impact of working with suicidal clients: Implications for counsellor self-care’, Counselling and Psychotherapy Research, 15(2), pp. 89-97.
- UK Government (2005) Mental Capacity Act 2005. London: The Stationery Office.
- Wheeler, S. and Richards, K. (2007) ‘The impact of clinical supervision on counsellors and therapists, their practice and their clients: A systematic review of the literature’, Counselling and Psychotherapy Research, 7(1), pp. 54-65.
