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Benchmark Ethical Vignette Paper Student's Name Department, University Instructor's Name Course Title Date Abstract This paper seeks to apply the ethical decision-making model outlined in the practitioner's guide to ethical decision-making. A hypothetical case is presented, and this decision-making framework is used to help solve the ethical dilemma. This paper makes use of the "A Helpful Receptionist" video, where a receptionist innocently shares client information with her husband. It is then revealed that the wife did not want the husband to know that she was undergoing counseling since they are in the midst of a divorce, and this information could hence be weaponized to take away her custodial rights. This ethical dilemma is hence centered on confidentiality and respecting clients' privacy. The paper highlights the fact that sharing client information, even in a seemingly innocent manner, can have serious ethical and legal implications. Furthermore, even when the counselor does not directly breach the client's

confidence, they bear primary responsibility since they are responsible for their staff and should hence cultivate an environment where the client's privacy is prioritized. Benchmark Ethical Vignette Paper Confidentiality is key to counseling, and a breach of confidence can cause irreparable damage to the relationship between a client and a counselor since the trust may be broken. A lot of clients do not even want others to know that they are in therapy, including their own spouses. Counselors, hence, go to great lengths to protect their privacy, including not acknowledging clients in public. This case will present a situation where a receptionist will divulge the fact that a client is receiving counseling at a particular facility to her husband in the middle of a divorce. The paper explores the ethical dilemma this situation presents. Identify the problem In the "A Helpful Receptionist" video, the receptionist divulges patient information to her husband without her consent. The husband comes and explains to the receptionist that he needs to leave town for his job and that the receptionist should relay a message to his wife to pick up the kids from soccer practice. However, after the wife finds out that her husband was just there, she immediately panics as she fears that he will use this information in their divorce to paint her as an unstable and unfit parent. Even though the receptions may have been well-intentioned, revealing this information to her husband may have inadvertently complicated her divorce, especially in terms of her custodial rights. The wife did not wish for her husband to find out that she was seeking counseling. Confidentiality is key to counseling, and as such, no outside parties should be privy to the fact that one is undergoing counseling. The counseling center should hence not have revealed this information to her husband without her expressed written consent. Even the fact that she was at the facility should not have been divulged. In this case, even though the receptionist is the one who revealed that the wife was indeed receiving counseling at the center, the counselor is still the one who bears the responsibility of maintaining the confidentiality of client records and ensuring that their staff, including the receptionist, understands and follows ethical and legal guidelines regarding client confidentiality. This case presents an ethical, professional, clinical, and even legal problem. Sharing client information

without informed consent could raise ethical concerns related to confidentiality and respecting the client's rights. The counselor has an ethical duty to protect the client's privacy and confidentiality unless there are legal or ethical exceptions. The counselor's actions could have clinical implications, as they may impact the trust and therapeutic relationship between the counselor and the client. The potential disclosure of sensitive information may affect the client's well-being and the effectiveness of the counseling process. This situation can be seen as a professional problem because it involves the counselor's adherence to the ethical standards and guidelines set forth by her profession, such as the ACA Code of Ethics. It also relates to maintaining professional boundaries and responsibilities. Furthermore, depending on the laws and regulations in the counselor's jurisdiction, sharing client information without consent may violate legal standards related to confidentiality and privacy. Legal consequences could arise if the counselor breaches confidentiality. Apply the ACA Code of Ethics The 2014 ACA Code of Ethics was formulated to provide counselors with guidance when dealing with issues related to ethical practice. The following standards apply to this particular case. Standard A.1.a. - Primary Responsibility This standard states, "The primary responsibility of counselors is to respect the dignity and to promote the welfare of clients." In this scenario, the receptionist's actions of sharing client information without authorization violated the primary responsibility of maintaining client confidentiality and promoting their welfare. The counselor, as a supervisor and responsible party, should ensure that all staff members understand and adhere to this primary responsibility (American Counseling Association, 2014). Standard B.1.b. - Respecting Client Confidentiality This standard states, "Counselors protect the confidential information of prospective and current clients." In the scenario where the receptionist shared client information without proper authorization, it is a direct violation of this standard (American Counseling Association, 2014). The receptionist's actions breached the principle of protecting the confidential information of clients, which is a fundamental ethical responsibility in the counseling profession. The counselor, as the responsible party, should ensure that all staff members, including the receptionist, are well-informed about the importance of safeguarding client confidentiality. Additionally, counselors should have policies and procedures in place to maintain the confidentiality of client records and information. Addressing this breach and reinforcing the principles outlined in Standard B.1.b. is essential to maintain the trust and ethical standards of the counseling profession. Applicable State Codes/Laws and Federal Mental Health Laws In California, professional counselors are required to maintain confidentiality, or they risk disciplinary action or even exposing themselves to civil or criminal liability. This is covered in a number of California statutes, including the Business and Professions Code 4982(m), which

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considers a breach of confidentiality as unprofessional conduct that could lead to one losing their license or even facing criminal penalties per the Business and Professions Code 4983 which includes imprisonment of up to 6 months, a $2500 fine or both. The California Association of Marriage and Family Therapists (CAMFT) also includes various stipulations in regard to confidentiality (Benitez, 2004). Standard 2.1, in particular, warns against disclosing patient confidences, including their names and identities (Benitez, 2004). This is relevant in this case, especially considering the fact that the receptionist confirmed to the husband that his wife was indeed receiving therapy at this particular facility. This should not occur unless the counselor is legally required to provide this information or the client has allowed this information to be shared in writing. In the context of federal mental health laws, one significant law that applies to scenarios involving the confidentiality of mental health information is the Health Insurance Portability and Accountability Act (HIPAA). While HIPAA primarily focuses on the privacy and security of health information, it includes provisions related to the confidentiality of mental health records and information. In this case, the HIPAA Privacy Rule 45 CFR Part 160 and Subparts A and E of Part 164 apply. The Privacy Rule found in 45 CFR Part 160 and Subparts A and E of Part 164 of the Code of Federal Regulations governs the use and disclosure of protected health information (PHI), which includes mental health information. In the scenario described, if a receptionist shares mental health information without proper authorization, it can constitute a violation of HIPAA's Privacy Rule, as it involves the unauthorized disclosure of PHI (Benitez, 2004). Determine the Nature and Dimensions of the Dilemma Based on this scenario, several ACA moral principles are applicable. These are:  Autonomy: Autonomy emphasizes the right of individuals to make their own choices and decisions regarding their personal information and treatment. In this scenario, the ethical principle of autonomy is relevant because it pertains to the client's right to control their mental health information and decide who can access it. The client has the autonomy to determine who should have access to their confidential information, and this principle supports the idea that unauthorized disclosure of this information is ethically problematic (Forester-Miller & Davis, 1995).  Fidelity: Fidelity refers to the ethical duty of counselors to be faithful and loyal to their client's trust. It involves maintaining the client's confidentiality and protecting their interests (Forester-Miller & Davis, 1995). In this scenario, the breach of confidentiality by the receptionist violates the principle of fidelity because it betrays the trust the client has placed in the counseling practice to safeguard their confidential information.  Nonmaleficence: Nonmaleficence emphasizes the obligation to "do no harm" to clients and to prevent harm whenever possible. Unauthorized disclosure of a client's mental health information can potentially harm the client by compromising their privacy and trust in the therapeutic relationship, as well as affecting their divorce and custodial rights. Nonmaleficence is, hence, the priority principle since it is considered to be the most critical (Forester-Miller & Davis, 1995). By releasing this information to her husband in the midst of her divorce, the counseling office could have jeopardized the client's future as this information could be weaponized to affect her custodial rights as well as the divorce settlement, which could determine the woman's future. The release of this

privileged information to an unauthorized third party could hence cause a lot more damage than the receptionist may have anticipated. Subramani (2019) highlights the need to balance confidentiality with third-party protection. This article asks a professional dealing with sensitive medical information to consider whether the harm that could result from not informing the spouse justifies breaching the patient's confidentiality. The harm principle suggests that confidentiality can be breached when there is a likelihood of harm to others. However, the extent and immediacy of harm are critical factors in this evaluation. Koocher (2020), on the other hand, highlights that counselors have a primary obligation to take reasonable precautions that will ensure that protected identifiable information is protected even when obtained or stored in any medium. The author also highlights the need to abide by minimum necessary disclosure when releasing information to third parties. In this particular case, the receptionist should have hence refrained from being too forthcoming with information related to the client who was using the counseling facility. While the counselor may not have directly shared the information, they are still responsible for maintaining the confidentiality of client records and ensuring that their staff, including the receptionist, understands and follows ethical and legal guidelines regarding client confidentiality. To obtain guidance on this ethical dilemma, I would ask my supervisor for guidance since they have experience and expertise in the field; I would also seek out the guidance of peers in online counseling forums or communities where counselors discuss ethical issues. While not a substitute for professional guidance, these platforms can provide different perspectives and ideas for addressing dilemmas. In terms of organizations, I would consult the California Association for Licensed Professional Clinical Counselors and the American Counseling Association (ACA). Generate Potential Course of Action. Immediate Response and Client Support: In response to the breach, my initial step would be to immediately contact the affected client. I would offer a sincere apology for the breach and express our commitment to their well-being and confidentiality. I'd ensure the client feels heard and supported during this difficult time (Lederman & Shefler, 2023). Additionally, I would discuss the option of involving a counselor or therapist to address any emotional distress resulting from the disclosure. This immediate, client-centered response aims to rebuild trust and offer practical support. Internal Investigation and Policy Review: Simultaneously, an internal investigation would be initiated. This investigation would involve interviews with the receptionist involved and any other staff members who might have relevant information. The purpose of this investigation is to gather all relevant facts and determine the extent of the breach. At the same time, I would conduct a comprehensive review of our counseling center's confidentiality policies. If necessary, these policies would be updated and strengthened to prevent similar breaches in the future. Subsequent staff training sessions would emphasize the critical nature of client confidentiality and the consequences of violating it (Lederman & Shefler, 2023). Client-Centered Resolution and Compensation: To address the emotional impact on the affected client, a dedicated session with a counselor or therapist would be offered. This session would focus on providing emotional support, helping the client process their feelings about the breach,

and discussing any potential repercussions, such as its impact on the divorce proceedings and custodial rights. If the breach has caused tangible harm, such as legal expenses or delays in the divorce process, compensation or fee adjustments may be considered to mitigate these losses (Appel, 2022). Throughout these discussions, clear communication would be maintained to reassure the client of our commitment to preventing similar incidents in the future. Conclusion This particular case hence highlights how revealing private information in a seemingly harmless manner can have serious consequences not only for the patient but also for the counselor. This case shows that the code of conduct in place for professional counselors serves a purpose and should, hence, be taken seriously. Furthermore, professional counselors take the blame for any disclosure of private information in their facility, even if they are not directly responsible. The procedures, policies, and practices within an office should hence reflect respect for patients' privacy. The counselor is responsible for the actions of their staff; if the receptionist shares client information without proper authorization, it reflects on the counselor's ability to maintain a secure and confidential environment. The counselor still has an ethical obligation to address the breach and take appropriate action. This, hence, calls for the retraining of the staff as well as other corrective measures that will prevent similar breaches in the future. References American Counseling Association. (2014). ACA code of ethics. Retrieved from http://www.counseling.org/docs/ethics/2014-aca-code-of-ethics.pdf Appel, J. M. (2022). Breach of Confidentiality. In Malpractice and Liability in Psychiatry (pp. 113-120). Cham: Springer International Publishing. Benitez, B. R. (2004). Confidentiality and its exceptions (including the US Patriot Act). The Therapist, 16 (4), 32-36. Forester-Miller, H., & Davis, T. E. (1995). A practitioner's guide to ethical decision making. Alexandria, VA: American Counseling Association. Koocher, G. P. (2020). Privacy, confidentiality, and privilege of health records and psychotherapy notes in custody cases. American Journal of Family Law, 41–50. Lederman, S., & Shefler, G. (2023). Ethical dilemmas in psychotherapy with older adults: A grounded theory analysis. Ethics & Behavior, 33 (2), 101-114. Subramani, S. (2019). The uninformed spouse: Balancing confidentiality and other professional obligations . Indian Journal of Medical Ethics, 4 (3), 211-215.

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