Canadian Psychologist Association
The case study I chose is:
A 23-year-old man, Mr. L., has been in psychotherapy with a psychologist, Dr. T. During the course of treatment, Mr. L. has described his anger at his former girlfriend, Ms. S., an undergraduate student at a local university. As therapy has continued, Mr. L.’s anger with Ms. S. has become more intense. During the most recent session, Mr. L. stated he was going to kill Ms. S. and left the office. What are the ethical issues involved?
In this specific case, the major ethical dilemma that I found relevant is the limits to confidentiality being challenged with regards to Mr. L stating that he is going to kill Ms. S.
According to the Canadian Code of Ethics for Psychologists (2017), informed consent is a mandatory process when beginning a therapist-patient relationship. Furthermore, informed consent can be in the form of oral or written language, but must be properly documented. Informed consent describes the nature of therapy, fees, third parties, and limits to confidentiality. Confidentiality, in Canada, respects the privacy of the client and therapist. For instance, in the Canadian Code of Ethics for Psychologists (2017), confidentiality means to protect information about colleagues, team members, other collaborators, primary clients, research participants, and more regarding what one deems confidential. Also, confidentiality clarifies what measures will be taken to protect privacy, as well as the responsibilities of group members in protecting such information. Confidentiality allows for sharing information only with others who are directly needed for the purpose of sharing (e.g., supervisor) and describes the limits to confidentiality. The limits of confidentiality in Canada include: reporting immediate and imminent harm or danger to a minor/child, reporting immediate or imminent harm or danger to seniors or people who are dependent on others, such as non-verbal, and reporting immediate or imminent harm or danger to oneself or others.
With that being said, in this case, Mr. L has now disclosed immediate or imminent danger towards Ms. S. Therefore, Dr. T has the obligation to report this to the authorities. This is obvious through the language that Mr. L uses such as “… I am going to kill…” Mr. L does not say “I have had thoughts, or I had dreams about killing Ms. S.” If Mr. L did disclose language such as thoughts or dreams, then Dr. T could explore that more with high monitoring before reporting.
If I was Dr. T in this situation, resolving would be mean reporting this to the authorities. It does not describe the script that Dr. T would have used at the beginning of this therapeutic relationship, but Dr. T had the obligation to explain informed consent, confidentiality, and limits to confidentiality. As an addictions counselor now, I am held to a high professional standard ensuring that these confidential standards are met. I conduct group therapy and on the first day of group we process and discuss confidentiality at length. In this discussion, I describe and explain the techniques that will be used and why, such as CBT, I explain that the program is voluntary, I explain the importance of boundary setting, and I explain the written documentation. To discuss the limits of confidentiality, I ask the group members what they think confidentially mean and if they can think of reasons why I would have to break it.
This specific case study interested me because it is very real. All of them were real of course and dilemmas that could occur, but this one is that fine grey line. Also, the more I study, read, or discuss limits to confidentiality, maybe the more prepared I am for when or if this happens to me.
Discuss the process of developing a personal racial or ethnic identity.