7.13 Case Study

Michael is a newly licensed professional counselor working in a community mental health center. One of his clients, Sarah, is a 27-year-old woman seeking help for anxiety and depression related to recent life changes. During their intake session, Michael provides Sarah with a consent form that outlines the nature of counseling, confidentiality, and its limits. He briefly explains the document and asks Sarah to sign it before beginning the session.

After several weeks of productive sessions, Sarah shares that she is considering filing for divorce from her husband but is worried about potential custody battles over their two young children. During the conversation, Michael references the limits of confidentiality and Sarah expresses surprise, saying, “I didn’t realize there were situations where you’d have to share what I say.”

Michael reviews the signed consent form and realizes he did not adequately explain the confidentiality section during their initial session. While Sarah signed the form, her reaction suggests she didn’t fully understand its implications. This oversight becomes more pressing when, in a later session, Sarah discloses that her husband has been physically abusive toward her and the children.

Discussion Questions

1. What are Michael’s ethical responsibilities in ensuring clients understand the informed consent process?
2. How should Michael address Sarah’s concerns about confidentiality now that the misunderstanding has come to light?
3. What steps can Michael take to ensure that he explains informed consent more effectively in the future?
4. How can Michael approach the new information about abuse in a way that upholds Sarah’s rights and safety while adhering to mandated reporting laws?
5. What impact might this oversight have on the therapeutic relationship, and how can Michael work to rebuild trust with Sarah?
6. How can supervisors or colleagues support Michael in learning from this experience and improving his practice?
7. What are the potential consequences for counselors who fail to adequately explain informed consent to their clients?
8. How can culturally sensitive language and practices be incorporated into the informed consent process to ensure all clients understand their rights?