13.6 Case Study

Alex, a 16-year-old high school student, has been receiving telehealth counseling sessions with Morgan, a licensed professional counselor, to address anxiety and self-esteem issues. Alex often joins sessions from their bedroom using a laptop, citing a lack of privacy elsewhere in the home. Morgan has noticed that Alex frequently keeps the camera off during sessions, stating discomfort with being on video.

During a routine session, Alex discloses that they have been experiencing persistent thoughts of self-harm. When Morgan probes for more details, Alex shares that they have access to sharp objects but insists they have no immediate plan to act. Morgan expresses concern and attempts to explore Alex’s support system and coping strategies. However, Alex becomes increasingly withdrawn and defensive, ultimately turning off their microphone and abruptly leaving the session.

Morgan immediately attempts to contact Alex using the telehealth platform’s messaging feature but receives no response. Reviewing Alex’s intake form, Morgan realizes they have no emergency contact information on file, as Alex’s parents were hesitant to participate in the intake process, citing a preference for Alex’s independence in therapy.

Morgan now faces an ethical challenge: they are obligated to take action to ensure Alex’s safety but lack critical information to do so effectively. Contacting emergency services without knowing Alex’s precise location may delay intervention and breach confidentiality unnecessarily. Furthermore, reaching out to Alex’s parents risks violating the client’s trust and could disrupt the therapeutic relationship.

At the same time, Morgan is aware that inaction could place Alex in serious danger. The counselor must weigh the ethical obligation to protect the client against the potential harm caused by breaching confidentiality or involving outside parties without clear justification.

Discussion Questions

1. How should Morgan balance the ethical principles of client safety and confidentiality in this situation?
2. What immediate steps should Morgan take to ensure Alex’s safety while maintaining professional integrity?
3. How might the lack of emergency contact information in the intake process inform future telehealth policies and procedures?
4. What strategies could Morgan use to rebuild trust with Alex if confidentiality is breached to ensure their safety?
5. How can telehealth counselors prepare for similar scenarios by creating proactive safety plans with clients, especially minors?