1.9 Case Study
Case Study: The Dilemma of Confidentiality and Duty to Protect
Maria, a licensed mental health counselor, is working with Alex, a 17-year-old client referred by his school counselor due to concerns about his declining grades and emotional withdrawal. During their fourth session, Alex reveals that he has been having thoughts of harming a specific teacher who he feels has unfairly targeted him. He mentions that he has been researching the teacher’s schedule but insists he is “just thinking about it” and has no immediate plans to act.
Maria is deeply concerned about the potential risk Alex poses to the teacher. She knows her ethical obligations under the ACA Code of Ethics to maintain confidentiality, except in cases where there is a clear and imminent danger (Standard B.2.a.). However, the situation is ambiguous—Alex has expressed thoughts but not a specific plan, making the “imminent” threat unclear.
Maria is also aware of her legal duty to protect under state law, which requires her to report credible threats to authorities or the intended victim. At the same time, she wants to maintain trust with Alex and avoid actions that might cause him to withdraw from counseling or escalate his feelings of alienation.
Discussion Questions
- How can Maria balance her ethical commitment to confidentiality with her legal duty to protect others?
- Should Maria involve Alex in the decision-making process about informing others?
- How can Maria document her decision-making process to ensure accountability and adherence to ethical standards?