Vignette analysis and narrative structure

Vignettes

The first step is analyzing the facts of the situation and identifying the problem. A client is just starting to develop trust with me. The client happens to have just turned of major age; just one year ago and my relationship with the client would be constrained by my ethical obligation to involve the parents in treatment.

However, the client is no longer a child, especially in the eyes of the law. Therefore, the client is obliged to enjoy the full rights and privileges bestowed on all clients related to confidentiality. The parent does not have any special privileges in this case, as the client is of major age and insurance is paying for the therapy sessions. These are the primary issues involved.

The next step is to evaluate my behavior and ensure that core moral principles are being adhered to in my practice. Core moral principles such as autonomy, nonmalfecience, beneficence, fidelity, and veracity remain extant in this situation. The third step is formulating an appropriate response to the mother. I will offer a terse and general response to the mother, such as, "I have only been working with your son for a few sessions, but I believe things are going well. I would like to continue seeing your son for therapy. Would you like to come in for therapy yourself?" It is possible that engaging the mother in therapy will help her to unravel reasons for her potentially dysfunctional behaviors related to her son.

After this, I need to assure the client that I would not under any circumstances share any information about the details of my sessions with the mother or anyone else. The child has become my client, and will be treated with the full rights and privileges thereof. I will inform the client of his rights, so that he may develop a deeper trust with me as the therapist. The only condition under which I would be ethically obliged to violate the contract of confidentiality with the patient is in the unlikely event that I believe the client is capable of causing harm to himself or others. I will disclose this consideration with the client in light of my ethical obligation to operate with full transparency.

2. The first step is analyzing the facts of the situation. I have privileged information that the client's boyfriend was abusive. This information has been given to me in full confidentiality, and I continue to be obliged to protect the client's privacy. However, the client's death is directly related to the boyfriend's abusive behavior. It is my belief that the boyfriend may pose a significant risk to other people, which is why it will be appropriate in this scenario to consider breaking my confidentiality agreement with the deceased and offering my testimony in a court of law or affidavit.

Second, I must remember that while I do have evidence that abuse occurred in the relationship, I do not have any evidence to suggest that the client's death was a direct result of that abuse. Therefore, I must carefully prepare my testimony to ensure nonmalfecience. I will need to consult with legal counsel if possible, or at least with professionals who have dealt with similar situations in my state. I need to know what, if anything, I am obliged to share with the authorities as well as with the family members of the deceased.