Marcie’s situation is very delicate because she is an adult with some severe mental health concerns. She clearly has an intact relationship with her mother who brought her to the session. Marcie appears to be competent to make her own decisions but she is needing a psychiatric evaluation to determine the severity of depression and therefore her mental competence. She also admits to having been suicidal and having the means to (a gun) to kill herself. It is likely that she signed a confidentiality notice and that she has not signed a release for information to be given to her mother.
The three ethical or legal concerns that are involved are:
1. The need to maintain confidentiality.
2. The need to protect the client from harm due to her suicidality.
3. The need to disclose that she has a gun in her possession which may need to be reported due to her possible mental instability.
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I would ensure that Marcie understands the limits of confidentiality before beginning the counseling process. I would also talk with her throughout her session about concerns over her mental status, her possession of a gun and her decision to not inform her mother about what is going on. I would assert with her that I cannot keep confidences that would seriously jeopardize her safety or the safety of others, such as the possession of a gun when she is potentially suicidal. I would encourage her to problem solve some strategies that could be useful in resolving these dilemmas.
If Marcie refuses or cannot participate in making these decisions, I would ensure that all necessary information, via my documentation and referral, is given to the psychiatrist. Since she is suicidal and has means, I would ensure that she is immediately assessed. The quickest possible evaluation could be accessed through a hospital emergency room. I would need to ensure that she be evaluated so as not to be guilty of negligence. She could be transported there via ambulance and would not need her mother to know. I would encourage Marcie to send her mother home and explain that she would contact her later. If she is not able or willing to do so, I would tell her mother that Marcie or someone will be in touch about next steps but that her daughter is not transportation home. I would continue to encourage Marcy to be up front with her mother about her plan not to return home with her.
- American Psychological Association (2010). Ethical Principles and Code of Conduct. Washington, DC: American Psycholigical Association
- Brems (2001). Basic Skills in Psychotherapy and Counseling. New York: Cengage Publishing.
