A Case Study on Family Violence, and Ethical Decisions
By Dr. Stapper, MD, Edited by Dr. Esmond
In this paper, the author discusses the case of Sally, a mature minor that experiences violence at her home. After the counsellor outweighs possible risks and benefits (for Sally, her brother and other family members) of three possible courses of action based on the six-step ethical decision-making model recommended by the Canadian Counselling Psychotherapy Association (CCPA), the therapist decides to report the case to the child aide society.
Moral principles are advantageous when in an ethical dilemma. Codes do not provide answers to a counsellor's ethical question. There are five moral principles. The principle of autonomy protects the individual capacity of governing himself or herself. The principle of beneficence requires that we always work in the client's "best interest." The third principle is Fidelity. It establishes that we as counsellors "need to honor commitments (such as time of appointments) made to our clients." The fourth one is the principle of justice. It suggests that all clients need equal treatment. There should not be discrimination. The last principle is the principle of non-maleficence. For instance, if psychotherapy does not help the client, it should not cause harm (Brennan, 2013).
The standards of practice of the Canadian Counselling and Psychotherapy Association (CCPA) (2015) and the Code of ethics of the CCAP (2007), contain guidelines for counsellors in Canada to conduct themselves professionally. Those guidelines contain "responsibilities," "expectations" and "obligations," look "to protect the public," and deal with counsellors' complaints.
Description of the individual involved in the case.
Sally, a "mature minor," comes to see the counsellor for the second time. When explaining the reason for her visit, she tells that "there is considerable violence within her home.” “Sally's father physically abuses her 14 years old (younger) brother." There are also problems between his father and other members of her family. Sally does not want to report her father to the appropriate agency because she believes it will probably make the situation at home worse, and also because he is going to move out of her home in the future weeks. Sally is not aware of the limits of confidentiality yet.
Ethical principles involved in Sally’s case.
(B4) suggests that when counselling starts, and through the process of counselling, the counsellor needs to explain possible treatment options, their risks and benefits and also the limits of confidentiality to the client (CCPA, 2015). (B2) states that counsellors do not need to keep client's information confidential if by doing this, the client and or others can be at risk of harm; when the counsellor receives a court request to release the records; and when there is a necessity to protect a child (CCPA, 2015). (B5) explains that children can give consent to a counsellor's treatment if they understand what the therapy is and the risks and benefits of it (CCPA, 2015).
Moral principles involved in Sally’s case. Counsellor's feelings and thoughts after sleeping on it and projecting the situation into the future.
1. Autonomy. Sally does not want to contact any protective agency such as the Child Aid Society (CAS) because she fears her father's abusive behavior against her brother and other family members will worsen. If the psychotherapist does what she wants and does not contact CAS, she or he will respect this client's autonomy principle. However, if we do that, Sally, Sally's brother, and other family members will probably continue experiencing the abuse (that can also escalate) from her father, and they will not feel (and will not be) safe and or protected in any way. The abuse can even get worse and lives could be in danger. 2. Non-maleficence. Brennan (2013), stated that "even if treatment does not resolve a client's problems, it should not make them worse (p. 276)." The counsellor can wait for a few weeks before he sees Sally again. By doing that, he or she can give some time to the client's father to get out of the house. At that time the abuse issue can be reassessed. This decision can make Sally happy because the counsellor respected her confidentiality wishes. The problem is that the father will probably continue abusing his family. Also, he might change his mind and never leave the family home. As a result, Sally and her family' psychological wound will deepen. The counsellor can lose his job and be liable for not disclosing crucial information to the respective authorities. 3. Beneficence. Brennan (2013), also states that "Beneficence requires always working in the best interest of the client (p. 246)." If the counsellor decides to report the case, Sally, her brother, and other family members that experienced the abuse will most likely receive counselling, advice and protection. On the other hand, Sally might feel that the counsellor broke her trust by revealing her personal and private information. However, in the end, Sally and her family could appreciate a life free from the abuse. Also, his family and father can receive the help they need. Most importantly, her father will not be able to cause more harm to his family.
Will the counsellor’s decision change in the future?.
1. If the counsellor decides to wait and reassess the client in a few weeks and sees that the father has not left the family home and or is not planning on doing it, the counsellor can report the father at that time. 2. If the counsellor already reported the father, no change will be needed in the future. 3. If the counsellor decides not to report and the family violent escalates and or continues, he or she may want to see Sally more often to make sure she (or her family members) is not in danger.
Counsellor’s plan of action.
Based on the above analysis, the counsellor decided to report the case to the CAS. The counsellor is worried because domestic violence can be psychologically damaging. The counsellor wants to protect Sally and her family of future anxiety, PTSD (post-traumatic stress disorder) and depression.
Witnessing and experiencing family violence, have damaging consequences for the member involved. Singh, B., and Moral, A. (2013), states that "While some of the health consequences have been researched, others have only recently been given attention, including psychiatric disorders and suicidal behavior. Importantly, there is evidence that major adult forms of illness including ischemic heart disease, cancer, chronic lung disease, irritable bowel syndrome and fibromyalgia are related to experiences of abuse during childhood (p. 503)".
Sally is a mature minor that comes to see a counsellor because of her family violence situation. Sally has witnessed abuse towards her younger brother and other family members. After the informed consent process is explained (as well as when confidentiality can be broken), the counsellor will listen to Sally’s history of abuse in detail. By using the ethical decision-making recommended by the CCPA, the counselor imagines the pros and cons of three possible scenarios. Finally, the counselor decides to report the case to the appropriate agency (CAS).
Brennan, C. (2013). Ensuring ethical practice: Guidelines for mental health counsellors in private practice. Journal of Mental Health Counseling, 35(3), 245-261. Retrieved from https://search.proquest.com/docview/1404761293?accountid=142373
Canadian Counselling and Psychotherapy Association (2007), Code of ethics. Ottawa, ON:
Author. Retrieved on the 25 of June from https://www.ccpa-accp.ca/wp-content/uploads/2014/10/CodeofEthics_en.pdf
Canadian Counselling and Psychotherapy Association. (2007). Code of ethics. Ottawa, ON: Author. Retrieved on the 25 of June from https://www.ccpa-accp.ca/wp-content/uploads/2014/10/CodeofEthics_en.pdf
Canadian Counselling and Psychotherapy Association. (2015). Standards of practice. (5th ed.).
Ottawa, ON: Author. Retrieved from http://www.ccpa-accp.ca/wp-
Singh, B., & Moral, A. (2013). Traumatic consequences of child abuse. International Journal of
Education and Management Studies, 3(4), 500-506. Retrieved from