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1. The parties impacted are Janet, Larry, the clinical supervisor, the Agency, Agency Staff and AA attendees. The social realms(families, community members, the recovery community) which are connected to these individuals may also be affected indirectly.
2. Boundary violations, non-maleficence, breaking confidentiality and client rights to treatment…… Conflict between the supervisee’s safety and the client rights to treatment complicate these ethical issues.
3 and 4. Four viable courses of action would be having a
1. meeting with a client to discuss further treatment options,
2. meeting the client to transfer him to another clinician,
3. written or phone communication terminating treatment and subsequent referral
4. involving Law enforcement.
Complicating this decision is how the processing with the supervisee helps her make this decision. Honoring her valid feelings of being unsafe while balancing the client’s rights to treatment and clarity around the therapeutic relationship may be challenging. It may help to focus on the client before the counselor in making the decision.
Possible risks for the client are that he may continue his confusion and inapropriate behaviors, challenging his social connections, mental health and efforts at recovery. Possible risks for the counselor include her safety, her efficacy in managing challenging clients, her professional work and her own recovery. The agency and supervisor are at risk for helping the client and the supervisee with professional treatment/ supervision. Without making ethical choices supporting professional treatment, the agency may also be inadvertently putting the outside community at risk.
Benefits to all are in having client, counselor, the supervisor and agency staff feel safer and to have clear boundaries and guidelines for being successful. The efficacy of all these parties can be increased when all are supported by ethical and professional treatment, including informed consent, confidentiality guidelines, etc.
5. My hope would be that within the agency, I would have my own supervisor of supervision who is experienced in both supervision-of-supervision as well as treatment of co-occurring disorders. If not, I would seek my own outside clinical supervisor or experienced professional to consult with on this matter – either with similar experience. I may also end up consulting law enforcement with a scenario to see what options they may have of support for this situation – without breaking confidentiality.
6. To address the boundary violations, client rights to treatment, safety concerns for all parties – I would focus on meeting with the client to clarify innapropriate boundaries, illuminate further possible consequences and offer referral options within and beyond the Agency. It would be crucial to know the clinician’s decision about involving herself in this meeting (clinician with supervisor, just the clinician, just the supervisor) because she has been the main interventionist.
7. After that decision has been made about the counselor’s involvement, if any at all, I woud proceed with the meeting, including sharing supporting documentation of inappropriate behavior and consequences. Discussion could include how law enforcement involvement may be involved if the boundaries are not held. The client would then chose his further treatment within or outside of the Agency. Harm reduction during this stressful time of change would be discussed to help client maintain his recovery. If the client continued treatment here, reviewing how the client is managing boundaries may be reviewed in session regularly (monthly).
A written document clarifying what is discussed may be helpful to the client and will be kept in the client’s file. Myself, the counselor and whomever I consult with will also be keeping our own documentation about this incident.
I will follow up with the counselor (possibly past and current now) to monitor the interations with the client. Treatment will also be reviewed regularly. I may also continue to process my continued supervision within my own supervision.