Novice Counselor's blog

Diana, a private practitioner, began working with Mrs. Cole, who was referred for counseling by her family doctor. Her doctor had not been able to find any physiological basis for her complaint that on several occasions she had felt as though she were choking and could not breathe. After several sessions, it became apparent that these choking symptoms occurred when Mrs. Cole’s husband came home from work. Through further exploration, Mrs. Cole came to realize that she felt a great deal of anger that she had not been able to express, and that her relationship with her husband was directly related to her choking. With Mrs. Cole’s permission, Mr. Cole was invited for conjoint therapy.

During the first conjoint session, Diana noted that Mr. Cole was not being congruent when he discussed his relationship with his wife. He said that he loved her, but his nonverbal communication and tone of voice indicated otherwise. When Diana asked him if he had any feelings other than love for his wife, he became defensive and said “no”. At this point, Diana told Mr. and Mrs. Cole that she wanted to see each of them separately. Concerned that Mr. Cole might become hostile and uncooperative, Diana neglected to discuss issues pertaining to secrets and how they are handled.

Mr. Cole did come for an individual session, during which he disclosed that he had been having an affair for 8 months. He was adamant instating that he would never reveal the affair to his wife. He also stated that he would deny it if the counselor brought it up in a conjoint session. He urged Diana not to bring up the affair during sessions with Mrs. Cole. He felt certain that his wife would leave him if she knew. He became very emotional when he spoke of their four young children, saying that he was a good father and did not want their lives disrupted. When Diana asked him if he was committed to the marriage, he said that he was, but he wanted very much to keep this other relationship. He stated that his goal in counseling was to adjust to balancing the two relationships and to reduce his stress, and he requested additional sessions to help him with these goals (Herlihy & Corey, 2006).

If the Novice Counselor was the counselor in this case, she would refer Mr. And Mrs. Cole to another therapist for conjoined therapy and perhaps continue seeing each one on an individual basis. Had the Diana written up an informed consent at the beginning of conjoint therapy, she would have made Mr. Cole aware that any information disclosed in private sessions with him would have been shared with Mrs. Cole, or in other words, no secrets allowed. However, Diana failed to address this issue so now she is stuck in the middle. Should she continue to counsel Mr. And Mrs. Cole in conjoined therapy, her neutral stance and ability to be an effective counselor would be compromised. Due to this initial mistake, the Novice Counselor feels that conjoined therapy is no longer possible with this particular counselor. However, individual therapy is still an option for them. Informed consent and confidentiality issues need to still be discussed before individual therapy can continue.

The Novice Counselor would handle this situation by addressing informed consent and confidentiality rules at the beginning of therapy so that there would be no surprises later. The informed consent document would discuss the limits of confidentiality, the rights and responsibilities of clients, and what can be expected from the therapist. Corey, Corey, & Callan, 2007 state that when informed consent is done properly, each family member is in a position to decide whether to participate in therapy and how much to disclose to the therapist.

One of the ethical issues to consider when deciding on the most appropriate form of treatment is whether an intervention that servers one person’s best interest would harm or burden another family member. In couples therapy there can be an issue when the partners do not have a common goal to work towards. For example, one partner is seeking a divorce while the other wants to save the marriage (Corey, Corey & Callan, 2007). In both these case, an individual treatment would seem to be recommended.

If the Novice Counselor was working with a couple, she would not be opposed to seeing each person individually if one person had a problem which the other one did not share, such as depression, an eating disorder, or some type of addiction. Under no circumstances however would the Novice Counselor use the private sessions to allow one person to keep secrets from the other. This would be clearly stated in the informed consent form. Keeping secrets such as an affair can have a devastating effect on the relationship (Atkins, Eldredge et. al. 2005). Studies have shown that discovery of infidelity is associated with increased levels of clinical depression in the noninvolved spouse (Atkins, Eldredge et. al. 2005). The Novice Counselor would use the private sessions with the non-involved spouse to address the depression issue.

References:

Corey, G., Corey, M.S., & Callanan, P. (2007). Issues and Ethics in the Helping Profession (7th ed.). Belmont:CA. Thomson Brooks/Cole.

Herlihy, B., & Corey, G. (2006). ACA Ethical Standards Casebook (6th ed.). Alexandria:VA. American Counseling Association.

Atkins D. C.; Eldridge K. A.; Baucom D. H.; Christensen A.; (2005) Infidelity and Behavioral Couple Therapy:Optimism in the Face of Betrayal. Journal of Consulting and Clinical Psychology Copyright 2005 by the American Psychological Association 2005, Vol. 73, No. 1, 144–150