A: Identify the Dilemma
Lauren is a 17-year-old student at Lincoln High School in Chicago. Just over a year ago
her mother walked out on her family, leaving Lauren and five younger siblings in the care of
their father, Dan. Lauren’s mother said she felt that she could no longer care for her six children
and felt overwhelmed by the demands. Her mother moved to California and has not contacted
the family since.
I am a Licensed Clinical Professional Counselor in a private practice. I have been
working with Lauren for just over a year. Lauren initially had serious issues about trust but has
been making significant progress in therapy. I feel that part of the reason Lauren has been able
to make such progress is due to the strong relationships she shares with her five siblings. I
consider Lauren’s father to be a constant source of support.
At Lauren’s weekly appointment, I notice a huge bruise on Lauren’s arm when she takes
off her sweatshirt. I ask Lauren what happened. Lauren explains with hesitation that she fell
down the stairs. When I press for more answers, Lauren begins to sob saying that her father
pushed her last night and she feel into the coffee table. Lauren says this only happened because
her father was drinking. Lauren says that her father apologized the next morning and promised
that it would never happen again. Lauren tells me that I am the only person she is telling because
I am the only person she trusts. Lauren asks me to promise not to say anything to anyone.
Lauren fears that if anyone found out her five siblings would be split up and put into foster care,
since they have no extended family. Lauren says she forgives her dad and knows it will not
happen again.
Illinois law requires professionals who work with children to report any suspected cases
of child abuse or neglect. I am faced with the ethical dilemma of whether or not to report the
abuse, even though the law requires me to do so. In order to report the abuse I must break the
confidentiality of my client and go against her wishes. My client has made a tremendous amount
of progress in therapy concerning trust issues and reporting the abuse could erase all the progress
made. Also, if I report the abuse the authorities could take Lauren and her siblings out of the care
of their father. The children already experienced a significant loss when their mother walked out
and I fear that being taken away from their father could have even more negative consequences
on the children. I also believe that even thought Lauren’s father pushed her, he does not pose an
immediate danger to the lives of his children.
On the other hand, if I do not report the abuse I am putting my client’s physical safety in
jeopardy. Although her father says it will not happen again there is no way to knowing this for
sure. Not only is Lauren’s safety in jeopardy but so in the safety of her younger siblings. Also,
the fact that her father was so intoxicated could be a problem in itself that needs attention.
Finally, if I did not report the abuse I would be sending the message to Lauren that this type of
behavior by her father is acceptable, which may even cause her to feel that she deserves it.
As a counselor, I am faced with the ethical dilemma of honoring my legal responsibility
to report the abuse and protecting my client’s physical safety vs. upholding my client’s wishes
and doing what is in the best interest of my client’s emotional well-being.
B: Identify my Initial Position
My initial position on the issue is to report the abuse to the authorities. Although Lauren
may not want me to report the abuse I feel that it is in her overall best interest. As a mental
health professional, I feel that it is my responsibility to protect my client. If I have the ability to
protect Lauren’s physical safety then I feel I need to take the necessary measures to ensure her
safety. Before I can help Lauren to serve the best interests of her emotional well being, it is
imperative that her physical safety is maintained first.
Her father’s drinking is also a serious concern to me. Since the children’s mother is no
longer around there is no other adult in the house to monitor what is going on. Lauren is too
young to be responsible for protecting all her siblings or for knowing how much alcohol is
acceptable for an adult to be drinking. I am concerned for Lauren’s safety because there is no
way to ensure that her father will not hurt her the next time he drinks.
I do realize that reporting the child abuse breaks the confidentiality of my client, but there
are many circumstances in this case that I would considered before a decision was made. I also
think that if this is the first time that abuse occurred then there is no better time to put a stop to it
then right at the beginning. Reporting the abuse sends the message to Lauren, her siblings and
her father that child abuse is not acceptable. My number one goal is to reach a decision that is
more beneficial to Lauren than detrimental.
C: Identify All Stakeholders
The first major stakeholder is Lauren. Lauren’s physical safety, emotional safety and
mental safety are all in jeopardy in this situation. Her love for her father and her care for his
well-being is also a concern. She fears what will happen to him if I report the abuse. Lauren is
also concerned with the well-being of her siblings. She does not want the family unit to be
destroyed and feels her siblings need her since she is the oldest and has always looked out for
them.
The next stakeholder is Lauren’s father. If I report the abuse he could lose everything
from his children to his job. He has been under a lot of pressure since his wife walked out on the
family. Could reporting the abuse cause him to have a breakdown? Also, reporting the abuse
could cause him to confront the issue of drinking which he may have been avoiding.
Lauren’s siblings are all major stakeholders. Their family life would be greatly affected
by whether or not I report the abuse. The children may be split up and put into foster homes.
Finding out that their father hurt their sister could cause them to think very differently of their
father. By living with their father, their physical safety and emotional well-being is also in
jeopardy. It is also possible for the siblings to get angry with Lauren for reporting the abuse and
disrupting life as they know it.
I am a stakeholder in this case. If I do not report the abuse and Lauren’s father abuses
again, then my professional capabilities and judgments are in questions. Lauren being hurt again
would also have many personal consequences for me because I failed to protect her. But what if
I report the abuse and Lauren blames me for ruining her family and ends our therapeutic
relationship. This would also have many personal consequences for me because I broke my
client’s trust and confidentiality.
The colleagues I chose to consult with are also stakeholders because they must evaluate
their own ethical stance on the issue. If I decided on a plan of action and they disagree with me,
then my colleagues are faced with a new ethical dilemma of what to do with my decision. Do
they stand back while I chose a plan that they feel does not serve the best interest of my client?
The final stakeholder is the counseling profession. If I report the abuse then I break the
trust of my client which is the foundation for building a solid therapeutic relationship. Clients
are supposed to be able to trust their counselors with confidential information. If clients do not
trust their counselors than the counseling profession is in serious trouble. On the other hand, if I
do not report the abuse then child advocates will say that counselors are trivializing the severity
of child abuse and not acting in the best interest of children. If counselors are looked at as
individuals who do not protect children from harm, than the counseling profession loses serious
credibility in the eyes of the public.
D: Identify State Laws, National Laws or Statues
The state of Illinois has mandated reporting laws for child abuse. The Abused and
Neglected Child Reporting Act (ANCRA) requires professionals working with children who
have “reasonable cause to believe a child known to them in their professional or official capacity
may be an abused child or a neglected child shall immediately report or cause a report to be
made to the Department”(325 ILCS 5/4). Licensed clinical professional counselors are among
the professionals stated in the Act. Section 4 also says, “The privileged quality of
communication between any professional person required to report and his patient or client shall
not apply to situations involving abused or neglected children and shall not constitute grounds
for failure to report as required by this Act”(325 ILCS 5/4).
The ANCRA also states that “any person who knowingly and willfully violates any
provision of this Section… is guilty of a Class A misdemeanor for a first violation and a Class 4
felony for a second or subsequent violation…”(325 ILCS 5/4).
The law of Illinois requires me as a licensed clinical professional counselor to report
Lauren’s abuse. If I do not report the abuse then I could face criminal charges, in addition to
losing my job and civil liabilities. Hammer and Lutner (2001) stated that since protecting the
well being of children is a state interest, mandated reporters are immune from civil and criminal
liability when they break the confidentiality of a client in order to report the abuse. Through
researching the law I have found my legal responsibility to be clear. But in a case like this with
so many factors, I think it is necessary to think beyond the law and consider all circumstances in
order to reach a decision that benefits Lauren as much as possible. It would be easy to just
follow the law, but as a counselor before I can reach my decision I must also rely on ethical
codes, moral principles and consultation.
E and F: Identify Relevant Ethical Codes and Resolutions the Code Provides
The first ethical code that applies to this dilemma is Client Welfare. The code states,
“The primary responsibility of counselors is to respect the dignity and to promote the welfare of
the clients” (ACA, 1995, A.1.a). On one hand I feel that to promote the welfare of Lauren I
should report the abuse to safeguard her physical safety. But on the other hand, I do not feel that
I would be respecting her dignity if I went against her wishes and broker her trust to report the
abuse. There is no clear answer as to which course of action the code would support.
Another code that applies to this situation is Clients Rights. The codes states,
“Clients have the right to expect confidentiality and to be provided with an explanation of its
limitations…” (ACA, 1995, A.3.a). As a counselor, I know that I would state the limitations of
confidentiality in my informed consent. Therefore, Lauren would have been aware that in the
case of child abuse I would need to report it. This code would support me reporting the abuse
because Lauren was aware from the beginning that confidentiality had limits.
Another ethical code that applies is Confidentiality. The code states, “Counselors respect
their clients right to privacy and avoid illegal and unwarranted disclosure of confidential
information.” (ACA, 1995, B.1.a). However the code goes on to state the exception that “The
general requirement that counselor keep information confidential does not apply when disclosure
is required to prevent clear and imminent danger to the client or others or when legal
requirements demand that the confidential information be revealed.” (ACA, 1995, B.1.c). The
exception that the code entails clearly allows for confidentiality to be breached when the law
requires it to be. According to Illinois law, I am required to report child abuse, which means I
can stay within the ethical guidelines even if I break Lauren’s confidentiality. The code also
states that confidentiality can be breached if clear and imminent danger exists. Although I do not
believe that Lauren’s life is in danger I do believe that her physical safety is jeopardy, along with
the safety of her siblings. The code would once again support reporting the abuse in order to
keep Lauren and her siblings safe.
Overall, the codes do not provide one clear answer. Although the majority does support
reporting the abuse, the code of Client Welfare could support either course of action taken. On
one hand I feel that it is more important to protect Lauren’s physical safety, while at the same
time I wonder if the harm she would suffer from having her trust broken would be irreversible.
The conflict in the codes illustrates not only the difficulty of coming to a decision in an ethical
dilemma, but also the fact that you cannot solely relay on the codes for an answer. Instead many
other factors and pieces of information must be considered in order to reach the best decision
possible.
G and H: Virtue Ethics and Foundational Ethical Principles
The first moral principle that applies to this situation is autonomy. In order for a client to
grow they need to be able to make their own decisions and not rely on their counselor to make
decisions for them. Corey, Corey and Callanan (2003) stated that “respect for autonomy entails
acknowledging the right of another to chose and act in accordance with his or her wishes…”
(p.16). If I report the abuse then I am not acting in accordance with my client’s wishes and
therefore I am not promoting autonomy. I feel very strongly about fostering independent
relationships, which causes me to question which decision is best for Lauren.
Nonmaleficence can support either reporting the abuse or not reporting the abuse. In
order to prevent physical harm to Lauren, I would have to report the abuse. But on the other
hand if I do report the abuse Lauren may suffer other types of harm such as losing her ability to
trust others. What if her father’s actions were a one-time outburst that will never happen again?
But I decide to report the abuse and Lauren suffers harm that could have been avoided.
The principle of beneficence can also support both courses of action. On one hand, if I
report the abuse I am promoting the safety of Lauren and her siblings. On the other hand, if I do
not report the abuse I am promoting Lauren’s best interests by honoring her wishes and ensuring
that she will not be separated from her younger siblings.
Fidelity would support not reporting the abuse because it would require me to break the
trust of my client. I have a responsibility to my client and breaking Lauren’s trust would mean I
was not horning my responsibility as a professional counselor. But on the other hand, veracity
would support reporting the abuse because I was truthful from the start with my client when I
provided her with informed consent. In the informed consent I explained that there were limits
to confidentiality.
There is an obvious conflict in the moral principles in this ethical dilemma. While some
of the principle support reporting the abuse, others support not reporting the abuse. To raise
even more conflict some of the principles can support both decisions. I see clear contradictions
between fidelity and veracity, nonmaleficence and beneficence and autonomy and beneficence.
Fidelity says not to break the trust of my client, while veracity says I can because I outlined the
limits in my informed consent. Just as nonmaleficence could support not reporting the abuse to
avoid harm to Lauren’s emotional state, but beneficence would say I am not promoting Lauren’s
physical well being. Beneficence can also contradict with autonomy because if I promote
Lauren’s physical safety by reporting the abuse then I am not honoring her wishes, which is not
supporting her autonomy.
I: Consultation
The first mental health professional I consulted with was Martina Varallo. (M. Varallo,
personal communication, May 20, 2005) Martina is a licensed clinical professional counselor at
a mental health agency. After reviewing the dilemma, Martina said that she would definitely call
DCFS. She said she would make the call not with the intention of removing the children from
their home, but instead to ensure that their father was put into the system. This way if Lauren or
her siblings see another counselor and make a similar claim about their father, when the
counselor reports the abuse to DCFS, Lauren’s father will already be in the system. Then, DCFS
will be able to recognize a pattern in his behavior and follow up. Martina allowed me to see that
I could report the abuse without removing the children from their home. This was a relevant
option for me since I did not feel that Lauren’s father posed a threat to the lives of his children.
The second professional I consulted with was Hope Weinstein. (H. Weinstein, personal
communication, May 26, 2005) Hope is a licensed clinical social worker who works in a private
practice. Hope specializes in working with children and adolescents. Hope also agreed that she
would report the abuse. She said although every case needs to be looked at on an individual
basis, she once faced a similar case where she did call DCFS to make a report. Hope said that
after the report was made she did maintain a positive therapeutic relationship with her client.
Hope feels that when I child is abused, no matter how small the bruise or even if it happened
once, that it is unethical for the abuse to go unreported. I felt that is was very beneficial for me,
to hear first hand, that Hope was able to maintain a relationship with her client after making a
report. One of my big worries is that Lauren will no longer want to see me because I made the
report. Although I cannot generalize that what happened in Hope’s case will happen in mine, at
least I was able to see that therapeutic relationships to endure after reports are made.
J: Professional Literature
In attempt to gain more guidance and acquire new insight I turned to the professional
literature to see what other professionals have done when faced with the same ethical dilemma. I
was fortunate to find a vast amount of literature that provided me with answers to many of my
questions.
My first worry when confronting this dilemma was that I was alone in questioning
whether or not to report the abuse because it would be in violation of the law. Berrick and
Lawrence (1995) stated that “problems involving people’s lives are not easily defined, solutions
not easily devised. Child welfare workers must serve the best interests of the child, but they must
also maintain and preserve the family” (p.4). They also point out how some scholars have called
for a reform in the mandated reporting system in order to allow mental health professional more
flexibility in reporting. This article allowed me to see that many mental health professional face
similar dilemmas. I found it very interesting to learn that some experts feel that a change needs
to occur that would allow professionals to have more control of what they report.
I was also curious to learn if there were any factors associated with improving the
chances of a client maintaining a therapeutic relationship after a breach in confidentiality.
Weinstein, Levine, Kogan, Harkavy-Friedman and Miller (2001) found that three variables were
found to be very important in maintaining a positive therapeutic relationship. Those three
variables were the quality of the relationship before the report was made, the length of time in
treatment before the report was made and effective handling of making the report. This study
provided me with a tremendous amount of insight and gave me knowledge on how to increase
the chances of maintaining a positive therapeutic relationship with my client, if I do chose to
report the abuse.
The next article I consulted with once again provided me with very interesting
information regarding the effects of child abuse reports on the therapeutic relationship.
Steinberg, Levine and Howard (1997) found that the more actively a therapist struggled with this
conflict, the poorer the client’s emotional response was to the reporting and the less likely it was
that the client would remain in treatment after a report. I found this finding to be very
interesting. Steinberg et al. (1997) contends that the client relies on the counselor for guidance
and if a client can sense the counselor’s own doubts than the client questions the counselor as a
“competent helper” (p.120). This new information will definitely aid me in how I present the
information to my client if I decide to make a report.
I also relied on the professional literature to see what specific effects have been shown to
come from mandated reporting. Levine, Doueck and Associates (1995) found the following:
The positive effects of mandated reporting are quite varied. They include the possibility
for an improved therapeutic alliance; the opportunity to teach clients about relationships;
new material for therapy; cessation of the abusive behavior; the obtaining of additional
services for a family; appropriate protection of the child by placing him or her outside the
home or by removing the perpetrator from the home; and a miscellany of intangible
benefits. (p.119)
This list of positive effects included benefits that I had never thought of before, which will
provide significant guidance when I make my final decision.
Lastly, I looked an article titled Mental Health Professionals’ Experiences Reporting
Suspected Child Abuse and Maltreatment. This article was a wonderful resource that provided
me with very important statistics. Weinstein, Levine, Kogan, Harkavy-Friedman and Miller
(2000) conducted a study that showed that in over 72% of the cases in which professionals filed
a report, making the report did not disrupt the therapeutic relationship and in many of the cases it
actually improved the therapeutic process. This statistic was so important because it showed that
the majority of clients were not only able to maintain the therapeutic relationship but that the
reporting was actually considered helpful in the therapeutic process.
Consulting with the professional literature provided me with a great amount of new
insight. It was reassuring to see how so many other mental health professionals face similar
dilemmas. I gained a lot of new knowledge that I will heavily rely on while making my final
decision. Seeing a statistical number which backed up what so much of the literature said was
very important to me. I felt as if the number gave more validation to everything I read. Seeing
agreement among the literature will definitely help me in choosing my course of action.
K: Possible Courses of Action and Potential Consequences
One possible course of action is not to report the abuse to authorities. If I do not report
the abuse than Lauren, her siblings and her father will carry on with their typical daily life. The
concern will still exist that Lauren could be abused again, which may cause her to live in fear or
act differently around her father. She may feel the need to always please him or walk on
eggshells when she is around him. As her counselor, I would be honoring Lauren’s wishes, but I
would continue to worry for the physical safety of Lauren and her siblings.
Another course of action is to confront Lauren’s father. I would only do this after
discussing my plans with Lauren. I would talk to her father to see if there was an alternative to
working out this situation rather than reporting it to the authorities. I would talk with him to see
if there were any friends or relatives who could come live with him and the children. Also, I
would suggest him receiving treatment for his alcohol use, in addition to treatment for his violent
behaviors. If I chose to take this course of action there is still no real protection for Lauren and
her siblings. Her father could become even more angry that Lauren told me and he could abuse
her again or her siblings. He could refuse getting help, deny there is a problem and his drinking
could escalate. If her father did not respond positively to me then Lauren and her siblings would
be in more danger. If he did acknowledge his problem and agreed to seek help, then it is
possible that a solution to the problem could be found without contacting the authorities.
Another course of action is to report the abuse to authorities. Lauren and her siblings
face the consequences of possibly being removed from their home, but there is no guarantee that
the state will take such measures. I would be clear to recommend not removing the children
from the home. By reporting Lauren’s father, he is now in the system and the state can keep an
eye on him. I think with the right treatment Lauren’s father could overcome his problem. Since
Lauren’s father faces the possibility of losing custody of his children, I would anticipate that he
would he would want to receive therapy or treatment. Therefore, reporting the abuse would
promote the physical safety of Lauren and her siblings. At the same time Lauren could feel that I
broke her trust and may want to end her therapeutic relationship with me. I would hope that after
explaining my long thought out decision-making process to Lauren that she would understand
and see that I was acting in her best interest. I would also tell Lauren of my plans before I made
the report. As the professional literature explained, the majority of clients are able to resume a
therapeutic relationship with their counselors after a warranted breach in confidentially.
L: Best Course of Action
I think my best course of action would be to report the abuse, with the recommendation
of not removing the children from their home. First, I think consultation is an extremely
powerful and important tool. Both colleagues recommended reporting the abuse which brings a
sense of validation to the decision because it shows that other colleagues in the same community
would act in the same way that I did. Second, by reporting the abuse I would be fulfilling my
legal responsibility as a licensed clinical professional counselor. Although, I do find it
imperative to consider all aspects of the ethical dilemma, being supported by the law is
extremely important to me. Next, although there was some conflict in the ethical codes I felt that
the majority of them guided me towards reporting the abuse. The ACA codes exist to help
counselors make ethical decisions. Therefore I am confident in relying on the codes to point me
in the right direction. There were many conflicts between the moral codes, but the principles of
beneficence, nonmaleficence and veracity all offer support in reporting the abuse. Promoting the
best interests of clients, preventing clients from harm and being truthful to clients are three very
important characteristics of a counselor that I highly regard. I feel that my decision to report the
abuse would honor all three of these characteristics.
Overall, I think reporting the abuse serves the best interest of Lauren. Although it goes
against her wishes, I think it will benefit her in the long run. Lauren may be too young to realize
it now, but chances are if the abuse went unreported then it is likely to happen again and only get
worse. I am confident that Lauren would see that I was acting in her best interest and therefore
would continue with her therapy. Therefore we could continue to work through the issues that
may have resulted from this situation. Chances are not only may she have doubts about trusting
me, but also she is likely to have doubts about trusting her father again. I am confident that these
issues could be worked out. Assuming that the state did not remove Lauren from her home, she
could then see that her family was able to stay intact, while her father received the appropriate
help. I think reporting the abuse shows Lauren that she does not deserve to be hurt, which is
essential for Lauren’s own self-worth.
M: Potential Negative Consequences
The first potential negative consequence of me reporting the abuse is that Lauren would
end our therapeutic relationship. Although I would hope that this would not happen, it is always
possible. Lauren may feel that she can no longer trust me and therefore no longer wants to see
me. The bigger problem is that Lauren may then feel she cannot trust any counselor and will
refuse therapy all together. In my opinion it is critical that Lauren be in therapy due to the new
issues that will have resulted from me reporting the abuse. In addition, she still has issues to
work out from the abuse of her father. I would respond to this challenge by first trying to contact
Lauren to explain my decision making process. If that did not work I would encourage her to see
her school counselor or another counselor for help.
Another negative consequence would be if the state went against my recommendation
and decided to remove the children from their home causing them to be split up. I would be
worried about the siblings being apart from one another and would fear that this would have
sever emotional damage to all of them. I would respond by asking the state to keep them
together and explain the deep bonds that they all share. I would explain the potential damage
splitting up the siblings could have.
N: Consequences That Would Cause Me to Change My Decision
After I make the decision to report the abuse there is no way for me to change my
decision. Once the state has been notified then a report will be made which will state in the
state’s system. That is why I want to be sure that the decision I make is the right one because it
has the ability to permanently alter many people’s lives. The only change I could make to my
decision would be if Lauren continued seeing me (assuming the state followed my
recommendation and left all the siblings in the care if their father) and revealed that her father’s
abuse was continuing. If that were the case then I would contact the state again and report the
new allegations of abuse and recommend that the children be removed and request for them to be
kept together.
I am confident that reporting the abuse is in Lauren’s best interest. Since there is no way
to foresee the future, all I can do is to continue to work with Lauren and respond to the
consequences as they occur. To serve the best interests of Lauren, I will continue to rely on a
combination of ethics, morals, consultation and the law, all which will allow me to enrich her life
while aspiring to meet the highest standards of counselor conduct.
References
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Hammer, S.D. & Lutner, R.L. (Eds.) (2001, October). When do I have to report child or
elder abuse? The Psychiatric/Legal Newsletter: A Periodic Report On Developing
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