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Case example: Patrice works as a nurse counselor in a local hospital in the outpatient chemical dependency unit. She goes to the reception area to greet her new client, Fatima, who is waiting with her husband. Fatima introduces Patrice to her husband and asks the counselor to allow her husband to sit with her through the intake session. When Patrice inquires as to the reason for the request, Fatima explains that in her native culture it is unacceptable for a wife to have secrets from her husband, and that she would not be comfortable in the session without him there. The intake session is held with the couple. Patrice clarifies that future sessions will be conducted with Fatima alone so that the counseling process can be focused on the concerns that prompted Fatima to call for an appointment. Patrice explains that the confidentiality of information shared during the sessions belongs to Fatima and that she may share information with her husband whenever she wishes. The husband loudly interrupts to reiterate that if he does not attend sessions that he needs Patrice to call him after each session to tell him what happened during the session. He slams his fist down on his chair handle loudly to emphasize his point. Fatima nods her head in agreement, staring blankly down at the ground, a tear rolling down her face. During the team meeting to discuss this culturally based ethical dilemma, the team also met to discuss their decision to provide an initial DSM 5 diagnosis after the first meeting with clients. This decision would require a diagnosis for Patrice and other clients based on the first meeting with the counselor. This decision was the result of some pressure from the agency director, who made it clear that establishing a diagnosis and formulating a treatment plan were required by the HMO (insurance). On ethical grounds, some of the professional staff objected to the pressure to formulate a diagnosis and specific treatment plan at the initial session. Others on the staff did not share the same ethical concerns and believed some policies could be changed. Please respond to the following questions: Explain how a client’s culture might affect his/her views about and expectations of confidentiality in counseling in a healthcare facility. What information would you give clients about the nature and purpose of confidentiality and how would you present it? Under what other circumstances would it be ethically acceptable to share confidential information about a client with a third party? What ethical principles might apply in this scenario? Identify these ethical principles and describe how they would apply. If you were a member of this interdisciplinary team, how would you deal with the broader ethical concern of having to formulate a diagnosis and specific treatment plan on an initial meeting with a client?

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