Fathima Bibi Khan
The case concerns a 14 year old adolescent girl I have been counselling for the past three months. Her home background has been unstable due to a conflictual family life. Her situation has been exacerbated by her poor nutritional health. She complained of severe depression and shared her intent to end her life. She sought advice from me in terms of the means to execute her wish to terminate her life. This was communicated in confidence and I was specifically asked not to divulge this information as she felt ashamed that she was not coping with her life. The case
Following the initial introduction, the client was informed of the basis of the counsellor-client relationship and the ethical responsibilities on the part of the counsellor, including the aspect of the degree of confidentiality. Due to the establishment of a trust relationship, the client shared information of a personal nature and also the emotional aspects that had a bearing on the case. The dilemma that I am faced with revolves around the following : 1 what recommendation should I make to the client
2 the ethical aspects relating to trust and confidentiality 3 who do I need to consult with
What recommendation should I make to the client ?
The first thing I would do is to re-assure the client that her feelings were understandable and that a treatment approach would help in resolving the issues experienced by the client. That is, I would affirm the aspect of hope to the client.
Due to the severe depression, I would suggest treatment such as Cognitive Behavioural Therapy (CBT) or interpersonal psychotherapy, in addition to one or more medications. I would introduce the client to the concept of CBT as a treatment method. I would talk about the equal, collaborative relationship that this form of therapy requires. This would reinforce the need on the part of the client to feel in control and to work with me rather than expect me to 'cure’ her.
Treatment with medication and an evidence-based psychological treatment (ie, CBT or interpersonal psychotherapy) increases the likelihood of improved symptoms and relationships with family and friends; it can also improve self-confidence and the ability to cope effectively.
Depending on the findings by the Clinician, the client has to be informed of the possible need for hospitalisation for a short period of time. Depression treatment often includes medication management, individual, group and/or family therapy. Other activities may include physical exercise, art/music therapy and school work.
The client needs to be re-assured of the treatment approach and the fact that she is not alone as there will be a team comprising of the psychiatrist, psychologist, social workers, etc. The client needs to participate in activities that improve her self-esteem and sense of mastery. Coupled with this, there is a need to adjust the nutritional side to build up the client’s health.
According to Tkachuk and Martin (1999), the importance of a healthy lifestyle (i.e., participating in regular physical activity, eating healthy foods) in maintaining a sense of well-being. In particular, regular physical activity can have a beneficial impact on depressed mood and should be discussed as an important element in any comprehensive treatment plan for adolescents with depressive symptoms.
The ethical aspects relating to trust and confidentiality
The fact that it is only of late that the client started to express the suicidal feelings cannot exclude the possibility that these feelings have been developing for some time prior to my engagement as the counsellor. The client may have held back expression of these feelings until the period where a sufficiently favourable client-counsellor relationship was established.
As regards the very serious possibility of a suicide attempt, I would...
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