Case #1
Veronica brought in her 14-year-old daughter to see Jamie. She called
in and explained to her “Sarah is really acting out. She is acting
different from before. I think she is doing drugs and having sex. I’m
terrified at the thought.”
Jamie had been seeing Sarah for 3 weeks now and they were building
a very good relationship. Sarah was very trusting of Jamie. She felt
connected to an adult figure for the first time in her life. At first, she
was skeptical of what she could share with the therapist. “What’s the
point of telling you everything, you’re just going to tell my parents!”
Jamie assured Sarah that the sessions are, “Completely confidential
and mentioned, “If you don’t want me to share the information with
your parents, I won’t. These sessions are for you.” Jamie, noticing
they both used iPhones also offered Sarah the option of having
sessions using FaceTime in between the sessions her mom brings her
to if she really needed. They exchanged cell phone numbers so they
could be in contact this way.
Sarah felt relieved and really supported by Jamie and began to share
intimate parts of her life with her. One day, Sarah texted Jamie with a
message that said, “Can u talk?” As soon as Jamie’s current session
ended, she called Sarah using Facetime. Sarah was really upset about
a disagreement with her boyfriend who she had never mentioned
before. As the story unfolded, Sarah told Jamie that her boyfriend was
a 20-year-old college student that she met online. She also revealed
that she was sexually active with him over the past year.
Jamie had a deep fondness for Sarah and really wanted to help her.
She was concerned that if she breaks the confidentiality, Sarah will be
mad at her and discontinue therapy all together.
The thought of not treating Sarah was heartbreaking and so Jamie
convinced herself to keep it a secret. After a month of sessions,
Sarah’s mother calls Jamie to check in.
“So what’s going on with my daughter? I know you can’t tell me the
details but is she ok? Is she having sex? Doing drugs? I can’t sleep at
night, I’m worried sick for her! I know something is just not right with
that girl.”
Jamie felt a pit in her stomach. She didn’t know how to respond. “She
is doing great and we are really connecting. I will let you know if
anything alarming comes up. “
As Sarah continued therapy, she was getting deeper into her
relationship with this older college student. Everything about their
relationship sounded wrong and Jamie started to feel guilty about
keeping this a secret. Without mentioning anything to Sarah, Jamie
decided to call Veronica and tell her about her daughter’s sexual
relationship with this older young man. Once she did, the mother was
furious both at the therapist and her daughter. She threatened Jamie
that she will report her negligence to the board and of course
discontinued therapy.
Case #2
Debbie and Bill decided they would begin couples therapy. They knew
they were fighting a lot and had grown distant for a while now.
Debbie and Bill went to see Jack, a therapist in practice for 8 years.
They started therapy working as a couple, but soon enough, Bill called
Jack and asked if he could come in privately. “I need to speak with
you about something.” At that point, Jack never had any rules about
seeing couples individually. In fact, Jack hadn’t worked with too many
couples and thought nothing of seeing Bill alone. Actually, Jack really
liked Bill and admired his strong worth ethic and intelligence.
Bill came in that Monday morning and opened up that he has been
having an affair for two years now. Jack wanted to help the couple and
didn’t want to “ruin things” by revealing this secret. Besides, he
thought. “Bill trusts me and I don’t want to break that trust.”
Jack could understand where Bill was coming from. He too was in a
miserable marriage and started having an affair. He ended the
marriage and married the “other woman.”
He thought that he should really help them do something he didn’t. He
really pushed for their marriage and never revealed the secret.
In one couples session, Debbie came in with a black and blue mark on
her left eye. It came out in that session that Bill hit Debbie last night.
They revealed that he had been hitting her “once in a while”
throughout their 10 years of marriage. Debbie and Bill didn’t have
children, and Jack remembered from his law/ethics course, “if
children aren’t involved, you do nothing!”
And as bad as Jack felt, he did nothing about this information. He
thought that if he helps them work on their relationship, and grow
closer emotionally, the physical abuse will stop.
One day, Jack revealed in couples session that Debbie hits her mother
whom they live with. “She gets angry and resentful for caring for her
and pinches her. Sometimes, she doesn’t even give her three meals a
day. She also uses her social security checks to go shopping.”
Debbie admitted to this and started crying. She was very remorseful
and promised to “never do it again!”
Jack believed her and felt bad that she was being abused as well by
her husband. Jack truly felt that if he works hard enough with this
couple, they will do well and all of these negative behaviors will stop.
Jack continued to work with them for another six months and he felt
more and more frustrated at the therapeutic outcome. Nothing was
changing.
Jack had a hard time brining this up but also believed that he was not
helping this couple.
He came into session one day and told the couple that he can no
longer work with them because he is not working with couples
anymore. The couple was devastated and wanted an explanation but
Jack kept it simple and brief.
“I’m sorry I know it’s hard because we have worked together for so
long, but this will be our last session. I wish you both the best.”
Discuss the above comprehension
Sample Solution
