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“Amala, a 24-year-old graduate student, comes to Dr. Orenstein for treatment for gender dysphoria. During the initial interview, Amala indicated that while her birth certificate indicated she was male, she had always known she was female and finally had saved up enough of her own money to begin a medical transition. She made the appointment with Dr. Orenstein because her physician requires a mental health evaluation before he will approve the medical treatment. Amala is enrolled in her parents’ health insurance plan and cannot afford to pay out of pocket for psychotherapy. She is afraid that because under the ACA her parents will receive an ‘explanation of benefits’ regarding coverage for her psychotherapy, they will learn about her gender identity and take her off their insurance policy.

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Identify the ethical and legal issues Dr. Orenstein needs to consider with respect to record keeping and potential confidentiality breaches associated with Amala’s insurance coverage and describe how Dr. Orenstein should integrate these concerns into the informed consent process.”

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Amala does not want her parents to know that she is suffering from gender dysphoria, but she is on their medical insurance still. When the explanation of benefits arrive in the mail, she does not want them to see why she sent to psychotherapy for fear of losing their support.

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The psychologist she is seeing needs to remember Principle A in this scenario because they are there for the wellbeing of the client.
"Principle A: Beneficence and Nonmaleficence
Psychologists strive to benefit those with whom
they work and take care to do no harm. In their professional
actions, psychologists seek to safeguard the welfare and
rights of those with whom they interact professionally and
other affected persons, and the welfare of animal subjects of
research. When conflicts occur among psychologists’ obligations
or concerns, they attempt to resolve these conflicts
in a responsible fashion that avoids or minimizes harm. Because
psychologists’ scientific and professional judgments
and actions may affect the lives of others, they are alert to
and guard against personal, financial, social, organizational,
or political factors that might lead to misuse of their influence.
Psychologists strive to be aware of the possible effect
of their own physical and mental health on their ability to
help those with whom they work" (APA, 2017).

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Since Amala is over 18 years of age, the psychologist has no legal reasons as to why the patients parents should know what goes on in their session, so therefore the psychologist needs to decide how they are going to code these sessions as to keep the patient's confidentiality. Standard 6.02 (b) touches on this scenario: "If confidential information concerning recipients of psychological services is entered into databases or
systems of records available to persons whose access has
not been consented to by the recipient, psychologists use
coding or other techniques to avoid the inclusion of personal
identifiers" (APA, 2017).

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On one hand, the patients parents should know the struggle she is facing with regards to her gender dysphoria, but on the other hand it is her decision if she wants to share this with her parents and is not at the discretion of the psychologist to decide. Standard 4.05 (a) explains where the psychologist stands in terms of sharing information with the client's parents: "Psychologists may disclose confidential information
with the appropriate consent of the organizational
client, the individual client/patient, or another legally authorized
person on behalf of the client/patient unless prohibited
by law" (APA, 2017).

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If the psychologist feels it is best for the patient to share this information with her parents, they could work that into therapy. Therapy could include a focus on working through scenarios as to as the patient feels the parents will react and learning how to handle the outcome of what may happen. The patient has to be ready to tell their parents on their own and it should not be forced by insurance explanation of benefits.
Another thing the psychologist could do is to offer the patient safe places they can go to receive therapy for free or at a discounted cost if the psychologist does not want to put it through the insurance with different codes.

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Helping the client overcome the fear of what may happen if they tell their parents is something that will most likely already be in therapy with learning to accept the gender dysphoria. It is the way in which the psychologist can code correctly to the insurance company and the client can be freed from a secret that certainly cannot be easy or mentally healthy to keep.

Guiding the patient to mental health care that is more discrete in terms of it not being submitted to insurance is also a great alternative to the scenario, but may not be feasible if the client is insistent on receiving care from a private practice psychologist over a clinic or youth center.

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Optimally the psychologist has to make the decision that is going to be best for the client in terms of treatment. If the client does not receive proper mental health care and is suffering from keeping a secret, it could be very dangerous for her. Standard 3.04 discussing how psychologist should avoid harm of their patient, whether is be physical or mental harm. "Psychologists take reasonable steps to avoid
harming their clients/patients, students, supervisees, research
participants, organizational clients, and others with
whom they work, and to minimize harm where it is foreseeable
and unavoidable" (APA, 2017).
The psychologist has to do what they feel is going to benefit the client in the long run and the steps they can take the keep the confidentiality while also assisting the client in sharing the secret with her parents.

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Ethical principles of psychologists and code of conduct. (2017). Washington, D.C.: American Psychological Association.