Case Presentation: Counseling Intern – Shanetta Williams by

Ethical Decision Making

shanetta84 — 2025-03-31 22:58:02 UTC

Hello, everyone! Today, I want to discuss with you all a case I encountered during my internship that was not clear-cut on how to handle. This is a case that required me to use ACA’s ethical decision-making model to resolve the issues I faced.

Client Information

shanetta84 — 2025-03-31 23:00:40 UTC

• Name (alias): “Jordan”

• Age: 12

• Gender: Female

• Presenting Issue: Emotional dysregulation, low self-esteem, recent adoption adjustment

• Diagnosis: No formal diagnosis assigned; symptoms align with trauma-related behaviors and possible mood disturbance.

Referral Reason

shanetta84 — 2025-03-31 23:02:39 UTC

Jordan was referred for counseling by her adoptive parents, expressing concern about emotional outbursts, sadness, and possible self-harming behaviors. They noted that she recently transitioned into their home following adoption and had a history of multiple placements.

Background Information:

shanetta84 — 2025-03-31 23:05:03 UTC

• Recently adopted (within the last 6 months) after a long period in foster care

• Has Type 1 diabetes, requiring regular insulin management

• History of hospitalizations related to insulin irregularities

• No current psychiatric medications

• School reports show inconsistent performance and social withdrawal

Recent Session

shanetta84 — 2025-03-31 23:07:45 UTC

During a recent session, Jordan disclosed that she has, on more than one occasion, intentionally given herself too much insulin in order to “get a reaction” or to be taken to the hospital. While she denied wanting to die, she was vague about her motivations and admitted she sometimes wants to “escape” or “feel like people care.”

Dilemma

shanetta84 — 2025-03-31 23:09:31 UTC

As an intern, I recognize that I lack in-depth knowledge of Type 1 diabetes and its psychological implications. I was uncertain whether this behavior constitutes suicidal intent, a cry for help, or a medical emergency triggered by trauma. I was also unsure of the best course of action regarding parent involvement, possible mandated reporting, and coordination with medical providers.

Code of Ethics

shanetta84 — 2025-03-31 23:12:53 UTC

Using the ACA Code of Ethics, I identified several applicable standards. Most importantly, B.2.a. emphasizes our duty to act when there’s a risk of serious and foreseeable harm. A.1.a. reminds us our primary responsibility is to promote client welfare, and A.6.a. speaks to advocacy, especially when a client’s health may be at risk.

Nature of Dilemma

shanetta84 — 2025-03-31 23:15:49 UTC

Ethically, this case involved multiple principles. Jordan is a minor, which limits her autonomy. Nonmaleficence and beneficence require me to prevent harm and act in her best interest. Fidelity means I must preserve her trust while also acting responsibly. Justice means I must consider her trauma history and emotional needs in how I respond.

Possibilities

shanetta84 — 2025-03-31 23:18:16 UTC

I brainstormed several potential actions: doing nothing, informing the parents, making a medical or psychiatric referral, possibly involving CPS, or consulting a diabetes specialist. Some weren’t viable due to the risks involved, but others opened the door for ethical intervention.

Course of action

shanetta84 — 2025-03-31 23:19:56 UTC

The best course of action involved informing the adoptive parents with supervisor support, referring Jordan for a full evaluation, and documenting everything. This approach prioritized her safety while remaining sensitive to her emotional and developmental needs.

Ethical Standards

shanetta84 — 2025-03-31 23:21:14 UTC

I evaluated the plan using the justice, publicity, and universality tests. Would I treat others the same? Yes. Would I be comfortable explaining this in public? Yes. Would I recommend it to another intern? Absolutely. This reassured me that the chosen path aligned with ethical standards.

Supervisor Consult

shanetta84 — 2025-03-31 23:23:07 UTC

I immediately consulted my supervisor, and together we informed the adoptive parents. A referral was made for further evaluation. We documented the process carefully, and I began working on trauma-informed interventions to support Jordan’s emotional safety moving forward.

Reflection...

shanetta84 — 2025-03-31 23:24:44 UTC

This experience taught me the importance of supervision, documentation, and collaboration with other professionals. It also helped me grow in my confidence to ethically navigate high-stakes situations, especially those involving child safety and complex medical needs.

Thank You

shanetta84 — 2025-03-31 23:29:36 UTC

Using the ACA Code of Ethics and the decision-making model helped guide me through a difficult situation while centering the client’s well-being.

Forester-Miller, H., & Davis, T. E. (2016). Practitioner’s guide to ethical decision making (Rev. ed.). American Counseling Association. https://www.counseling.org/docs/default-source/ethics/practioner%E2%80%99s-guide-to-ethical-decision-making.pdf