Case of Counselor Cammie 1

Ethical Dilemma
Kelsey Finch, Joseph Fox, Katie Frits, Julie Hewett, Ayla Leopold, Kim Karwhal




























Case of Counselor Cammie 2

Ethical Dilemma Scenario

Julia Hew, case manager at a residential facility for women, The Forks: A Road to Recovery,
has reported the onsite partnered counselor, Cammie Peterson, from The Summit
Counseling Center, to the Disciplinary Board due to an ethical violation. The case manager
believes the therapist was in violation of non-maleficence, among other codes, for failure to
report the self-injurious thoughts/behaviors of a resident (Amanda) she currently sees for
counseling services after the resident ended up in the hospital from a suicide attempt.

The case manager was informed of the violation when another resident (Sophia) explained
the scenario and timeline. At the point of Sophia’s report, Amanda had overdosed and was
hospitalized the day prior.

According to Sophia’s report to Julia, Amanda was on the patio when Sophia overheard
Amanda’s phone conversation. Sophia reports that Amanda was discussing the recent
removal of her children by the Department of Human Services (DHS). Sophia reports that
Amanda stated she was “thinking of just ending this.” Sophia notes Amanda’s statement has
caused her to think about her own experience with DHS three years prior, which caused
Sophia to think about her past negative experiences. Sophia sought help from Cammie to
process her own emotional response. During this visit, she discloses Amanda’s phone
conversation.

After learning of this encounter with Cammie, the case manager documented the discussion
with Sophia and reviewed the ethical standards that should have motivated Cammie to
report the possible incidence of self-harm of Amanda to Residential Assistants for
intervention services over the holiday weekend. Due to the 2014 ACA Code of Ethics, B.2.a.
Serious and Foreseeable Harm and Legal Requirements, Case Manager brought this
scenario to the attention of the Board of Ethics.





Case of Counselor Cammie 3

Statement of Charges
&
Statement of Facts



























Case of Counselor Cammie 4

BEFORE THE BOARD OF BEHAVIORAL SCIENCE EXAMINERS

OF THE STATE OF IOWA

IN THE MATTER OF THE ) NO. 17-711

STATEMENT OF CHARGES )
AGAINST )
)
Cammie Peterson ) STATEMENT OF CHARGES
) AND STATEMENT OF
RESPONDENT. ) FACTS

The Iowa Board of Behavioral Science (Board) files this Notice of Hearing

and Statement of Changes pursuant to Iowa Code sections 147.55(3) and chapter

645 Iowa Administrative Code 33.2(29).

1. The Board issued Respondent license number 0908546 on June 8, 2015,

to practice as a mental health counselor in the state of Iowa. Respondent’s

license is currently active and next expires on June 8, 2019.

2. The Board has jurisdiction of this matter pursuant to Iowa Code

chapters 272C.9 and 272C.10(2). Licenses issued by the Board are subject to the

laws of the State of Iowa and the administrative rules promulgated by the Board.

Method of disciplines is stated at 645 chapter 33.3.

STATEMENT OF CHARGES

COUNT I

Respondent is charged pursuant to Iowa Code sections 147.55(3), by violating

IAC Chapter 33.2(1), failure to comply with the national association’s code of

ethics, the American Counseling Association (ACA) 2014 Code of Ethics, by

Case of Counselor Cammie 5

violating ACA Code of Ethics C.2.e, Consultation on Ethical Obligations and

A.1.a, Primary Responsibility of a counselor is to promote the welfare of clients.

It is alleged you breached IAC Chapter 33.2(1) when you failed to consult with

supervisor regarding or notify responsible onsite party that could have

intervened with a suicide attempt, once you had learned of the client’s intent.

COUNT II

Respondent is charged pursuant Iowa Code Sections 147.44(3), by violating IAC

Chapter 33.2(3), professional incompetency, section c., failure to exercise the

degree of care which is ordinarily exercised by the average practitioner acting in

the same or similar circumstance.

It is alleged you breached IAC Chapter 33.2(3), section c. when you failed to

immediately respond and assess client’s need for higher level of care or suicide

risk after receiving disclosure of the intent.

COUNT III

Respondent is charged with violation of ACA Code of Ethics Section B.2.a,

Serious and Foreseeable Harm and Legal Requirements, by not disclosing

information pertinent to the protection of a client from serious and foreseeable

harm.

It is alleged you breached ACA Code of Ethics Section B.2.a. when you

dismissed client’s intent as attention-seeking behavior and failed to intervene

with the disclosed intent of self-harm.

Case of Counselor Cammie 6

STATEMENT OF FACTS

Comes now the Iowa Board of Behavioral Science Examiners, and in support of

the grievances filed in this case, sets forth the following facts:

· Respondent provided counseling services with Amanda beginning on March

14, 2017, at The Forks, a residential facility for women.

· May 26, 2017, Sophia, also receiving services from the respondent, disclosed

to the respondent that she overheard Amanda disclose foreseeable self-harm,

during a counseling session.

· May 26, 2017 respondent scheduled an appointment with Amanda to take

place on May 30, 2017.

· May 28, 2017 Amanda overdosed on Hydrocodone, which was hidden within

her residential facility room, amount unknown, resulting in hospitalization.

· May 29, 2017 Sophia disclosed to on-site Case Manager the discussion with
respondent prior to the incident.








Case of Counselor Cammie 7

Opening Remarks,
Questioning
&
Closing Remarks






















Case of Counselor Cammie 8

Opening Remarks

Prosecutor (P) [Kim]: I would like to begin this hearing by quoting the American
Counseling Association (ACA) Code of Ethics Purpose, “When counselors are faced with
ethical dilemmas that are difficult to resolve, they are expected to engage in careful
considered ethical decision-making process, consulting available resources as needed.”
This case will review the events that led up to a tragedy. A tragedy that could have been
easily avoided if this purpose had been followed by the respondent, Cammie Peterson. Our
victim in this case currently lies in the hospital. Julia Hew, a Case Manager at The Forks, a
renowned residential facility for women, will share with you the facts of the matter, that
Ms. Peterson did not meet her profound ethical duty, her duty to protect her client,
violating IAC Chapter 33.2(1), failure to comply with the national association’s code of
ethics, IAC Chapter 33.2(3), professional incompetency, and ACA Code of Ethics section
B.2.a. Serious and Foreseeable Harm. This is why the following charges have been against
Cammie Peterson:
Count 1: Respondent, Cammie Peterson, has been charged pursuant to Iowa Code for
failure to comply with the National Association’s Code of Ethics, the American Counseling
Association 2014 Code of Ethics, Consultation on Ethical Obligations, and Primary
Responsibility of a counselor is to promote the welfare of clients. Cammie was in violation
because she failed to consult with her supervisor or notify responsible onsite parties that
could have intervened with a suicide attempt, once she had learned of the client’s intent.
Count 2: Respondent is charged pursuant to Iowa Code, Professional Incompetency, section
c., Failure to Exercise the Degree of Care, which is ordinarily exercised by the average
practitioner acting in the same or similar circumstance. It is alleged that Cammie was in
violation when she failed to immediately respond and assess her client, Amanda’s need for
a higher level of care or suicide risk after receiving disclosure of the intent.
Count 3: Cammie is charged with violation of the ACA Code of Ethics Serious and
Foreseeable Harm and Legal Requirements, when she dismissed her client’s intent as
“attention-seeking” behavior and failed to intervene with the disclosed intent of harm.
If you are not currently familiar with Tarasoff vs. The State of California, you should be aware
that in this case and in many others nation-wide, the courts have found that if someone’s life
or health is at risk, the benefit from a breach in confidentiality significantly outweighs the
cost of that breach and should be undertaken to protect human life (Tarasoff vs. State of
California). Today’s discussion and you, the board’s decision, will come down to breaching
confidentiality or protecting and doing no harm to human life.



Case of Counselor Cammie 9

Defense Lawyer (L) [Ayla]: A duty to protect. That is the statement that the prosecution
will attempt to demonstrate was broken in this case. But the duty to protect a client is more
than a simple implementation of a quoted code of ethics. The facts of this case stem back
months, through 14 visits between my client and the victim, Amanda. The duty to protect
Amanda was approached on May 26, 2017 when Ms. Peterson scheduled an appointment,
the start of the next business day. Ms. Peterson also adhered to her duty to protect
Amanda’s confidentiality, and the duty to protect Sophia, who cannot be excluded from the
equation of this case. In regards to Tarasoff, courts in Iowa have yet to recognize this ruling
as other states have, because this state comprehends its limitations. As Donald N. Bersoff of
Drexel University said in 2013, the Tarasoff decision is “bad law, bad social science, and bad
social policy”, because the limitations force the counselor to decide the seriousness of the
threat being made. You will hear in the evidence presented that Ms. Peterson made a
judgement that was soundly based in experience and knowledge of her client. My client, Ms.
Peterson did her due diligence to protect her clients, Amanda and Sophia.



Case of Counselor Cammie 10

Questioning Case Manager Julia (Julie)

P: State your name, job title, and credentials for the record.

J: Julia Hew. Case Manager for 12 years at The Forks. Bachelor’s Degree in Child, Adult, and
Family Studies from Iowa State University.

P: Ms. Hew, could you please state the reason you are present in this hearing today?

J: I am here because I believe Counselor Cammie acted negligently.

P: What actions, on the part of Ms. Peterson, were negligent?

J: She did not alert any staff that she had obtained reason to believe that Amanda, a
resident, was at foreseeable harm from self-injury.

P: Ms. Hew, please explain how Amanda was at risk of foreseeable harm?

J: On May 28, 2017, Amanda, was hospitalized from overdosing. It was later brought to my
attention by another client, Sophia, that Sophia had disclosed Amanda’s intent to her
counselor, Cammie.

P: Please explain how these actions, by Ms. Peterson, warrant a complaint to the
disciplinary board.

J: When it was brought to my attention that Amanda made a statement prior to her
overdose and that Counselor Cammie was aware of this, I recognized that Cammie could
have prevented this incident.

P: And what actions did you take next?

J: I consulted with the Clinical Supervisor at The Summit Counseling Center, Dr. Fox and
completed the 7-Step Ethical Decision Making Model.

P: The board will find this in their evidence packet. And did you act on any advice from Dr.
Fox?

J: Yes. Dr. Fox suggested I file a complaint to the board against Counselor Cammie’s actions.

P: Thank you, Ms. Hew. I have no further questions.
Case of Counselor Cammie 11

Cross Examination of Julia

L: Hello Julia.

J: It’s Julia.

L: Excuse me. Julia, can you explain your role in relation to the residents at The Forks.

J: Yes. I case manage all of the 25 clients at The Forks.

L: Please explain what case management means.

J: I oversee all client welfare, help clients track goals, and stay in contact with other
professionals in their lives.

L: When you say ‘other professionals’ does that include counselors?

J: Yes.

L: What type of information would be shared on your part?

J: I would share client information that I believe is important to a therapy session.

L: Could you provide me an example?

J: If a client recently relapsed, this would be useful to a counselor.

L: Do you have any documentation or signed consent that states any counselor must
disclose to you any summary or session notes for any client?

J: No.

L: Would you say it is a common practice for counselors to disclose to you any treatment
plans for clients?

J: It is not a common practice, but has been helpful for clients in certain circumstances, like
suicide.

L: Ms. Hew, I would like to inquire about a case note you wrote on April 10, 2017 during a
conversation with Amanda. Would you please read this note?
Case of Counselor Cammie 12

J: “Client shares with this Case Manager that she talked with the therapist and is better
understanding why her attention seeking behaviors started.”

L: If Amanda had previously stated to you that she engages in attention seeking behaviors,
as this note demonstrates, would you have acted upon Sophia’s report had Sophia come to
you instead of Counselor Cammie?

P: OBJECTION! Leading the Witness.

L: Ms. Hew, let me rephrase, what actions should be taken for second-hand self-harm or
suicide intent?

J: As a Mandatory Reporter, I would alert on-site staff and according to policy, crisis
intervention would be implemented.

L: Thank you Ms. Hew. Please step down.



Case of Counselor Cammie 13

Questioning of Dr. Fox (Joseph)

P: State your name, job title, and credentials for the record.

F: My name is Dr. Fox. I am a Counseling Supervisor at The Summit. I obtained my Psy.D
from Cambridge University, I also have my PhD in Philosophy from Harvard.

P: Dr. Fox, earlier Ms. Hew stated that she consulted with you after learning of a possible
ethical misconduct on the part of Ms. Peterson.

F: Yes.

P: Dr. Fox, why did Ms. Hew contact you?

F: Ms. Hew was seeking advice about the potential ethical misconduct by the counselor,
Cammie.

P: Would you please explain the nature of this possible misconduct.

F: Well. Let’s see, (pause for dramatic effect) According to the ACA Code of Ethics. Cammie’s
actions were a total disregard to C.2.e, Consultation on Ethical Obligations, which states:
Counselors take reasonable steps to consult with other counselors, the ACA Ethics and
Professional Standards when they have questions regarding their ethical obligations or
professional practice.

P: Dr. Fox, how did Ms. Peterson violate this ethical guideline?

F: Cammie was aware of her client’s intent and neither disclosed this discussion to me nor
consulted with her client to assess the risk. This is a critical position for a professional
counselor to be in and one that requires great depth of inquiry and necessitates a duty to
the welfare of her client (Amanda).

P: Dr. Fox, in addition to these actions being in violation of the ACA Code of Ethics, it is in
violation of your organization’s policy and procedures. Correct?

F: Yes. You are correct. Consultation and guidance in arduous ethical terrains is something
that is substantially important in the sphere of ethical obligation within the counseling
profession. Many counselors are apprehensive and reluctant to seek consultation,
supervision, guidance when it comes to conflicts and dilemmas. The research (Mullen et. al
Case of Counselor Cammie 14

2017) shows that counselors who are self-aware and practice self-reflection while also
seeking peer consultation and supervisory input are more likely to practice ethically and
consider the alternatives from a metacompetence and metacognitive scope.

P: Dr. Fox, do you have any additional evidence to present to the board in support of these
charges?

F: In light of the charges against Ms. Cammie Peterson, so much of the counseling process is
listening for what’s not being said. For the record, I don’t believe that counselor (Cammie)
purposely or intentionally acted with negligence. There is much that transpires in the
understanding of the nature and dimensionalities of counseling as it relates to ethical
guidelines and practice. However, as suggested by (Welfel, 2016) “our profession demands
that we be able to justify our ethical decisions based on careful consideration of the facts
involved as well as the consistency with professional standards for practice.” As this situation
stands, counselor Cammie, as part of her professional responsibility and ethical
obligation(s), should have sought consultation and/or supervision on this matter.




















Case of Counselor Cammie 15

Cross Examination of Dr. Fox

L: Dr. Fox, can you please state your professional relationship with Ms. Hew for the record?

F: Ms. Hew and I have a correspondence that goes back many years. We developed a
professional relationship that has been formed by our interprofessional affiliation. I am
someone she regards as a trusted professional that she feels she can confide in when she
has questions that pertain to various aspects of counseling, ethics, modalities, and best
practices frameworks.

L: What are your legal and ethical obligations as a counseling supervisor while consulting?

F: My professional, ethical, and legal obligations are all uniquely tethered to the welfare of
all parties involved in the counseling arena. First and foremost, my duty like the practicing
counselor/supervisee, is to the client. My primary focus as a counselor supervisor is to
oversee and review the performance and efficacy of the supervisee and ensure that the
counselee is receiving the best possible services, and that there are no ethical or legal
breaches of conduct (Walz, Bleuler 2015). It is also my ethical responsibility to practice the
guidelines that all practicing counselors adhere to which is the ACA Code of Ethics.

L: Can you please state the ACA code regarding confidentiality of a client?

F: Section B, in the ACA Code of Ethics, states that confidentiality and privacy should be
respected and upheld unless certain limitations make this impossible. Specifically, the
ethical code, B.1.c. Respect for Confidentiality makes it clear that a counselor should
protect the confidential information of prospective and current clients. Counselors disclose
information only with appropriate consent or with sound legal or ethical justification.

L: I see. (Arthur & Swanson, 1993) state confidentiality is a legal and ethical responsibility
and a professional duty that demands that information obtained from a private interaction
with a client not be shared. So, did counselor Cammie adhere to the code of ethics
regarding confidentiality when she chose not to share private information about a client
from session to other staff?

F: Initially yes. The ethical code regarding confidentiality was upheld. Within Section B, in
reference to the confidentiality codes, ethical code B.2.a. Serious and Foreseeable Harm
and Legal Requirements, is the exception to the principle of confidentiality. This code
establishes that a counselor has a duty to protect and warn of potential threat or harm to
self or to others. When serious and threatening harm is revealed to the counselor, a
Case of Counselor Cammie 16

counselor has a legal and ethical obligation to break confidentiality and protect all persons
involved.

L: By setting up a private appointment with Amanda did counselor Cammie do her due
diligence considering the circumstances to protect Amanda from harm?

F: (Pause for a deep breath and short sigh)...sly smile...that question is a bit ambiguous. By
that I mean she did, but I guess the question is, did she go far enough in her professional
responsibility and duty to serve Amanda? According to the ACA ethical codes and lack of
consultation with fellow colleagues and/or supervisors, it appears as Cammie didn’t
appropriately weigh the consequences of her actions or lack thereof.

L: I have no further questions, thank you for your time.



Case of Counselor Cammie 17

Questioning of Counselor Cammie (Kelsey)

L: Ms. Peterson, please approach.

L: Please state your name, title, and credentials for the record.

C: Cammie Peterson, Clinical Mental Health Counselor, graduated from Liberty Online
University in May 2013. My license number to practice mental health counseling in Iowa is
0908546, and is current. It will expire on June 8, 2019.

L: Ms. Peterson, can you please walk me through the events that happened with your client
Amanda from May 26th to May 29th.

C: On May 26, my client Sophia was in my office for an appointment. She was having a
difficult time because she had overheard Amanda outside her window on the phone.
Amanda was very upset because she had a court hearing the previous day and had lost
custody of her second child, which had triggered Sophia’s memory of when she lost custody
of her child. As Sophia was detailing the situation, she mentioned that Amanda said, “I am
so devastated that I might as well kill myself.” I knew I would need to follow up, so I
contacted Amanda and scheduled an appointment for Tuesday at 9 AM with her, which I
was coming in early for.

L: If you knew there was a risk, how did you do your due diligence?

C: Because Amanda had a strong history of attention-seeking behavior, I thought it would
be OK to follow up on Tuesday, so I scheduled an appointment with Amanda for Tuesday
when I returned at 9 AM. On May 28, Amanda overdosed.

L: Thank you, can you describe your interchange with Amanda in detail after you had your
session with Sophia?

C: Because I wanted to make sure I adhered to the confidentiality of Sophia, I did not want
to let Amanda know Sophia told me. When I called Amanda, I told her that I knew she had a
rough court case and I would like to see her sooner than our next appointment. She said
she would like to see me sooner, too, so I asked her if Tuesday at 9 AM would work. She
said it would. I told her to hang in there and I would see her next week.

L: Please describe your past interactions with Amanda, and her attention seeking
behaviors.
Case of Counselor Cammie 18

C: If you look at my running log of notes, I have detailed many types of attention-seeking
behavior throughout the time I have seen her. The case manager Julia has also noted these
types of behaviors. Amanda has admitted to using suicidal talk to get attention. We worked
on the root of these behaviors and on coping mechanisms to deal with stress. Amanda
acknowledged that these behaviors of hers get worse when she is more stressed out and
that attention for her, even if negative, is better than no attention at all. Again, because of
her history, I thought this event was similar to previous events.

L: Ms. Peterson, do you believe you did your due diligence in protecting your client Amanda
from harm in immediately setting up an appointment with her at the earliest appointment
time you had?

C: I do. My schedule for the rest of the day was full, and it was a 3-day weekend. I looked at
the details and assessed the risk. I did not think there was urgency because of Amanda’s
previous use of threats of suicide with her attention-seeking behavior. Additionally,
according to Griffith and Griffith 1978, professionals argue that patient confidentiality is
essential to effective mental health treatment and forcing a breach of confidentiality
essentially compromises effective mental health treatment.




















Case of Counselor Cammie 19

Cross Examination of Cammie

P: Hello, Ms. Peterson. Thank you for being here today.

C: Uh huh.

P: Ms. Peterson, when Sophia told you about the conversation Amanda had, did you believe
there was a risk?

C: I thought there was a slight risk, but I did not see it as urgent.

P: Was a risk assessment implemented?

C: No.

P: Did you document that there was a risk?

C: I put in my notes what had happened and that I was scheduling an appointment with her.

P: Cammie, are you a mandatory reporter?

C: Yes.

P: Cammie, I am curious what your response is to the law surrounding Mandatory
Reporters. The Iowa law required disclosure about the following exceptions to protecting
patient confidentiality: “Mandatory duty to warn of threatened or actual violent behavior of
physical violence against a reasonably identifiable victim or victims appears to apply only to
those psychologist who have a duty to control the conduct of the third person” (Iowa Code
232.69).

C: I know the law. I am also familiar with Ewing v. Goldstein (2004), which ruled that
counselors must ensure clients are aware of the confidentiality according to the state’s
regulations. My clients were aware of confidentiality and I am aware of my duties as a
mandatory reporter.

P: Cammie, did you feel this situation worthy of bringing to your supervisor?

C: No.

Case of Counselor Cammie 20

P: Cammie, even if a client has made multiple statements of attention-seeking behavior,

does that negate a duty to protect and prevent harm?

C: I do not think I negated my duty. After contemplation about what I knew, I scheduled an
appointment with Amanda, one that I created just to see her at the beginning of my day.

P: Ms. Peterson, as Dr. Fox stated earlier “according to Welfel, 2016, your “professional
demands that you be able to justify your ethical decisions based on careful consideration of
the facts involved as well as consistency within professional values and standards for
practice”. Do you believe you adhered to this careful consideration?

C: I do.

P: Cammie, how can careful consideration be applied if you cannot review past notes?

C: I don’t know what the question is.

P: Cammie, what is your agency’s required time frame from conducting a session to
summarizing the session in notes?

C: I know I wasn’t caught up with my notes, I was planning to do them over the long
weekend.

P: Cammie, I have one final question. I would like to bring your attention to the informed
consent form that was signed by you and your clients, Amanda and Sophia. What does this
consent form say in the ‘expectations to confidentiality’?

C: “The counseling staff works as a team. Your therapist may consult with other counseling
staff to provide the best possible care. These consultations are for professional and training
purposes.
A court order, issued by a judge, may require the Counseling Services staff to release
information contained in records and/or require a therapist to testify in a court hearing.”
P: If there is evidence of clear and imminent danger of harm to self and/or others, a
therapist is legally required to report this information to the authorities responsible for
ensuring safety (Walz, Bleuler 2015). Your knowledge of Amanda’s threat were neither
fully documented nor reported.
Thank you for your time.

Case of Counselor Cammie 21

Questioning of Ms. Hannah Karleeh

L: Please state your name, title, and credentials for the record.

H: My name is Hannah Karleeh, Lead Floor Supervisor at The Forks residential facility. I am
not licensed. I received my bachelor’s of science in psychology.

L: Thank you Ms. Karleeh, what is your relationship to Ms. Peterson?

H: Cammie provides counseling services to the residents I work with at The Forks. We
oftentimes work alongside each other to ensure the best care for our clients.

L: How long have you been in a professional relationship with Ms. Peterson?

H: We have been working alongside each other for about two years now.

L: In your knowledge, for the past two years that you have known Ms. Peterson, has she
upheld the ethical and legal obligations for clients through agency policies and through the
ACA Code of Ethics?

H: Absolutely, without a doubt. Ms. Peterson would never intentionally harm one of her
clients.

L: What is your definition of duty to protect clients within your agency?

H: At The Forks, we believe it is absolutely necessary to ensure the safety of each one of our
clients, whether it be from someone harming themselves or from someone threatening the
safety of others in our facility. Our goal is to make sure that no one is physically harmed, be
it from themselves or from another client, at the end of the day.

L: What is your professional definition of duty to protect clients?

H: I want to make sure that every client I work with is safe. I need to make sure they get the
help they need if they cannot keep themselves or others in the facility safe.

L: As Werth and Rogers (2005) note, “... a person whose behaviors would… lead to death
within foreseeable future may or may not be considered to engender the duty to protect,
depending on a variety of factors associated with the client and the counselor.” Can you
explain what the factors were prior to Amanda’s overdose?
Case of Counselor Cammie 22

H: Since Amanda’s admission to The Forks, she has instigated fights with her peers and has
on several occasions made threats of self-harm. Staff has discussed this with Amanda
regularly and continue to process why she may be doing this and how this can be very
alarming to staff and peers. One of the factors for Cammie would have been Amanda’s prior
statements and behaviors. I don’t want to generalize, but Amanda’s statements have
become the “status quo,” or baseline, for her. You can check the staff logs. Another factor is
that Cammie heard this from another client. Rumors spread like wildfire around here, and
most often it isn’t true. For all Cammie knew, Sophia’s encounter with Amanda wasn’t even
real, and was just meant to stir the pot with the other residents. On top of that,
confidentiality restricted Cammie from acknowledging that she even sees Amanda for
therapy. In this situation, it could be very reasonable to just quickly ask Amanda how she is
doing, as to not instigate any further rumors if Sophia’s original comment was a rumor. Life
here at The Forks is definitely interesting when it comes to rumors.

L: You’ve made it clear, Hannah, that there are a variety of factors as to why Cammie did
what she did. In this particular case, did Ms. Peterson take steps to protect her client,
Amanda, by setting up an appointment with her at her earliest time?

H: Yes. Cammie’s hours in the office are at set times. After Sophie’s session, Cammie sought
out Amanda to schedule the earliest time available to meet with Amanda after the holiday
weekend. I’m sure Cammie briefly followed up with Amanda to do a quick risk assessment
to see if she was doing okay and to ask if she wanted to talk briefly. Like I said, Cammie
upholds her ethical and legal obligations; she wouldn’t just walk away if she felt like
Amanda was at risk of harming herself.

L: Thank you for your time, no further questions.














Case of Counselor Cammie 23

Cross Examination of Hannah

P: Hello, Ms. Karleeh

H: Hello.

P: Hannah, do you believe Cammie took reasonable actions to prevent foreseeable harm?

H: I do not believe that Amanda’s actions were “foreseeable.” According to Jablonski v.
United States (1983) the court held that specific threats are not the only indicator of
foreseeability, but that that a patient’s history may be sufficient. Amanda has had a history
(as seen in staff notes) of attention-seeking behaviors. Amanda has had behaviors similar
to this prior to this incident. Over the past few months that Amanda has been in treatment,
she has made similar statements of self-harm and then laughed them off, noting she would
never want to harm herself.

P: Hannah, do you believe Cammie took reasonable actions after hearing of the self-
harming statements made by her client.

H: Yes.

P: Why were Amanda’s actions not “foreseeable” when she made self-harming statements?

H: According to Bellah v. Greenson (as described by Werth & Rogers) “A practitioner that
knows the patient is likely to attempt suicide should take preventative measures”. Cammie
was aware of Amanda’s history of attention-seeking and took preventable measures by
scheduling an appointment at the first opportunity.

P: Do you believe Cammie violated her ‘Duty to Protect?’

H: According to James and Rogers (2005), “the decision to apply the duty to protect is
situationally dependent and related to that professional’s attitudes and knowledge” (p. 8).
Cammie scheduled an appointment and used her professional judgement in doing so. In her
scheduling with Amanda, she did not feel that Amanda needed immediate assistance. She
was doing what she felt was professionally appropriate for the situation, especially with
her knowledge of Amanda’s previous behaviors. Not to mention, Amanda has talked
directly with staff, her case manager and Cammie about acknowledging how she uses
threats of harm as a way to seek attention. This situation is very complicated.

P: Hannah, what would you have done in Cammie’s situation?
Case of Counselor Cammie 24

H: I’m not a counselor.

P: No further questions.































Case of Counselor Cammie 25

Closing Remarks

P: Today reviewed two sides of the same story, resulting in the injury of a client, Amanda. A
client whom the counselor held a duty to protect. Individuals took the stand who all hold
high standards of services and have good reputations in our community yet the
circumstances surrounding these charges brought us here today. It is at this time I ask you,
the board, to take the time to review the facts, keeping in mind the reality of care that these
clients, and all individuals in our state deserve, and the number one care is to ensure safety
for the client which is what Ms. Peterson failed to do. In the end, it is a conflict between Ms.
Peterson’s thoughts surrounding the ethical dilemma which resulted in the lack of action.
According to Smith, 2016, the concept of “I thought” statements inherently include
application of past expectations. In the application of past expectations onto the risk of
suicide, risk must be assessed. Because risk was not assessed and Ms. Peterson did not did
not take immediate actions nor consult with her supervisor, she violated her ethical
demands, her duty, and her responsibility.

L: I do agree with one statement my colleague just said, asking you to review the facts.
Along with this review, take into consideration the nature of human behavior and the
limitations of the Code of Ethics. As any action taken by my client would have resulted in an
ethical violation, she decided that the best answer to protect her client was to set up an
appointment with her immediately. According to Duty to Warn from the National
Conference of State Legislatures, “Although ethical codes are written to provide ethical
guidelines for professionals, they are not meant to provide absolute rules”. It is unfortunate
that Amanda’s actions resulted in her own harm, but in this case brought to the Board of
Behavioral Sciences my client believes she did everything in her power to do no harm to
her client by setting up an appointment with Amanda, and protecting her confidentially in
her sessions with Sophia and Amanda.

Case of Counselor Cammie 26

References
































Case of Counselor Cammie 27

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