There are some extra considerations around duty of care to take into account when working with someone with intellectual disability. If the client discloses something that raises a counsellor’s concern, the counsellor needs to consider a range of safety, security and ethical issues (MacDonald, 2008; J. Olver, personal communication, 9 November 2011).
Safety and security issues to explore and consider include:
- Encourage the client to consider their safety and security. Are they at risk of further victimisation? Do they need a different physical location?
- Discuss relationships regularly. Vulnerability and a lack of understanding about relationships can lead to people putting themselves at risk. Help the client to understand concepts about relationships in concrete terms
- Check back with the client over time to monitor the situation. Don’t presume the client can make judgements about safety. Talk through the situation to explore their understanding of their own risk. Talk about consequences or likely outcomes of different decisions.
Ethical issues to explore and consider include:
- Inform the client of any obligations that counsellors have to report the information the client has disclosed (taking care not to compromise the safety of yourself or others). Where your obligations are not clear, seek guidance through reflecting with colleagues on the circumstances of the matter and your professional and ethical obligations
- Name any confidentiality issues
- If the matter is of a legal nature (for example, the client has disclosed that they have perpetrated or been the victim of a crime), explain that you, as their counsellor, may be called as a witness if the matter proceeds to court
- If the client has reported that they committed an offence or they are alleged to have committed an offence, reflect on any personal and/or professional values that may limit your capacity to provide effective support. If you are unable to provide support, you need to arrange alternative support options
- Support the client to clearly describe what occurred. Ask open questions (for more information, see the section: ‘Narrative interviewing techniques’). Diarise the exact words that the client uses to describe the incident, preferably at the one sitting.
- Diarise details such as the time between the event’s occurrence and the time when the client first disclosed the event. Your task here is not to interview the client or interpret their information, but to clearly document the client’s account of events at the time of first disclosure (it is possible that the client’s capacity to retain or recall this information may reduce as time passes)
- Take extra care about the language used in case notes. While it is always important to take care in case notes, it can be particularly important for clients with intellectual disability, as this client group is more likely to have court procedures or need reports for government agencies. Listing the person’s difficulties in case notes can work against them
- Discuss and clarify the options of reporting or not reporting the incident to the police and the likely course of events associated with each option
- Support the client to consult a lawyer or specialist agency
- Support the client to make a complaint to the police if they wish. If the client is not ready to go to the police, remember that, in time, they may change their mind.