Client Case Study Information: Ethical Practices for Publication,Presentation,and Social Media

Abstract

Client case study publications are a helpful way to disseminate innovative practices and clinical counseling interventions. Case study submissions are increasing both in peer-reviewed journals and practice publications. Likewise, marriage, couple, and family counselors and therapists are sharing case study examples via social media. We examine relevant ethical guidelines and describe alternatives to using real client data. We offer an example of client consent forms for professional presentation or publication of case studies.

Keywords

case study ethics social media

Individual, marriage, couple, and family counselors frequently develop innovative practices, encounter unique client circumstances, and/or work with marginalized populations. Often this work remains siloed within the confines of individual, group, or community mental health practices. Case study publications offer opportunities for practicing marriage, couple, and family counselors and therapists to disseminate their clinical work for the benefit of all counselors and clients. Recently, a peer-reviewed journal, Journal of Humanistic Counseling (n.d.) and practice publication, Counseling Today (Wilkinson, 2024) encouraged professional counselors to submit client case studies to share strategies and interventions for knowledge sharing and practice support. To encourage increased case study submissions to The Family Journal (TFJ), we address important ethical considerations, and offer alternatives to using real client data. We offer a sample consent form to protect client rights.

Case Study Descriptions

Distinguished from qualitative case study (Yin, 2018) or practice-based evidence research (Margison et al., 2000; Singh, 2014), descriptive clinical case studies serve to disseminate information for practitioners. There are many benefits to publishing or presenting case studies beyond contribution to academic scholarship. According to Sankey et al. (2020) case study writing strengthens the practitioner and client relationship, amplifies clinical information, and enhances supervisory and mentoring relationships. Case study information also bridges the gap in practice information for marginalized populations to include members of Black, Indigenous, and People of Color (BIPOC), Queer, and differently abled communities, among many others. Specific to marriage, couple, and family counselors, Wilkinson (2024) suggests that case studies, “tell a compelling story that can provide a meaningful glimpse into the otherwise private therapeutic world of a counselor and their clients” (p. 17).

Sankey et al. (2020) encouraged medical practitioners to approach every new client as a possibility for a case write up to maintain curiosity, interest, and engagement with case study opportunities. They also encourage referencing relevant literature and consulting with others as helpful starting points to considering a case study write up. The benefits of case study information sharing are numerous; however, the decision to utilize case study information in publication, presentation, including teaching, and social media do carry risks. We review the risks and outline ethical practices for case study use next.

Ethical Guidelines

The biggest risk to case study usage is the possibility of breaching client (s) confidentiality and protected health information (PHI) (Juyal et al., 2013; Sankey et al., 2020). Therefore, client information should be de-identified as a starting point to mitigate harm. Yet, practicing professional counselors must do much more than simply de-identify client data to use case study data ethically. The American Counseling Association ([ACA], 2014) and the International Association of Marriage and Family Counselors ([IAMFC], 2017) both require counselors and therapists to obtain client consent and review the write up with the client(s) before publishing or presenting case study information. Other mental health professions similarly require client consent. Table 1 lists applicable ethical codes regarding using client case study data for counselors and other mental health providers. We adapted Sankey et al.'s (2020) medical consent form for case study presentation or publication by counselors and therapists (Appendix).

Table 1.

Client Case Study Ethical Codes.

Organization	Applicable ethical code(s)
American Counseling Association (2014)	G.5.a. Use of Case Examples The use of participants’, clients’, students’, or supervisees’ information for the purpose of case examples in a presentation or publication is permissible only when (a) participants, clients, students, or supervisees have reviewed the material and agreed to its presentation or publication or (b) the information has been sufficiently modified to obscure identity (p. 17).
American Association of Marriage and Family Therapists (2015)	2.4 Confidentiality in Non-Clinical Activities. Marriage and family therapists use client and/or clinical materials in teaching, writing, consulting, research, and public presentations only if a written waiver has been obtained in accordance with Standard 2.2, or when appropriate steps have been taken to protect client identity and confidentiality.
American Psychiatric Association	4.3 Clinical and other materials used in teaching and writing must be adequately disguised in order to preserve the anonymity of the individuals involved (p.6). 4.10 With Regard For The Person's Dignity And Privacy And With Truly Informed Consent, It Is Ethical To Present A Patient To A Scientific Gathering If The Confidentiality Of The Presentation Is Understood And Accepted By The Audience (P.7). 4.11 It Is Ethical To Present A Patient Or Former Patient To A Public Gathering Or To The News Media Only If The Patient Is Fully Informed Of Enduring Loss Of Confidentiality, Is Competent, And Consents In Writing Without Coercion (P. 7).
American Psychological Association (2017)	4.07 Use of Confidential Information for Didactic or Other Purposes Psychologists do not disclose in their writings, lectures, or other public media, confidential, personally identifiable information concerning their clients/patients, students, research participants, organizational clients, or other recipients of their services that they obtained during the course of their work, unless (1) they take reasonable steps to disguise the person or organization, (2) the person or organization has consented in writing, or (3) there is legal authorization for doing so.
International Association of Marriage and Family Counselors (2017)	G.13. Couple and family counselors respect the present and future confidentiality of partners or family members in publishing or presenting clinical case studies, especially when the case involves minors or other persons who cannot give consent or may be harmed in the future (p. 8). G14. Couple and family counselors protect the rights and confidentiality of clients presented in case studies by obtaining written consent from the client(s) after their review of the descriptive case material. The counselor must not misuse nor exploit clients in publications or presentations (p. 8). G15. When written consent cannot be obtained, clinical case studies should be disguised by altering several salient characteristics provided the alteration does not invalidate the research or contribute to false conclusions. Clinical case studies may be disguised by offering composite cases, restricting details, or adding extraneous material, as well (p. 8).
National Association of Social Workers (2024)	(u) Social workers should not disclose identifying information when discussing clients for teaching or training purposes unless the client has consented to disclosure of confidential information.

Other Considerations

Special care should be taken with minor client, family, or partner case study information within the couple and family counseling context. The IAMFC (2017) Code of Ethics, G.13, outlines parameters for family counselors to contemplate including potential future harm when using partner and minor client information. Couple and family counselors should seek consultation and supervision when contemplating using couple or family counseling case information, particularly with minor clients.

Practicing counselors and therapists should reflect on their positionalities including the power they hold in the therapeutic relationship (Duffy, 2010), privileged and marginalized identities of both clinician and client, and client cultural backgrounds (Ratts et al., 2016) as they consider seeking consent for client case study use. Specifically, couple and family counselors and therapists should consider the ACA (2014) ethical code, B.1.a, Multicultural/Diversity Considerations, where they “respect differing views toward disclosure of information” (p. 6). Clinicians should contemplate the subsequent impact of a written or published case study for the ongoing therapeutic relationship (Davis, 2021). To thoroughly work through these considerations, counselors and therapists may employ an ethical decision-making model to determine the best course of action before seeking client collaboration and consent for case study write up.

Social Media Case Study Sharing

Social media platforms can serve as educational and informational outlets for current and potential clients, counselor-in-training, and practicing individual, couple, and family counselors. Some practicing counselors and other mental health professionals utilize social media for mental health advocacy purposes and to reduce help-seeking stigma (American Psychological Association [APA], 2021). This practice evolved to include mental health social media “influencers” who cultivate hundreds to thousands of followers (White & Hanley, 2022); some of whom may divulge client information as case examples of mental health symptoms and counseling interventions. One could argue client case example sharing via social media is the equivalent of sharing client information for publication, presentation, or teaching purposes (APA, 2021). In this vein, counselors should implement safeguards to share de-identified client information on social media and adhere to the ACA ([H.6.d] 2014) standard, “counselors take precaution to avoid disclosing confidential information through public social media” (p. 8). We believe the consent process applicable to using client case information in professional presentations or publications apply is to social media applications.

Alternatives to Client Data

The IAMFC (2017) code of ethics indicates that when client consent cannot be procured, “clinical case studies may be disguised by offering composite cases, restricting details, or adding extraneous details as well” (G15, p. 8). Composite case study examples are a “blending of the clinical material from two or more client case sources and presented as a single case” (Duffy, 2010, p. 147). Duffy (2010) outlined six composite case study write up guidelines:

Identify clinical focus.

Identify clinical examples based on counselor experience that represent clinical focus.

Select examples from each case that describe the clinical focus.

Blend the examples into one representative case study.

Create the composite demographics by equally distributing identity aspects of each client to merge into one case example.

Indicate in the manuscript case study submission that “the case material is composite material” (p. 152).

In addition to composite case studies, counselors, therapists, supervisors, and educators may consider other options in lieu of de-identified client information for case study write ups. These include using movie, television or streaming series, or book character examples to demonstrate how to use a counseling intervention. They may also utilize artificial intelligence programs (e.g., ChatGPT, Claude AI, etc.) to create fictitious client examples for illustrative counseling purposes.

Implications for Marriage and Family Counselors

Couple and family counselors may incorporate several practice accommodations to establish the foundation for ethical case study practice. First, practicing counselors may include information outlining the process to use client case study information in their informed consent. This should emphasize the client consent and collaboration process as well as the client's right to decline participating in a case write up without fear of loss of services. If a client consents to their de-identified information being shared as a case study, the practicing counselor or therapist should carefully review the consent form, transparently share the content with the client and answer their questions or concerns before submitting the material for publication or presenting. Counselors and therapists who seek to use family counseling case study information with minor children should refer to the IAMFC (2017) ethical guidelines, seek consultation and/or supervision, and apply an ethical decision-making model to guide the case study information process. Finally, marriage and family counselors should consider both their own and client privileged and marginalized identities as well as the inherent power differential in the counseling relationship during the case write up and consent process (Duffy, 2010; Ratts et al., 2016).

Conclusion

Professional marriage, couple, and family counselors and therapists may use a client case study to share clinical practice information that may benefit other clinicians, trainees, and clients. Case study information can be shared in professional publication and presentations, including for teaching purposes. Professionals who use case examples on social media should adhere to the same ethical guidelines for publication and presentations. The major risk to client case study dissemination is potential breach of client confidential data. To mitigate the risks, we outlined ethical guidelines and shared a model consent form for publication.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Susan F. Branco

Appendix

References

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American Psychiatric Association. (2013). The principles of medical ethics: With annotations especially applicable to psychiatry. https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/Ethics/principles-medical-ethics.pdf

American Psychological Association [APA]. (2017). Ethical principles of psychologists and code of conduct. https://www.apa.org/ethics/code

American Psychological Association [APA]. (2021). APA guidelines for the optimal use of social media in professional psychological practice. https://www.apa.org/about/policy/guidelines-optimal-use-social-media.pdf

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