“Client Confidentiality”
Confidentiality is a complex obligation, with several exceptions and
nuances, and both legal and ethical implications have to be considered. To me as a
therapist you must respect the confidentiality of your client's communications.
Therapists are advised to err on the side of being overly cautious in protecting the
confidentiality of their clients, unless faced with a mandatory exception to
confidentiality such as reporting child abuse (Benitex, 2004). Confidentiality
belongs to the client, and therapists generally do not find it problematic if the
client requests that they share information. The APA ethics code provides the
following guidelines for disclosure of confidential information: “Psychologists
may disclose information with the appropriate consent of the organizational
client, the individual client, or another legally authorized person on behalf of the
client unless prohibited by law” (Issues and Ethics in the helping profession).
In order to protect your client’s rights in confidentiality Fisher’s 2008 6step ethical practice is recommended. Preparation, inform your clients about the
limits of confidentiality, you must understand the limits yourself. The truth “up
front”, inform your clients about the limits you intend to impose on
confidentiality. Obtain truly informed consent before making a disclosure, only
make disclosures if legally avoidable; document your clients consent before
disclosing. Respond ethically to legal requests for disclosure, limit the amount of
confidential information to the extent that is legally possible and inform your
client of a pending legal demand for information. Avoid the “avoidable”, avoid
making unethical exceptions to the confidentiality rule. Talk about confidentiality,
model ethical behavior and practice.
Exceptions, the general requirement that counselors keep information
confidential does not apply when disclosure is required to protect clients or
identified others from serious and foreseeable harm or when legal requirements
demand that confidential information must be revealed. Counselors consult with
other professionals when in doubt as to the validity of an exception. Additional
considerations apply when addressing end-of-life issues. When subpoenaed to
release confidential or privileged information without a client’s permission,
counselors obtain written, informed consent from the client or take steps to
prohibit the disclosure or have it limited as narrowly as possible due to potential
harm to the client or counseling relationship.
Duty to Warn: There are times, when statements are more than mere
words, foreshadowing an actual menace. When a counselor believes this to be so,
the duty to warn the potential victim supersedes the concern for confidentiality.
Confidentiality always comes first. If a threat should arise, we must be aware and
attentive to all it implies, and then act according to ethics and principles, both for
the client, others, and for ourselves as therapists. Balancing client confidentiality
and protecting the public is a major ethical challenge (Donner et al., 2008.)
Dangerous clients: Determining whether or not if you have a potential
dangerous client can be the most difficult task. Although practitioners are not
generally legally liable for their failure to render perfect predictions of violent
behavior of a client, a professionally inadequate assessment of a client’s
dangerousness can result to liability for the therapist, harm to third parties, and
inappropriate breaches of client confidentiality. Bemmett et al. stress the
importance of knowing the law in your state regarding the duty to wan or protect.
Most states permit (if not require) therapists to breach confidentiality to warn or
protect victims.
Wisconsin is one of the four states that do not have a Statutory Standard, although
they have established a duty to warn through court decisions. Social workers often have
responsibility for making difficult determinations regarding the assessment and treatment
of clients, including taking steps to assure their safety and that of others. Some of the key
issues for clinical social workers to review in a case involving a possible duty to warn
are:
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whether the client is the individual who represents a threat to self or others
who has disclosed the threat and under what circumstances
how much time has passed since the threat was made
whether the client possesses the means and capacity to carry out the threat
whether the duty to warn has been established as a mandatory requirement in
state law
whether the threat of harm is to a specific individual or represents a general
threat to the public at large
whether the criteria for involuntary commitment may apply
whether the state permits disclosure of a threat even if it is not mandatory
who needs to be warned to effectively discharge the duty to warn (e.g. law
enforcement, the intended target, the Department of Motor Vehicles, a treating
physician, a responsible family member)
“References”
http://www.zurinstitute.com/ethicsofconfidentiality.html
Issues and Ethics in the Helping Professionals
http://www.mytherapypractice.com/therapies/counselling-confidentiality.html
http://www.socialworkers.org/ldf/legal_issue/2008/200802.asp?back=yes