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Client Confidentiality
Client Confidentiality
Lindsey Rasmussen
Client Rights, Confidentiality, & Ethics
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Client Confidentiality
The ACA Code of Ethics (2005) states trust is the cornerstone of the counseling
relationship. The counselor seeks to earn the client’s trust through developing rapport,
establishing and upholding healthy boundaries, and perhaps most important, maintaining
confidentiality (p.7). Confidentiality is the counselor’s ethical responsibility to protect the
client’s private communication, and is at the very core of effective counseling (Corey,
Schneider-Corey, & Callanan, 2011, p.210). This is arguably the counselor’s most important
professional duty; yet paradoxically, confidentiality creates the most serious ethical dilemmas
for the practitioner. As a result, there exists much confusion and anxiety about confidentiality
and its limits (Fisher, 2008).
Ethical dilemmas involving confidentiality are not new, but they are persistent. This is
because confidentiality is not absolute and circumstances that require it to be breached not
explicit or well-defined. As a result, the counselor’s professional judgment becomes of the
utmost importance (Corey et al., 2011, p.221). In other words, the counselor cannot promise
the client that everything disclosed in the course of counseling will remain confidential, because
there are exceptions to and limitations of confidentiality. These exceptions and limitations must
be explained to the client at the outset of counseling, during the process of informed consent.
More specifically, many ethical dilemmas involving confidentiality result from the
counselor’s dual responsibility. Specifically, the counselor has obligations to both society and
the client, which include protecting other people from a potentially dangerous client; and
protecting the client from themselves. This first responsibility is typically referred to as the duty
to warn and requires the counselor to balance the client’s right to privacy while at the same
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Client Confidentiality
time protecting the public. This is a significant ethical challenge because of the potential for a
difficult outcome no matter what the decision (Gaskill, 1996). Therefore, the counselor needs
to consult with other professionals, exercise reasonable professional judgment, and apply
commonly accepted practices of the profession when making the decision to warn (Corey et al.,
2011, p.235).The counselor also has the duty to help protect the client from themselves. In
general, this means the therapist has the responsibility to prevent the client’s suicide if they can
reasonably anticipate it and/or demonstrate the adequacy of their treatment through their
consultation with other professionals in the field and by careful documentation of treatment
decisions and rationale (Corey et al., 2011, p.246).
Overall, counseling should be a place where the client can safely express what they truly
think and how they honestly feel. At times this may include thoughts or threats of harming
themselves or others. However, as cited in Corey et al. (2011), Bennett et al. (2006) states that
few threats of violence are actually carried out, so as a result, the counselor is not expected to
disclose all verbal threats. On the other hand, if the counselor broke confidentiality in response
to every real or perceived threat, counseling would be of little use. Because without a sense of
safety or a relationship built on trust, the counselor would be ineffective at helping the client
process through anything that had the potential to illicit strong feelings.
A concept closely associated with confidentiality is privileged communication. The latter
is a legal concept that essentially protects the client’s disclosures during counseling from being
revealed during legal proceedings (About the limitations of confidentiality and its limits on
helping PDF document, p.1). However, privileged communication does not apply to cases of
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Client Confidentiality
abuse or neglect of children, the elderly, and/or dependent adults because of the clinician’s
status as a mandatory reporter. Overall, the professional has an obligation to protect
vulnerable persons who cannot protect or advocate for themselves. Generally speaking, the
counselor is advised to err on the side of caution and report any reasonable suspicions of abuse
or neglect. This is because the duty to protect is stronger than the therapist’s obligation to
maintain client confidentiality (Corey et al., 2011, p.250-251).
On the other hand, the clinician’s legal responsibility to protect sexual partners of HIV
positive clients is unclear at this time. According to the ACA Code of Ethics, as cited in Corey et
al. (2011), the counselor may be justified in disclosing this information to a third party at risk,
but isn’t necessarily obligated to take this course of action (p.261). In theory, as is the case with
breaching confidentiality in general, warning an identifiable victim should be considered the
last resort. This is because typically, if counseling is given the chance to work, there is a good
chance the client will voluntarily disclose this information to their partner.
Overall, there are no simple answers to the complex questions and issues practitioners
are faced with throughout their course of practice. This is especially true as it relates to the
issue of client confidentiality and its exceptions and limitations. Ethical dilemmas will continue
to exist because of the conflicts inherent in the counselor’s many responsibilities. This can be
attributed, in part, to the relatively wide parameters of acceptable practice the counselor lives,
works, and makes decisions within. In theory, breaching client confidentiality should be the
counselor’s last resort, only after less obtrusive measures have failed, and if disclosure does not
conflict with the law (Corey et al., 2011, p.264)
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Client Confidentiality
References
About the limits of confidentiality and its limitations on helping [PDF document]. Retrieved from
http://smhp.psych.ucla.edu/qf/confic_qt/overview2.pdf.
American Counseling Association. Code of ethics [PDF document]. Retrieved from
http://www.counseling.org.
Corey, G., Schneider-Corey, M., & Callanan, P. (2011). Issues and ethics in the helping
profession (8th ed.). Belmont, CA: Brooks & Cole, Cengage Learning.
Fisher, M. (2008). Protecting confidentiality rights: The need for an ethical practice model.
American Psychologist 63(1), 1-13. Retrieved from http://www.centerforethicalpractice.
org/articles.
Gaskill, E. (1996). Duty to warn. Retrieved from http://www.naswma.org.