04_Privacy and Confidentiality Flashcards
Privacy
Freedom to choose the time, circumstances, and extent to which one’s beliefs, behaviors, and opinions are to be shared or withheld from others
Confidentiality:
Expectation of Privacy
Once private information has been disclosed with therapist, with an expectation that such information will not ordinarily be disclosed to third parties, it becomes confidential
Confidentiality:
Overview
Obligation to protect clients from unauthorized disclosure of information revealed in the context of a professional relationship
Confidentiality is an Ethical principle
In some situations it is a legal requirement
Privilege
Legal concept that protects the client’s confidentiality in the context of legal proceedings
Federally recognized in 1996
Jaffee v. Redmond
“Holder of the Privilege”
Patient/client, or legal guardian or representative
When can a Psychologist become Holder of the Privilege?
Claim/assert privilege on behalf of the client when asked to disclose confidential information in a legal proceeding
Exceptions to Therapist-Client Privilege
Waivers
Mandatory reporting
Danger to self or others
Legal/Regulatory actions
True or False?
Exceptions to privileges are automatic.
False.
The judge reviews the relevant material to determine whether an exception applies and then issues an order to release information
Most “Ethically Troubling Issue” for Psychologists
Confidentiality and Privilege
Usually the conflict between ethical obligation to maintain confidentiality and legal requirement to breach confidentiality
When Legal Exceptions To Privilege are Applied
“When mandated by law or permitted by law for a valid purpose”
Legal mandates ordinarily take precedence over ethical obligations
Minors and Confidentiality
What rights do parents/guardians have?
Legal right to be informed of information revealed by the minor during the course of their treatment
Legal Exception to general rule regarding Minors and Confidentiality
When minor is emancipated or legally able to consent to their own treatment
Legal exception to Guardian being holder of the privilege for a minor
When caregiver is accused of crimes against the patient
Psychotherapist-patient privilege then belongs to the child
Discussing Limits of Confidentiality:
Timing
At the outset of the relationship
And thereafter as new circumstances may warrant
Limits of Confidentiality Considerations:
Group Therapy
Discuss how confidentiality will be managed when therapist also sees group members in individual therapy
Limits of Confidentiality Considerations:
Three rules for Group Therapy
Discuss confidentiality in prescreening interviews and initial therapy sessions; periodically remind group members
Encourage members to confront others in therapy about possible confidentiality violations
Remind group members to continue to maintain confidentiality when the group ends
Limits of Confidentiality Considerations:
Couple and Family Therapy
How to handle “secrets” when therapist also sees partners or family members in individual therapy
Best practice: inform partners or family members at the outset of treatment that information disclosing private sessions “will be deep dive bulged will be diagnosed as they see fit in accordance with the greatest benefit for the couple or the family”
Limits of Confidentiality Considerations:
Minors
Inform parent or guardian that sharing information may undermine effectiveness of treatment
Good practice is to have all parties agree at the outset of treatment about what kind of information will and will not be disclosed
Limits of Confidentiality Considerations:
Deceased Clients
Confidentiality following a client’s death is not explicitly covered by the ethics code
Some jurisdictions have laws that state:
“all communications shall be deemed to be treated as confidential in perpetuity”
Records cannot be released without a release from the executor or administrator of the estate
Limits of Confidentiality Considerations:
Services delivered or stored electronically
Inform clients of possible limits on privacy and confidentiality
Passwords /de-identification/ Encryption to restrict access to identifying information on shared databases
Two Limits of Confidentiality specific to a Military Psychologist
When client is deemed to be unfit for duty
When client poses a threat to national security
Limits of Confidentiality Considerations:
Employee Assistance Programs
Similar to other contexts:
When client signs authorization for release
When disclosing confidential information without authorization is permitted or required by law
Acceptable Breaches of Confidentiality:
Danger to Self
Imminent risk
Discuss intended actions with the client
Only share information that is relevant to the situation
E.g. no-suicide contract, contacting family, hospitalization
Acceptable Breaches of Confidentiality:
Danger to Others (Tarasoff Decision)
Duty to warn/protect intended victim by warning them, notifying police, or taking other steps
Specific requirements vary by jurisdiction
Two Requirements to Implement Duty to Warn/Protect
Clear and imminent danger
Identifiable victim(s)/ class of victims
Situations in which Duty to Warn Does is Not Applied
Disclosure of past crime/murder
Client says that someone they know has been talking about killing their boss
Ethics Code states that a legal duty to protect third parties from HIV infection should not be imposed.
However after considering specific legislation, disclosure is permitted when these 3 conditions are met
Identifiable third party whom provider has compelling reason to believe is at significant risk for infection
Reasonable belief that the third party has no reason to suspect that they are at risk
Client has already been urged to inform the third-party, but has either refused or is considered unreliable /unwilling
Requirement for Mandated Reporting
Knowledge or Suspicion that child abuse has occurred
Child Abuse reporting:
Statute of limitations
There are no time limits on child abuse reporting
As long as the victim is still a minor, psychologists have an obligation to file report
Child Abuse Reporting:
Adult Clients who reveal they were abused as a child
Psychologists are NOT legally required to make a report
*Unless there is reason to believe the abuser is still victimizing a minor
E.g. client’s father continues to abuse minor sibling,; if abuser is a teacher or other person who has responsibility for children
Child Abuse Reporting:
When a psychologist learns about a case of child abuse outside of their professional capacity
They have the option, like any other citizen, to make or not make a report
Child Abuse Reporting:
Recommendations for client involvement
It is preferable to involve the client in the reporting
(or duty to warn/protect) process
It is recommended to contact third-party or appropriate authority in the client’s presence
Confidentiality in Consultations
Only discuss information with client’s prior consent
Only share information relevant to the purpose of consultation
*Unless the client’s identity can be disguised
Use of confidential information for didactic purposes is prohibited.
However information can be used in 3 situations…
Reasonable steps have been taken to remove all personally identifiable information
Obtain written consent from individual or organization
Legally authorized to do so
True or False?
Using a pseudonym for the individual or organization is sufficient when presenting information in writing/lectures/public media
False. Pseudonyms are not sufficient.
Especially when potentially identifying characteristics for details have not been changed
When a Psychologist asserts Holder of the Privilege, what are two crucial things they must do?
State that they are claiming privilege on the client’s behalf
Release information only when ordered by the court
[or with client’s consent]
True or False?
Mandated reporters are immune from civil or criminal liability when the report has been made in good faith.
True.
