04_Privacy and Confidentiality

Question 1

Privacy

Answer 1

Freedom to choose the time, circumstances, and extent to which one’s beliefs, behaviors, and opinions are to be shared or withheld from others

Question 2

Confidentiality:

Expectation of Privacy

Answer 2

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

Question 3

Confidentiality:

Overview

Answer 3

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

Question 4

Privilege

Answer 4

Legal concept that protects the client’s confidentiality in the context of legal proceedings

Federally recognized in 1996
Jaffee v. Redmond

Question 5

“Holder of the Privilege”

Answer 5

Patient/client, or legal guardian or representative

Question 6

When can a Psychologist become Holder of the Privilege?

Answer 6

Claim/assert privilege on behalf of the client when asked to disclose confidential information in a legal proceeding

Question 7

Exceptions to Therapist-Client Privilege

Answer 7

Waivers

Mandatory reporting

Danger to self or others

Legal/Regulatory actions

Question 8

True or False?

Exceptions to privileges are automatic.

Answer 8

False.

The judge reviews the relevant material to determine whether an exception applies and then issues an order to release information

Question 9

Most “Ethically Troubling Issue” for Psychologists

Answer 9

Confidentiality and Privilege

Usually the conflict between ethical obligation to maintain confidentiality and legal requirement to breach confidentiality

Question 10

When Legal Exceptions To Privilege are Applied

Answer 10

“When mandated by law or permitted by law for a valid purpose”

Legal mandates ordinarily take precedence over ethical obligations

Question 11

Minors and Confidentiality

What rights do parents/guardians have?

Answer 11

Legal right to be informed of information revealed by the minor during the course of their treatment

Question 12

Legal Exception to general rule regarding Minors and Confidentiality

Answer 12

When minor is emancipated or legally able to consent to their own treatment

Question 13

Legal exception to Guardian being holder of the privilege for a minor

Answer 13

When caregiver is accused of crimes against the patient

Psychotherapist-patient privilege then belongs to the child

Question 14

Discussing Limits of Confidentiality:

Timing

Answer 14

At the outset of the relationship

And thereafter as new circumstances may warrant

Question 15

Limits of Confidentiality Considerations:

Group Therapy

Answer 15

Discuss how confidentiality will be managed when therapist also sees group members in individual therapy

Question 16

Limits of Confidentiality Considerations:

Three rules for Group Therapy

Answer 16

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

Question 17

Limits of Confidentiality Considerations:

Couple and Family Therapy

Answer 17

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”

Question 18

Limits of Confidentiality Considerations:

Minors

Answer 18

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

Question 19

Limits of Confidentiality Considerations:

Deceased Clients

Answer 19

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

Question 20

Limits of Confidentiality Considerations:

Services delivered or stored electronically

Answer 20

Inform clients of possible limits on privacy and confidentiality

Passwords /de-identification/ Encryption to restrict access to identifying information on shared databases

Question 21

Two Limits of Confidentiality specific to a Military Psychologist

Answer 21

When client is deemed to be unfit for duty

When client poses a threat to national security

Question 22

Limits of Confidentiality Considerations:

Employee Assistance Programs

Answer 22

Similar to other contexts:

When client signs authorization for release

When disclosing confidential information without authorization is permitted or required by law

Question 23

Acceptable Breaches of Confidentiality:

Danger to Self

Answer 23

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

Question 24

Acceptable Breaches of Confidentiality:

Danger to Others (Tarasoff Decision)

Answer 24

Duty to warn/protect intended victim by warning them, notifying police, or taking other steps

Specific requirements vary by jurisdiction

Question 25

Two Requirements to Implement Duty to Warn/Protect

Answer 25

Clear and imminent danger

Identifiable victim(s)/ class of victims

Question 26

Situations in which Duty to Warn Does is Not Applied

Answer 26

Disclosure of past crime/murder

Client says that someone they know has been talking about killing their boss

Question 27

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

Answer 27

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

Question 28

Requirement for Mandated Reporting

Answer 28

Knowledge or Suspicion that child abuse has occurred

Question 29

Child Abuse reporting:

Statute of limitations

Answer 29

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

Question 30

Child Abuse Reporting:

Adult Clients who reveal they were abused as a child

Answer 30

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

Question 31

Child Abuse Reporting:

When a psychologist learns about a case of child abuse outside of their professional capacity

Answer 31

They have the option, like any other citizen, to make or not make a report

Question 32

Child Abuse Reporting:

Recommendations for client involvement

Answer 32

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

Question 33

Confidentiality in Consultations

Answer 33

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

Question 34

Use of confidential information for didactic purposes is prohibited.

However information can be used in 3 situations…

Answer 34

Reasonable steps have been taken to remove all personally identifiable information

Obtain written consent from individual or organization

Legally authorized to do so

Question 35

True or False?

Using a pseudonym for the individual or organization is sufficient when presenting information in writing/lectures/public media

Answer 35

False. Pseudonyms are not sufficient.

Especially when potentially identifying characteristics for details have not been changed

Question 36

When a Psychologist asserts Holder of the Privilege, what are two crucial things they must do?

Answer 36

State that they are claiming privilege on the client’s behalf

Release information only when ordered by the court
[or with client’s consent]

Question 37

True or False?

Mandated reporters are immune from civil or criminal liability when the report has been made in good faith.

Answer 37

True.