Ethical Standard4.Privacy and Confidentiality

Question 1

What is psychologists’ obligation to maintaining confidentiality?

Answer 1

Standard 4.01 Maintaining Confidentiality
Psychologists have a PRIMARY obligation and take reasonable precautions to PROTECT confidential information obtained through or stored in any medium, recognizing that the extent and limits of confidentiality may be regulated by law or established by institutional rules or professional or scientific relationship. (see also standard 2.05 delegation of work to others)

Question 2

What is the difference between privacy, confidentiality, and privilege?

Answer 2

4. 01 Privacy refers to “freedom of individuals to choose for themselves the time and the circumstances under which and the extent to which their beliefs, behaviors, and opinions are to be shared [with] or withheld from others” (Siegal, 1979, p. 251).In the context of therapy, once the information is shared in privacy with therapist it becomes confidential and will not ordinarily be shared with third parties.
   - Confidentiality refers to the obligation of psychologists to protect clients from unauthorized disclosure of information revealed in the context of a professional relationship. Confidentiality is an Ethical principle and is some situations, A Legal Requirement.
   - Privilege is a LEGAL Concept that protects a client’s confidentiality in the context of legal proceedings. Psychotherapist-patient privilege was recognized at the federal level in 1996 by the US Supreme Court decision in Jaffee v. Redmond, and most jurisdictions now have laws that establish privilege for communications between licensed mental health professionals and their clients.

Question 3

Who is the holder of the privilege in a legal proceeding?

Answer 3

4.01 THE CLIENT OR CLient’s legal guardian or representative is the holder of the privilege. A psychologist may “CLAIM/ASSERT/INVOKE” the privilege on behalf of the client when the psychologist is asked to disclose confidential information in a legal proceeding.

INterchangeably used all mean the same: claim the privilege; assert the privilege; invoke the privilege

Question 4

If for the first time the therapist is asked to disclose information about a client when providing testimony in court, the psychologist should do what?

Answer 4

4.01 The psychologist should ordinarily state that he or she is claiming the privilege on the client’s behalf. The therapist would then release the information ONLY when ordered to do so by the COURT or when the client or the client’s representative consents to the release.

Question 5

Legally, What are some exceptions to privilege, which could vary from jurisdiction to jurisdiction?

Answer 5

4. 01 (Koocher, 1998):
   - Waivers: The client authorizes a release of information
   - Mandatory Reporting: The therapist knows or suspects that a client is involved in child, elder, or dependent adult abuse.
   - Danger to Self or Others: The therapist believes the client is a danger to him/herself or others
   - Legal/Regulatory Actions: The client is suing the therapist for malpractice; has filed a complaint against a psychologist with the Ethics Committee or licensing board; is a party in a custody dispute; or is the subject of a court-ordered evaluation.

*In most cases, An Exception to privilege is not automatic. A judge reviews the relevant material to determine whether an exception applies and issues an order to release the info if determines there is a valid exception.

Question 6

When a client is a minor, a minor’s parent or legal guardian has legal right to be informed of information revealed by the minor during course of treatment unless a legal exception applies such as_______.

Answer 6

When a minor is Emancipated or is legally able to consent to his/her own treatment. OR Legal exceptions to privilege when abuse is involved.

Ex: Father accused of molesting minor son, the court concluded psychotherapist-patient privilege belonged to son not parent.

Question 7

Psychologists discuss two key issues when addressing limits of confidentiality with persons (including person who are legally incapable of giving informed consent and their legal representatives) and organizations with whom they establish a scientific or professional relationship.

Answer 7

Standard 4.02 Discussing the Limits of Confidentiality
(a) to the extent FEASIBLE psychologist discuss:
(1) the relevant limits of confidentiality
(2) the foreseeable uses of the information generated through their psychological activities
(See also standard 3.10 Informed Consent)

(b) Unless it is not feasible or is contraindicated, the discussion of confidentiality occurs at the OUTSET of the relationship and thereafter as new circumstances may warrant.
(c) Psychologists who offer services, products, or information via electronic transmission inform clients/patients of the risks to privacy and limits of confidentiality.

Question 8

As an example in a specific setting problems with confidentiality. Describe how therapist manage limits of confidentiality in group therapy.

Answer 8

4.02
Group therapy: Standard 10.03 requires psychologists to inform group members about the limits of confidentiality. This includes discussing how confidentiality will be managed when the therapist also sees group members in individual therapy and discussing legal limits of confidentiality. Hummel, Talbutt, and Alexander (1985) recommend group therapist (a) discuss need for confidentiality in both prescreening interviews and initial therapy sessions and periodically remind group members of importance of confidentiality in later sessions; (b) encourage members to confront each other in therapy about possible confidential violations and (c) remind group members about confidentiality when group ends.

Question 9

As an example in a specific setting problems with confidentiality. Describe how therapist manage limits of confidentiality in couple and family therapy.

Answer 9

4. 02
   - Couple and family therapy “secrets” can arise,especially when it’s the therapists policy to also see partners and family members in individual therapy. Ex:wife discloses is having marital affair in individual therapy. Therapists needs to decide whether to reveal in marital therapy or maintain woman’s confidentiality. This is a complex issue and is not directly addressed by the Ethics Code. Corey, Corey, and Callahan suggest that the best policy is for the psychologist to let the partners and family members know at the OUTSET of treatment that Information disclosed in private sessions “will be divulged as [he/she sees] fit in accordance with the greatest benefit for the couple of the family” (1998, p. 307).

Question 10

As an example in a specific setting problems with confidentiality. Describe how therapist manage limits of confidentiality in therapy with Minor Clients.

Answer 10

4.02
Except in legally defined situations, the parent and legal guardian of a minor client has right to information that the minor reveals during the course of treatment. However, disclosure of information to the parent or guardian may undermine the effectiveness of treatment, and a good practice is to have all parties agree at the OUTSET of treatment what kinds of information will and will not be disclosed (even though the agreement may not be legally binding).

Question 11

As an example in a specific setting problems with confidentiality. Describe how therapist manage limits of confidentiality with Deceased Clients.

Answer 11

The confidentiality of client information following a client’s death is not explicitly covered by the Ethics Code, but some jurisdictions have laws that apply to this situation. Ex: Massachusetts statute relevant to the practice of psychology states that “all communications…shall be deemed to be treated as confidential in perpetuity(251 CMR 1.11). In jurisdictions that have such laws, the records of a deceased client cannot be released to a family member or other person without a release from the executor or administrator of the client’s estate.

Question 12

As an example in a specific setting problems with confidentiality. Describe how therapist manage limits of confidentiality in terms of Services delivered or stored electronically.

Answer 12

4.02
Maintaining the confidentiality of information stored or delivered electronically poses a number of challenges and is addressed by several Standards. Standard 4.02(a) requires psychologists to inform clients of possible limits on privacy and confidentiality when they deliver services electronically; while Standard 6.02(b) states that, when psychologists store information in databases or other systems that can be accessed by others, they must use coding or other techniques that restrict access to identifying information. Methods for protecting electronically stored information include using passwords, de-identifying confidential information, and establishing and monitoring procedures for maintaining client confidentiality.

Question 13

As an example in a specific setting problems with confidentiality. Describe how therapist manage limits of confidentiality in terms of Services provided by military psychologists to military personnel.

Answer 13

4.02
Military psychologists must strive to protect the confidentiality of their clients while also adhering to Department of Defense rules that pertain to this issue (Ford, 2006). Consequently, they must clearly explain the limits on confidentiality (e.g., the need to violate confidentiality when the psychologist believes the client is unfit for duty or poses a threat to national security) and discuss concerns related to who the client is in the situation (e.g., the Department of Defense versus the individual).

Question 14

As an example in a specific setting problems with confidentiality. Describe how therapist manage limits of confidentiality in Employee Assistance Programs (EAPs).

Answer 14

4.02
Confidentiality may be breached in the context of an EAP in the same situations that it can be breached in other contexts (e.g., when a client is believed to be a danger to self or others). In addition, when an employee comes for counseling as the result of a referral to the EAP by his or her supervisor, the supervisor may be given limited information–i.e., the supervisor may be told if the employee kept the appointment, whether the employee needs treatment, and whether the employee accepted treatment. The supervisor should not be given any other information about the employee without the employee’s consent (Dickman, 1988).

Question 15

Before recording the voices or images of individuals to whom psychologists provide services to, what must be obtained?

Answer 15

Standard 4.03 Recording
Psychologists must obtain permission from all such persons or their legal representatives (see also Standards 8.03 Informed Consent for Recording Voices and Images in Research; 8.05 Dispensing With informed consent for Research, and 8.07 Deception in Research).

Question 16

How do psychologists minimize intrusions on privacy in written and oral format?

Answer 16

Standard 4.04 Minimizing Intrusions on Privacy

(a) Psychologists include in written and oral reports and consultations ONLY INFORMATION Germane to the purpose for which the communication is made.
(b) Psychologists DISCUSS confidential information obtained in their work ONLY for appropriate scientific or professional purposes and ONLY with PERSONS clearly concerned with such manners

Question 17

When can psychologists disclose confidential information?

Answer 17

Standard 4.05 Disclosures
(a) Psychologists may disclose confidential information with the appropriate consent of the organizational client, the individual client/patient, or another legally authorized person on behalf of the client/patient unless prohibited by law.

Question 18

When can psychologists disclose confidential information Without consent of the individual only as mandated by law, or where permitted by law for a valid purpose?

Answer 18

4.05
(b) Psychologists disclose confidential information without the consent of the individual only as mandated by law, or where permitted by law for a valid purpose such as to
(1)provide needed professional services
(2) obtain appropriate professional consultations
(3)protect the client/patient,psychologist,or others from harm (e.g., suicide, homicide, Tarasoff duty to warn victim/protect client; the client is perpetrator or victim of child abuse)
(4)obtain payment for services from a client/patient, in which instance disclosure is limited to the minimum that is necessary to achieve the purpose
(see also Standard 6.04e, Fees and financial agreements)

Question 19

When consulting with colleagues, what information do psychologists avoid disclosing?

Answer 19

Standard 4.06 Consultations
(1) Psychologists Do not disclose confidential information that reasonably could lead to the identification of a client/patient,research participant, or other person or organization with whom they have a confidential relationship unless they have obtained the prior consent of the person or organization of the disclosure cannot be avoided, and
(2) they disclose information only to the extent necessary to achieve the purposes of the consultation
(see also standard 4.01 maintaining confidentiality)

Question 20

What kind of “reasonable steps” must psychologists take in order to remove all personally identifiable information about clients, students, research participants, organizations, or other recipients of their professional services in their writings, lectures or other public media?

Answer 20

Standard 4.07 Use of Confidential Information for Didactic or Other Purposes
-reasonable steps to remove personally identifiable information, have obtained written consent from individual or organization, or are legally authorized to do so.Using a pseudonym for the individual or organization may not be sufficient, especially when potentially identifying characteristics or details have not been changed.