Chapter 5: Confidentiality and Privileged Communication

Respect for autonomy(applied to confidentiality/premise one )

refers to the clients rights to self-determination, and the clients right to determine who knows what information about them in what circumstances.

confidentiality

refers to the counselors obligation to protect clients privacy and promise to clients that the information they disclose during sessions will be protected from discloser without their consent.

confidentiality breach to protect someone from danger

sometimes situations arise that require you to breach confidentiality in order to protect or warn someone who is in danger.

1% -5% of complaints made of counselor(Breaches of confidentiality are rare)

studies show that only 1%-5% of complaints made of counselors to boards involve violations of confidentiality.

limitations to confidentiality

the advantages of informing clients about limits of confidentiality outweigh any disadvantages in terms of inhibited disclosure.

Code of ethics alerts counselors ..

the code of ethics alerts counselors to make every effort to ensure that privacy and confidentiality of clients are maintained by subordinates, including employees, supervisees, students, clerical assistants, and volunteers.

Privileged and death

the common law is that privileged doesn't end with death, but if their isn't any statutory language regarding privileged and death the common practice is that a legal representative of the deceased person will assert the privilege.

Umbrella

the umbrella of confidentiality can be extended to covers others who assist or work with the counselor in providing services to clients

Jaffee vs. Redmond

this case solidified the need for confidentiality in the mental health profession because it brought awareness to the stigma that society places on individuals would discouraged them from seeking help.

Clients requesting discloser

when a client request for information to be disclosed, counselors should honor that request.

when others involved don't keep confidentiality

when others don't keep confidentiality, a counselors responsibility is not diminished by the presence of additional persons in the counseling session.

Pledge of silence(premise three)

which is the offer of confidentiality extended by the counselors to the client. Counselors are bound to pledge both in word and deed. Once given their word counselors are obligated to actively seek to protect clients secrets disclosure.

when sharing client information with other professionals...

you may be asked to share client information with other professionals that the client has a relationship with to enhance their care... this is appropriate to do so when the client has giving you permission.

Limits to confidentiality include ..

1. counselors must take action when they suspect abuse or neglect of children or other persons presumed to have a limited ability to care for themselves 2.Counselors must take action to protect clients who pose a danger to themselves 3. counselors must take action when a client poses a danger to others 4. counselors must disclose confidential information when ordered to do so by a court

exceptions to confidentiality and privileged communication

1. in cases of dispute between counselor and client 2. when a client raises the issue of mental condition in legal proceedings 3. when a client condition poses a danger to self or others 4. in cases of child abuse or neglect(in addition to mandated reporting laws) 5. when the counselor has knowledge that the client is contemplating commission of a crime 6. during court ordered psychological evaluation 7.for purposes of involuntary hospitalization 8. when the counselor has knowledge that a client had been victim of a crime 9. in cases of harm to vulnerable adults

Clients right to waive privacy

Confidentiality and privilege belongs to clients, not counselors. As s result, clients can waive their privacy.

Maintaining confidentiality when consulting

counselors are encouraged to seek advice from other counselors, but not to do so in public sitting such as halls of an agency, institution, restaurant etc.

Vicarious liability

counselors can be held accountable for assistants who breach confidentiality.

Clients entering and exiting

counselors must take special precautions to guard their clients privacy when exiting and entering because clients usually have to come through the waiting area.

chooses consultants

counselors should choose consultants who have appropriate expertise for the question at hand. if you have an ethical or clinical question, consult with a professional colleague. If you have a legal question, ask an attorney.

confidentiality is not absolute

counselors should make every effort to avoid inadvertent breaches, however sometimes confidentiality must be breached. Counselors must inform clients at the outset that there are limitations to their confidentiality.

three types of duties

duty to warn, duty to protect, and duty to report

family members as interpreters

if a family member is used as the interpreters, the counselor should carefully explain the purposes and importance of confidentiality and ask the interpret to keep all disclosures completely confidential. It is preferable to use a professional interpreter, if one is available who understands the context of the clients life.

Respect for human relationship(premise two)

in a professional relationship, the intimate context in which secrets are shared is seen as essential in counseling.

Supervision/confidentiality

in supervision the clients identity cannot be concealed. Supervisors may observe actual counseling sessions from behind a one-way mirror, review tapes, review case and counseling records. According to the code of ethics Clients have a right to be informed of anyone who may have access to their information ie. supervisors, peers, classmates. etc Counselors must also obtain permission from clients before allowing others (ie.) to view any client information.

Privacy

is the broadest among the three concepts (privacy, confidentiality, privileged communication). Refers to the rights persons have to decide what information about themselves will be shared with to withheld from others.

privileged communication

is the narrowest of the three terms, and is a legal concept. refers to laws that protect clients from having confidential conversation disclosed in a court of law without their permission.

Record keeping

it is important to remember that records are keep for the benefit of the client and counselors are obligated to provide clients with access to their records, unless the records contain information that may be misleading or harmful to the client.

According to Bok, What are the four premises that confidentiality is based on?

Respect for autonomy, Respect for human relationships and for the secrets that certain types of relationships entail, pledge of silence, and utility.

responding to a subpoena

confidential information should not be revealed in response to an subpoena until the counselor has been advised by attorney.

Utility(Premise four)

confidentiality in counseling is useful to society, because clients would be reluctant to seek help without an assurance of privacy.

Unintentional violation

according to one study, 61.9% of psychologist reported that that had unintentionally violated their clients confidentiality.

Subpoenas

are legal documents that might require a written response to a written list of questions; produce copies of records; appear for a deposition, court hearing, trail, or bring records with them to court. These are official court documents and can not be ignored. counselors who do not respond appropriately to subpoenas can be held in contempt of court and could be fined or jailed until they comply. Counselors should seek legal advice when dealing with subpoenas.

ethical obligations for student counselors

are the same as those set for practicing counselors

counselors may reveal confidential information when it is necessary to defend themselves against charges brought by clients..

as a result... the law of privileged communication requires that clients waive their privilege when they bring complaints or malpractice lawsuits against their counselor.

statutory privilege

belongs to the client rather than the counselors; it is up to the client to assert privilege if you are subpoenaed. if the client cant be located; it is up to the counselor to assert privileges on behalf of the client. Counselor should seek legal advice from an attorney.

Explaining supervision to clients

clients can be told that supervision is to help you do a better job and that the focus of the supervision will be on you and your performance rather than on them and their problems.

A very difficult dilemma for counselors...

a very difficult dilemma for counselors is posed when one spouse demands that the counselor not reveal information related in a marital counseling session and the other demands that the counselor does.

confidentiality and privileged communication

only exist when a counselor-client relationship exist and when counselor is providing professional counseling services.