Last week we talked about confidentiality and how we discuss this with our clients. Below are some specific situations in regards to maintaining confidentiality that are important to know. Come back on Friday for a question related to one of these areas…
Family and Couples Counseling and Therapy: When providing family or couples counseling or therapy, you should, as early as possible in the relationship, (a) discuss confidentiality thoroughly with the participants, (b) seek an agreement from the participants to maintain one another’s confidentiality, and (c) notify the participants that you cannot guarantee that all of them will abide by the agreement.
In family or couples therapy, the problem of “secrets” can arise. This problem is especially likely to occur if you also see one member of the family or one or both members of the couple in a private session. For instance, a wife might disclose during a private session that she is having an affair. What should you do in this situation? This is a complex issue, and to help avoid such dilemmas, you should, as soon as possible in the relationship, clearly state your own position, as well as your employer’s or agency’s policy, with regard to keeping or sharing “secrets.” Corey, Corey, and Callahan have suggested that the best policy is to let clients know that information given in private sessions “will be divulged as … [you] see fit in accordance with the greatest benefit for the couple or the family” (1988, p. 307). It’s also recommended by many experts that you get written client consent in advance to share confidential information with other participants in family, couples, or group therapy when deemed relevant and significant to the goals and purposes of therapy (Bernstein & Hartsell, 2000). Note that it’s also considered a good practice to keep separate records for all individual sessions held with each participant and a common record for all joint sessions.
Group Counseling and Therapy: At the beginning of group counseling or therapy, you should (a) discuss confidentiality thoroughly with each group participant, (b) seek an agreement from each participant to maintain the confidentiality of all information disclosed to the group, and (c) inform each participant that you cannot guarantee that all participants will abide by the agreement. The latter is important because group members are not required by any law or other standard to maintain the confidentiality of what they hear from other members during group meetings. You should also inform the clients of your own, your employer’s, and your agency’s policy regarding whether or not and when you will disclose confidential information among the clients involved in the group counseling or therapy. Finally, while the Code of Ethics does not explicitly require you to obtain from group participants a written commitment to preserve the confidentiality of all information disclosed to the group, experts recommend that you do so.
Consultation: When seeking consultation, you should not disclose identifying information about a client unless you have obtained signed permission from the client or there is a compelling need to disclose such information. Furthermore, you should share with the consultant only relevant information; specifically you should share only information that is necessary to achieve the purpose(s) of the consultation. Note that an implication of this ethical standard is that it is not necessary to get a client’s permission to discuss his/her case with a consultant as long as you do not disclose information that would reveal the client’s identity to the consultant.
Third-Party Payers: You should not disclose confidential information to third-party payers (insurance companies, Medicare, etc.) unless the client has authorized you to do so.
Legal Proceedings: To the degree permitted by law, you should protect the confidentiality of your clients during legal proceedings. If a legally authorized body, such as a court of law, orders you to disclose confidential or privileged information without a client’s consent, and you believe that such disclosure could result in harm to the client, you should (a) ask the court to withdraw the order, (b) try to limit the order as narrowly as possible, or (c) ask the court to keep the relevant records under seal, where they are unavailable for public inspection. This issue is discussed in more depth in the section on Privilege, below.
Deceased Clients: You should protect the confidentiality of deceased clients in a manner consistent with confidentiality standards found in the Code of Ethics. This means that you should not release confidential information after a client’s death without proper authorization (e.g., a release from the executor of the client’s estate or the client’s legal representative).