Who's Outside the Box

Locations of visitors to this page

Thursday, February 18, 2010

Confidentiality is Key

What are the limits of confidentiality and providing direct services to the student?

According to Jacobs and Hawthorne (2006, p. 65) confidentiality is described as an ethical decision or agreement not to expose any personal information about the individual unless:

· The individual requests that information be shared with another party
· There is a situation involving danger to the individual or others
· There are legal obligations to testify in a court of law
As school psychologist, we are encouraged to discuss the limitations of confidentiality at the onset of services. We are asking our clients to share their innermost thoughts and feelings with us and assuring them that the information will remain confidential, contingent upon the content.
Do you think that a conditional promise of confidentiality will help or hinder the psychologist’s effectiveness with the client?


This Blog was created by Danielle Muhammad and Prattima Kaulessar.

17 comments:

Rebeccca said...

First of all we have an obligation to tell our clients what the limitations of confidentiality are therefore there is never a promise but they should know what rights they have and where the line will be drawn. If you don't explain the limits of confidentiality you could be help liable even if you acted correctly when disclosing information.

Also, it is in both parties best interest to feel that there is confidentiality becuase otherwise nothing would be shared. This is why courts have ruled that we have client-patient privilages otherwise there would be no sharing between the two parties and nothing would be accomplished.
With that in mind, the idea of having a conditional promise does not make sense to me, you simply tell them the rules and say you will abide by them and remain as condifential and as ethically as you can.

danielle allegra said...

I firmly believe that without confidentiality, nothing, or at least the important information, will not be disclosed. If a client knows and believes that the information is kept secret, except for the above circumstances, i think one is more likely to disclose. and if there is a case, for example, danger is present, and confidentiality must be broken, it is in the client's best interest and a psychologist should have stated, from the onset, the limits of confidentiality. The bottom line is that a psychologist is there to help these people. With that being said, they should just let the clients know about the limits and be ready to listen and take action if necessary

Prattima Kaulessar said...

Confidentiality is the crux of counseling because clients share very private information with therapists and that information should be used for counseling purposes only. It is imperative to disclose confidentiality limitations at the onset of services because every client has the right to know their limitations with regard to information shared during sessions. However, just as you, the therapist, are to protect the privacy and rights of your client, you are equally obligated to protect the greater good of society. For example, if something is disclosed during a session that speaks of danger then the therapist must share the information with the proper authorities because therapists have a duty to warn potential victims in foreseeable danger.

A scenario illustrative of the limitations of confidentiality would be the Tarasoff v. California case where P. Poddar, a foreign exchange student and psychotherapy client, revealed his intentions to harm T. Tarasoff, Poddar’s schoolmate and ex-girlfriend. The therapist notified his supervisor who, consequently notified campus police but allegations were denied by Poddar when questioned. The matter never reached the local police department and Poddar eventually killed Tarasoff. In this case, the therapist had a greater responsibility to the safety of Tarasoff than the confidentiality of Poddar.

Mark said...

This is a topic that we will deal with on a daily basis. In my position as a school-based counselor I review the confidentiality guidelines with each student before I do an intake. Without fail each student presents with a different expression, whether it is concern, doubt, or fear. It is up to me to ensure that before we move forward that confidentiality is our goal and can be broken if the content of the session will put them in harm/ or they are harmed, or if they are a threat to society. In order to develop rapport and create a safe environment for the client it is important to discuss confidentiality. For some they may refuse but more often than not the client begins to acknowledge how trust is established and that any action taken is for the best interest of the client.

Danielle Muhammad said...

I agree with all of you on the point that we have an obligation to tell our clients about the limitations of confidentiality. But, how much more information would our clients share with us if they felt a stronger sense of security? Do clients really feel like they can be open with us? Especially when we are telling them that we will BREAK confidentiality if necessary.
According to Jacobs and Hartshorne (2006 p. 64), school psychologist must weight a number of factors in deciding the boundaries of a promise of confidentiality (e.g., age and maturity of the student/client, self-referral or referral by others, reason for referral).

danielle allegra said...

Danielle, i think it depends on those factors, age, maturity, and reason for referral, to decide if the client will open up more when feeling like its "confidential" even with knowing that it is possible confidentiality could be broken

Prattima Kaulessar said...

I believe clients share rather freely with their therapists. If confidentiality limitations were not an issue, I am certain clients would share much more freely; however, just because an individual is honest does not mean they should be exempt from following rules and laws that govern society. More specifically, if an individual shares information that is of a dangerous nature, meaning the client has intentions of self-harm or harm to others, then those issues need to be dealt with after the most pressing issue, the harmful ideology, is eradicated.

Denise said...

I would only agree that clients share information with their therapist freely to a certain extent. Especially in that of a school setting, the therapist needs to develop a rapport with their client so that they may eventually open up to them. By reviewing confidentiality guidelines with clients at the beginning of a session such as Mark noted, you are being up front with them right off the bat about what is legally required of you and by doing so, you protect yourself in the case where you would need to break confidentiality.

Alaafia said...

A conditional confidentiality can help in the psychologist's effectiveness with the client in the sense that instances where such promises might be broken are brought up for discussion with the client from the onset, and the psychologist explains the legal and ethical responsibilities he or she is obliged to adhere to, and the client is able understand all these modalities, I believe will go a long way in building trust.

Prattima Kaulessar said...

I agree Alaafia. Honesty is built knowing limitations and expectations from the inception of treatment. In my opinion, sharing confidentiality requirements will help build a rapport with the client because he/she knows the therapist is bound by law and ethics to keep personal information confidential unless in a scenario of imminent danger to self or others.

AmandaBish said...
This comment has been removed by the author.
AmandaBish said...

As long as the conditions of confidentiality are explained to the student, I think more often than not it will not affect the effectiveness of the psychologist in a negative manner. I understand there are some situations where a student may divulge information that has to be repeated that the student will feel betrayed, but in the end the student will know it was for the better. Why else are they even discussing it unless they want or need help?

I also agree with Mark that rapport is key in defining confidentiality with a student. They need to trust you to make the right decision with the information they are going to give you.

Ana said...

Regarding confidentiality, I feel like there is only so much you can do to encourage a client to share their innermost feelings and thoughts. The ethical thing to do is tell them about the limitations of confidentiality. I feel like we must find other ways to ensure our client's that they can trust us. We must be able to build rapport, even after we notify them about this.

Rebeccca said...

Amanda, I agree with you that they probably would not tell you information unless they want help. In addition, I would add that though it is good to be our student's friends and companions that is not our role or goal. We are not trying to be their friends and if they don't forgive us at least we protected the student this time.

Prattima Kaulessar said...

I agree that most clients would not be affected too much by confidentiality limitations. Most seek the opportunity to speak to someone, other than family and friends, about issues. Also, they probably find it easier to speak more candidly with uninvolved individuals and hear unbiased third party feedback.

I find it hard to believe that therapists break confidentiality laws often. Very few may be affected by confidentiality limitations, as some of you have already said, but it is true must of the time when professionals share information it is to gain insight, advice, or to share concerns about safety issues. A therapist may have to break confidentiality but for good and valid reasons and hopefully the client will understand you are doing your job to help and protect them and others.

Rebeccca said...

One thing I have notice with confidentiality is that when the school psych tells a student that he or she wishes to discuss the case with someone else as a reference and wishes to ask their permission first, many students (high school) do not seem to realize that they could say no.

Often, when dealing with kids I don't think they always fully understand that they can tell and adult with authority that they don't like something. This is why it is so important to involve the parents, to some extent, when dealing with kids.

Which then in itself can be tricky becuase you don't want the student not to trust you becasue you spoke to their parents.

Anel said...

Rebecca brings up an important point in terms of students' right to simply say no. I would imagine that this thought would rarely even cross their minds, since they view us as an authority figure. As mentioned earlier, we are not there to be their friends, but we also have to find that balance that will allow them to be comfortable enough to build a rapport with us.

Would it help if we were more specific with students? I would think that if we spoke very clearly and illustrated the kind of scenarios that would lead us to divulge any information, it would encourage them to be more open. But on the other hand, if the scenarios we describe (i.e. suicide) is something they are thinking about, it may cause them to not speak up. It's a risk we take either way when trying to reach out to them.