Chapter 6 questions

1
Chapter 6 questions

• Do you think that informing clients about
  confidentiality increases or decreases trust?
• What are some ways you might invade a clients
  privacy unintentionally?
• Why is record keeping important? Under what
  conditions do you disclose client records to
  another party, or to the client?

2
Chapter 6 cont

• What are the ethical issues involved in either
  maintaining or breaching confidentiality with
  clients who are sexually active? Are there any
  legal/ethical considerations? (what about clients
  with HIV)
• Some believe that professionals should decide
  whether or not to report child abuse if their
  client is an offender, on the grounds that
  reporting could result in the end of therapy with
  this client. What do you think?

3
Key Terms chapter 6

• Confidentiality An ethical concept that expects
  that communications will be kept within the
  bounds of the professional relationship.
• Privileged communication A legal concept that
  protects against forced disclosure in legal
  proceedings.
• Privacy The constitutional right of an
  individual to decide the time, place, manner, and
  extent of sharing oneself with others. Its
  the law.

4
Limits of Confidentiality

• When clerical assistants handle confidential
  information
• When counselor consults
• When counselor is being supervised
• When client has given consent
• When client poses danger to self or others
• When client discloses to commit a crime
• When counselor suspects abuse or neglect of a
  child or vulnerable adult
• When court orders counselor to make records
  available

5
Duty to Protect Potential Victims

• Identify clients who are likely to do physical
  harm to third parties
• Protect third parties from clients judged
  potentially to be dangerous
• Treat those clients who are dangerous

6
Liability for Civil Damages When Practitioners
Neglect Duty by

• Failing to diagnose or predict dangerousness
• Failing to warn potential victims of violent
  behavior
• Failing to commit dangerous individuals
• Prematurely discharging clients from a hospital

7
Legal Precedents

• Tarasoff Case
• Duty to warn of harm to self or others
• Duty to protect
• Bradley Case
• Duty to negligently release a dangerous client
• Jablonski Case
• Duty to commit a dangerous individual
• Hedlund Case
• Extends duty to warn to anyone who might be near
  the intended victim and who might also be in
  danger
• Jaffee Case
• Communications between licensed psychotherapists
  and their clients are privileged and therefore
  protected from forced disclosure in cases arising
  under federal law

8
Guidelines for Implementing Duty to Warn
Requirements

• Get informed consent
• Plan ahead through consultation
• Develop contingency plans
• Obtain professional liability insurance
• Involve the client
• Obtain a detailed history
• Document in writing
• Implement procedures to warn

9
Guidelines for Assessing Suicidal Behavior

• Take direct verbal warnings seriously
• Pay attention to previous suicide attempts
• Identify clients suffering from depression
• Be alert for feelings of hopelessness and
  helplessness
• Monitor severe anxiety and panic attacks
• Determine whether individual has a plan
• Identify clients who have a history of severe
  alcohol or drug abuse
• Be alert to client behaviors (e.g. giving prized
  possessions away, finalizing business affairs, or
  revising wills)
• Determine history of psychiatric treatment

10
Ethical Guidelines for Disclosure of a Clients
HIV Status

• Sufficient factual grounds for high risk of harm
  to third party
• Third party is at risk of death or substantial
  bodily harm
• Harm to the third party is not likely to be
  prevented unless counselor make disclosure
• Third party cannot reasonably be expected to
  foresee or comprehend high risk of harm to self

11
Recommendations to Professionals who Counsel HIV
Clients

• All limits to confidentiality should be discussed
  with the client at the outset of treatment
• Therapists must be aware of state laws regarding
  their professional interactions with HIV-positive
  clients
• Therapists need to keep current with regard to
  relevant medical information
• Therapists need to know which sexual practices
  are safe