Tag Archives: Confidentiality

Family Therapy Confidentiality


Although there are differing perspectives on how secrets should be handled within the context of family therapy, my personal perspective is that the family should have visibility into the individual sessions.  Essentially, anything said during an individual session is subject to being included in family therapy.  Inherent in this perspective is the assumption that this is fully disclosed and discussed in the process of informed consent, so that all members of the family understand the concept.  This perspective comes with both benefits and with drawbacks.

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There are some situations where I suspect an individual would not disclose information in an individual session where they might have otherwise.  An extra marital affair is one such example.  With my personal framework and expectations, the individual may not want to disclose such information with me in individual sessions due to the fact that I would admittedly introduce that subject up in the family session.  The end result is a perpetuation of the secret, and the therapist being “cut out of the loop” on individual secrets.

I believe the benefit is that it adds transparency into the family therapy environment.  I believe a foundation of trust and mutual respect is the foundation on which a family should be built, and as a result, there should be few if any secrets.  One party (the husband, for example) can have confidence in allowing his wife to engage in individual therapy with me because he understands that relevant findings will be brought to the attention of the entire family.  In any case, I would implement this policy because I believe the very act of keeping the secret is an act of collusion.  I agree with the text that this policy is liberating in the respect that it frees me, as a therapist, from being put in the position of keeping a secret of a client participating in conjoint therapy.  I think the situation of having to keep a secret is best avoided entirely with by establishing a framework of transparency from the outset.

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Reflections on Group Counseling


Based on your experiences and the readings how is group work different from other counseling in terms of ethical issues? Based on the chapter readings do you think any specialized training is need before doing group work?  In your experience do you think that most group leaders have the necessary training?

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There are specific ethical concerns that are raised and should be considered when we enter into the group counseling environment.  First and foremost, proficiency in individual counseling does not necessarily translate into competency in the group environment.  They are two different dimensions of service, and group leaders should be adequately trained to meet the specific needs of a group.  For example, co-leadership or co-counseling is not typically a concern in individual therapy, but can be a real cause of distress in the group which employs multiple leaders.

Group work gives rise to specific concerns regarding confidentiality, since confidentiality cannot be controlled to the degree that it would be in an individual counseling relationship.  It’s literally impossible for us to “police” multiple members to ensure that they do not divulge excessive information regarding group members, although we can take practical steps to encourage best practices among group members.

Member screening is not something that is typically conducted within the context of individual therapy, but it should definitely be a consideration for leaders of group therapy.  Ideally, members of a group should share common goals or issues, including a common motivation to help each other succeed.  Specifically, the text cites several types of individuals that may not be a good fit for group therapy, including “brain-damaged people, paranoid individuals, hypochondriacs, those who are actively addicted to drugs or alcohol, acutely psychotic individuals, and antisocial personalities.”  (Corey, Schneider-Corey, & Callanan, 2007, p. 489)

Aside from supervised experience and adequate education, the most important training that can occur is to engage in group members ourselves.  “One of the best ways to learn how to assist group members in their struggles is to be a member of a group yourself.”  (Corey et al., 2007, p. 482)  Specifically, the text recommends self-exploration groups, which is something I am definitely going to engage in as soon as possible.  Specifically, the text recommends at least basic training in “nature and scope of practice; assessment of group members; planning group interventions with emphasis on environmental contexts and the implication of diversity; implementation of specific group interventions; co-leadership practices; evaluation of process and outcomes; and ethical practice, best practice, and diversity-component practice.”  (Corey et al., 2007, p. 481)

I don’t believe I am in a position to judge whether or not most group facilitators have sufficient experience and training to conduct groups.  I have never personally had an experience with group therapy, but I am led to believe by the text that there is reason to be concerned.   I should be better able to answer this aspect of the assignment after engaging in group therapy myself, but it is my expectation that the facilitator process a certain degree of competence before they engage in leading a group.  On the whole, I think “we try” but there is certainly room for a great deal of improvement.

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Reference

Corey, G., Schneider-Corey, M., & Callanan, P. (2007). Issues and ethics in the helping professions (8th ed.). Belmont, CA: Brooks/Cole.

Confidentiality in the Team Environment


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Although it can surely be a challenge, clients being serviced by a team of professionals are nonetheless entitled to a similar degree of confidentiality as their peers that are being serviced by individuals.  However, because group care requires a team approach, the team needs to share information in order to be effective.  For example, in the case of 24 hour inpatient service, there needs to be an effective communication between and among the shifts to determine if “Jimmy has had a good day.”  This contributes to a level of consistency in care, support, and treatment.

Just as in an individual relationship with a counselor, all staff members have a responsibility to breach confidentiality if the client is a danger to self or others.  So, if Jimmy is experiencing suicidal ideation, it is only reasonable that the staff that works directly with that specific client be made aware of the situation.  Secondly, if we have reason to believe that a child, elderly, or dependent adult has been abused, we should again breach confidentiality as a measure of compliance to mandatory reporting law.  In short, the mandatory reporting rules that apply to us as individual clinicians also apply in a group setting.

In my current position, it is generally understood that “anything said to one staff member is said to all.”  There are literally no secrets.  This policy comes with benefits and limitations.  First and foremost, it prevents us from inadvertently breaching confidentiality that was anticipated by our clients.  As higher functioning developmentally disabled adults, they have agreed to such policy, and have acknowledged that they understand it.  However, I also believe it places limitations on the relationships you are able to effectively build, in part because it pits “staff” against “clients.”  There would likely be situations where an individual client would share sensitive information due to the rapport and level of trust with an individual staff member… but that information would not be shared due to the implications of the policy.  The end result may be that the trusting relationship between individual staff members and a client is diminished, in part or wholly as a result of that policy.

Another implicit policy is that it is acceptable to disclose information “up” but not “out.”  This translates in our ability to share information regarding clients to our supervisors and bosses, but not with other staff that do not regularly interact with the clients themselves.  There are, however, situations where information may need to be shared on a need to know basis… for example, when someone picks up a shift, it is probably wise to let them know not to talk about Jimmy’s mom because she just got in a car accident.  In any event, information is provided on a need to know basis, where appropriate, with the client’s best interest in mind.

In the end, I agree with and support the policy of “what is shared with one staff is shared with all” because it is conducive to a team environment.  While it does place limitations on our ability to leverage individual relationships with clients, the benefits outweigh the limitations.  As a result, if I work in a group or a team environment, I would prefer to work in that “everyone knows everything” situation because I believe it’s what’s best for “Jimmy.”

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Confidentiality | Silence is golden!


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Confidentiality is at the foundation of safe therapy because it promotes open and candid communication between the therapist and the counselee.  This right to confidentiality has been repeatedly reaffirmed in judicial system, with the case of Jaffee v. Redmond (1996) serving as a key example.  In that ruling, Justice John Paul Stevens of the US Supreme Court wrote expressed that “effective psychotherapy depends upon an atmosphere of confidence and trust in which the patient is willing to make frank and complete disclosure of facts, emotions, memories, and fears.”  (Corey, Schneider-Corey, & Callanan, 2007, p. 214)  Justice John Paul Stevens couldn’t be more correct, because without a measure of confidentiality, the process of mental health treatment would not be possible.  Clients themselves would need to be constantly concerned about the ramifications of divulging sensitive information.  It is extremely important that we communicate a client’s right to confidentiality to promote that free flow of communication.  Not only are we ethically and legally responsible for disclosing it at outset, in the form of an informed consent document, but we should also endeavor to continue to have candid conversations around confidentiality as the relationships continues to develop.

We, as mental health professionals, should seek to protect the image of the larger profession and give our clients every reason to believe in our pledge of confidentiality.  That integrity aside, we also need to be candid and forthcoming regarding the limitations of that confidentiality, because it is not without exceptions.  If the client is a danger to self or others, we are bound by mandatory reporting procedures to report the incident, as well as “warn and protect” other people from potentially dangers clients.  In cases where abuse is detected, be it with children, elderly, or dependent adults, we are mandated by law to report such cases to proper authorities.  Furthermore, we should follow up on such cases to be assured that proper action has been taken.  In the case of counseling a minor, an underage client should be aware of specific limitations regarding disclosure of information to parents, particularly when he or she is a danger to themselves or others.  We also much acknowledge that confidentiality is the client’s right, and they also have the ability to waive that right.

I would hope that clients really believe what they say is confidential.  I would also hope that they understand the implicit limitations on that confidentiality before the process of counseling begins… so, they should also understand that some of what they may say is not confidential.  In any case, it very much depends on the context, the situation, the content of the disclosure, the professional judgment of the clinician, and the ethics codes, laws, and agency policies that govern our practice.

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Reference

Corey, G., Schneider-Corey, M., & Callanan, P. (2007). Issues and ethics in the helping professions (8th  ed.). Belmont, CA: Brooks/Cole.