Continuing Education & Resources for Mental Health Professionals

Ethical Practice Model Adapted for Multi-Client Cases

Protecting Confidentiality Rights:  An Ethical Practice Model

(Adapted for Use in Multi-Client Cases: Couple Therapy, Family Therapy,
Child Therapy with Parents, Individual Therapy w/Collaterals)

Mary Alice Fisher, Ph.D.
2013

I. PREPARE

            A. Understand Clients’ Rights and Your Ethical Responsibilities in Behalf of Those Rights

Rights of Adult Therapy Patients

Rights of Minor Therapy Patients

Rights of Parents of Minor Patients and Other “Collaterals”

Rights of Referral Agency or Others?

            B. Clarify Your Own Personal Ethical Position About Confidentiality in Multi-Client Cases

            C. Learn the Laws that Can Affect Your Ability to Protect Confidential Information

            D. Develop Plan for Ethical Response to Laws That Require You To Disclose “Involuntarily”

E. Decide When/How You Will Limit Confidentiality Voluntarily 

            F. Choose Reliable Ethics Consultants and Legal Consultants and Use as Needed

            G. Devise Informed Consent Forms that Reflect Your Real Intentions

            H. Prepare to Discuss Confidentiality and Its Limits in Understandable Language  

 

II. TELL PROSPECTIVE CLIENTS THE TRUTH  (Inform Their Consent)

            A. Conduct Conversation in Language Reasonably Understandable to Each Party

            B. Inform All Recipients of Services About Involvement of Any Third Parties + Implications

C. Inform Prospective Recipients of Services About Limits of Confidentiality

1. Foreseeable uses of the information to be gathered

2. Potential disclosures to other member(s) of couple/family, or to parents about minor child

3. Potential voluntary disclosures to others (e.g., by policy; by third party contract, etc..)

4. Potential “involuntary” disclosures (e.g., legally-required reports; subpoenas) [See IV, below]

            D. Explain Roles, Contracts, or Potential Conflicts of Interest That Might Affect Confidentiality

            E. Obtain Consent to Participate from All Parties, Including Collaterals

(With Minors, Seek Assent; Consider Preferences and Best Interests)         

III. OBTAIN INFORMED CONSENT BEFORE DISCLOSING ANYTHING VOLUNTARILY

            A. Respect the Rule: Disclose Without Client Consent Only if Legally Unavoidable

            B. Inform Clients Adequately About Content and Implications of the Potential Disclosure

            C. Obtain and Document the Client’s Consent Before Disclosing

 

IV. RESPOND ETHICALLY IN LEGALLY-IMPOSED DISCLOSURE SITUATIONS

            A. Notify Parties of Pending Legal Requirement for a Disclosure Without Their Consent

            B. Respond According to Plan (from Step 1,E above)

1. Laws requiring psychologists to initiate disclosures (e.g., reporting laws)

2. Laws giving others access to information without client consent

3. Exceptions to psychologist–client privilege in court cases

4. Laws allowing others to re-disclose information that psychologists disclose

            C. Limit Disclosure of Confidential Information to the Extent Legally Possible

 

V. AVOID PREVENTABLE BREACHES OF CONFIDENTIALITY

            A. Avoid Making Unethical Exceptions to the Confidentiality Rule

            B. Establish and Maintain Protective Policies; Train Staff  & Technical Assistants

            C. Monitor Note Taking, Report Writing, and Record Keeping Practices

            E. Anticipate Legal Demands; Empower Clients to Act Protectively in Their Own Behalf

            F. Protect Client Identity in Presentations, Consultations

 

VI. TALK ABOUT CONFIDENTIALITY

            A. Model Ethical Assessment Practices; Confront Others’ Unethical Practices

            B. Provide Peer Consultation About Confidentiality Ethics

            C. Teach Ethical Practices to Students, Supervisees, Employees

Adapted From:  Fisher, M.A. (2008). Protecting Confidentiality Rights: The Need for an Ethical Practice Model. American Psychologist, 63 (1), 1-13. (See at http://www.CenterForEthicalPractice.org/)

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Articles Related to Confidentiality in Multi-Client Cases

American Psychological Association Practice Organization, Legal and Regulatory Affairs Staff. (2005). A matter of law: Privacy rights of minor patients.  Retrieved from http://www.apapractice.org/apo/insider/practice/pracmanage/legal/minor.html#

American Psychological Association Insurance Trust. (2006). Sample outpatient services agreement for collaterals. Retrieved from http://www.trustinsurance.com/download.aspx

American Psychological Association Working Group on the Older Adult. (1998).  What practitioners should know about working with older adults. Professional Psychology: Research and Practice, 29(5), 413-427.

Fisher, M.A. (2009c).  Replacing “Who is the client?” with a different ethical question.  Professional Psychology: Research and Practice, 40, 1-7.  doi: 10.1037/a0014011  (Retrieved from http://www.centerforethicalpractice.org/articles/articles-mary-alice-fisher/

Gottlieb, M. C., Lasser, J. and Simpson, G. (2008). Legal and ethical issues in couple therapy. In A. Gurman (4th Ed.), Clinical Handbook of Couple Therapy. (pp. 698-717). New York: Guilford.

Kuo, F-C. (2009). Secrets or no secrets:  Confidentiality in couple therapy.  The Journal of Family Therapy, 37,351-354.  doi:  10.1080/01926180701862970

Weeks, G.R., Odell, M. & Methven, Susanne (2005) If Only I Had Known. . . Avoiding Common Mistakes in Couple Therapy.  New York: W. W.Norton.

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Portions of Sample Contract for “Collaterals”

From APA Insurance Trust

“WHO IS A COLLATERAL? A collateral is usually a spouse, family member, or friend, who participates in therapy to assist the identified patient. The collateral is not considered to be a patient and is not the subject of the treatment. Psychologists have certain legal and ethical responsibilities to patients, and the privacy of the relationship is given legal protection. My primary responsibility is to my patient and I must place their interests first. You also have less privacy protection.

“THE ROLE OF COLLATERALS IN THERAPY: The role of a collateral will vary greatly. For example, a collateral might attend only one session, either alone or with the patient, to provide information to the therapist and never attend another session. In another case a collateral might attend all of the patient’s therapy sessions and his/her relationship with the patient may be a focus of the treatment. We will discuss your specific role in the treatment at our first meeting and other appropriate times. . . .

“MEDICAL RECORDS: No record or chart will be maintained on you in your role as a collateral. Notes about you may be entered into the identified patient’s chart. The patient has a right to access the chart and the material contained therein. It is sometimes possible to maintain the privacy of our communications. If that is your wish, we should discuss it before any information is communicated. You have no right to access that chart without the written consent of the identified patient. You will not carry a diagnosis, and there is no individualized treatment plan for you. . . .

“CONFIDENTIALITY: You are expected to maintain the confidentiality of the identified patient (your spouse, friend, or child) in your role as a collateral.” 

From: American Psychological Association Insurance Trust. (2006). Sample outpatient services agreement for collaterals. Retrieved from http://www.trustinsurance.com/download.aspx  [emphasis added]

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