The Ethics of Conditional Confidentiality:
A Practice Model for Mental Health Professionals
Mary Alice Fisher, Ph.D.
Oxford University Press, 2013
If confidentiality were protected absolutely, then therapists could simply promise that “Everything you tell me will remain in this room” . . . or perhaps, “I will disclose nothing without your consent.”
But today, therapists are unable to keep such promises unless they are willing to risk severe legal penalties for disobeying all the laws that now require them to disclose confidential information about their patients.
Confidentiality is still the ethical rule, but it now has many exceptions, meaning that we can promise to protect it only “conditionally” rather than absolutely. Ethically speaking, this makes confidentiality very complicated, leaving many therapists unsure about when it is ethical to disclose information and when it is not.
This book provides a patient-protective practice model that can guide therapists’ decisions about confidentiality and disclosure.
“No one has written more thoughtfully, knowledgeably, and realistically about confidentiality than Mary Alice Fisher. She has rescued the ethics of confidentiality after they have been all but hopelessly confused with legal mandates, risk management, and impractical guidelines. This book is unsurpassed in helping us think through the hard questions we encounter in practice, work through conflicting values, and find creative ways to meet our responsibilities. It deserves to land on the required reading lists in all graduate programs and find its way into the libraries of all clinicians, from those just starting out to the most experienced.” — Kenneth S. Pope, Ph.D., ABPP
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HOME STUDY TEST
8 CE Credits
$108.00 Per testIncludes sales tax, shipping and handling
1. Outline the preparation necessary for protecting clients’ confidentiality rights.
2. Describe the components necessary for obtaining informed consent about confidentiality.
3. Describe the ethical difference between voluntary and legally-required (involuntary) disclosures.
4. Name some ways to avoid “avoidable” disclosures.
5. Explain why it is important to educate each other and the public about confidentiality.
Table of Contents
PART I. The ABC’s of “Conditional Confidentiality”: An Ethical, Legal, and Ethical/Legal Review
Chapter 1. Ethical Responsibilities about Confidentiality
Chapter 2. Law Affecting Confidentiality
Chapter 3. Placing Laws into Ethical Context
PART II. Protecting Patients’ Confidentiality Rights with an Ethics-Based Practice Model
Introduction to Part II: “The Ethics of Conditional Confidentiality”
Chapter 4. Step 1 – Preparing
Chapter 5. Step 2 – Telling Prospective Patients the Truth about Confidentiality’s Limits
Chapter 6. Step 3 – Obtaining Truly Informed Consent before Disclosing Information Voluntarily
Chapter 7. Step 4 – Responding Ethically to Legal Demands for “Involuntary” Disclosure
Chapter 8. Step 5 – Avoiding Preventable Breaches of Confidentiality
Chapter 9. Step 6 – Talking about Confidentiality
Part III. Practical Considerations
Chapter 10. Clinical Record Keeping
Chapter 11. Confidentiality with Specific Patient Populations
Chapter 12. Confidentiality in Specific Roles and Settings
Chapter 13. Ethics-Based Staff Training about Confidentiality
I. Selected Ethical Standards Relevant to Confidentiality Listed Numerically
II – Ethical Standards (using categories from Knapp and VandeCreek (2006))
III – Laws Affecting Confidentiality – Summary and Examples
IV – HIPAA Regulations – Summary
V – Ethical Practice Model (with legal annotations)
VI – Ethical Responsibilities in Forensic Contexts: Which Hat Are You Wearing?
VII – Ethical and Professional Resources
VIII – Ethics-Based Staff Training About Confidentiality – Sample Outline