Continuing Education & Resources for Mental Health Professionals

Confidentiality Practice Model

Protecting Confidentiality Rights: An Ethical Practice Model

Mary Alice Fisher, Ph.D. (2008)

This HTML version may not exactly replicate the final version of this Model as published in the APA journal American Psychologist, Vol. 63, No. 1, pp. 1-13 in the article entitled, “Protecting Confidentiality Rights: The Need for an Ethical Practice Model.”
It is not the copy of record.

Step 1. PREPARE

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

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

C. Clarify Your Personal Ethical Position About Confidentiality and its Legal Limits

D. Decide When/How You Will Limit Confidentiality Voluntarily

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

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

I. Conduct Confidentiality Training for Employees, Supervisees, Interns, Etc.

Step 2. TELL CLIENTS THE TRUTH “UP FRONT” (Inform Their Consent)

A. Inform Prospective Clients About the Limits You Intend to Impose on Confidentiality

B. Explain Any Roles or Potential Conflicts of Interest That Might Affect Confidentiality

C. Obtain Informed Client’s Consent to Accept Limits as a Condition of Receiving Services

D. Reopen the Conversation If/When Patient’s Circumstances (Or Your Intentions) Change

Step 3. OBTAIN INFORMED CONSENT TO DISCLOSE VOLUNTARILY

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

B. Inform Client Adequately About Content and Implications of Potential Disclosures

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

Step 4. RESPOND ETHICALLY TO LEGALLY-IMPOSED DISCLOSURES

A. Notify Client Of Pending Legal Requirement for a Disclosure Without Client’s 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 redisclose information that psychologists disclose

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

Step 5. AVOID THE “AVOIDABLE” BREACHES OF CONFIDENTIALITY

A. Avoid Making Unethical Exceptions to the Confidentiality Rule

B. Establish and Maintain Protective Policies and Procedures; Train Non-Clinical Staff

C. Monitor Note Taking and Record Keeping Practices

D. Avoid Dual Roles that Create Conflicts of Interest in Courtroom and Elsewhere

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

F. Protect Client Identity in Presentations, Research, Consultations

G. Prepare a Professional Will to Protect Client Confidentiality In Event of Illness or Death

Step 6. TALK ABOUT CONFIDENTIALITY

A. Model Ethical Practices; Confront Others’ Unethical Practices

B. Provide Peer Consultation About Confidentiality Ethics

C. Teach Ethical Practices to Students, Supervisees, Employees, Agency

D. Educate Attorneys, Judges, Consumers and the Public

From: Fisher, M.A. (2008) Protecting Confidentiality Rights: The Need for An Ethical Practice Model. American Psychologist, 63 (1), 1-13.

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