The cornerstone of the therapeutic relationship
A fundamental aspect of the ethical practice of psychology involves clearly defining the rights and responsibilities of both the client and the psychologist as they engage in the collaborative task of therapy. These guidelines permeate all phases of the treatment relationship and represent issues paramount for protecting all parties and serving the best interest of the client. The topic encompasses both moral and legal issues, including informed consent, record keeping, involuntary hospitalization, malpractice, confidentiality, and the duty to warn and protect.
Confidentiality refers to the “ethical responsibility and legal and professional duty to safeguard clients from unauthorized disclosures of information given in the therapeutic relationship” (Corey, Corey & Callahan, 2002, p. 196). Privileged communication, a related issue, refers to “a legal concept that protects against forced disclosure in legal proceedings that would break a promise of privacy. Privilege is the client’s right to prevent a mental health professional from revealing confidential communications in a legal proceeding” (p. 198). Because of the sensitive and private nature of issues discussed in therapy, confidentiality has always been considered one of the cornerstones of the therapeutic relationship and essential to successful treatment.
According to Bersoff (2008) most mental health professionals agree that “Except for the ultimate percept – above all, do no harm – there is probably no ethical value in psychology that is more inculcated than confidentiality. Whether psychologists are engaging in research; assessing children, families, employees, criminal defendants, or others; or providing any of the several forms of psychological intervention – regardless of whether they are employed in private or public settings – they bear the responsibility for protecting information disclosed to them in the context of a professional relationship” (p. 155). That said, he goes on to insist that, “to the same degree that this litany of protections evidences the heightened importance of confidentiality and privacy in society, like the ozone layer of the atmosphere, there has been a gradual but constant erosion of these fundamental values” (p. 155).
Mental health professionals face a conflict between their obligation of confidentiality toward their patients and their duty to protect others from potentially dangerous patients. On the one hand, it is the assurance of confidentiality that has allowed many patients to seek help who otherwise may have been reluctant to do so. However, there is a widespread and generally accepted acknowledgement that confidentiality is not absolute.
Limitations on confidentiality, in law and social policy, derive from circumstances in which a particular social interest is determined to outweigh the value of maintaining absolute confidentiality. As a consequence, limited disclosures of client communications or breaches of confidentiality may be permitted and in some cases are required. However, in such cases, only relevant information should be disclosed and only to appropriate individuals or organizational entities (Tribbensee and Claibborn, 2003). Examples of well-recognized exceptions to confidentiality are those related to child abuse, suicide, infectious diseases, and the various mental health acts. On the other hand, there are professional bodies that argue for absolute confidentiality and have requested that psychiatrist–patient communications be given unqualified privilege (Chaimowitz, 2000).
Ethical issues involving aspects of the rights and responsibilities inherent in each role of the therapeutic relationship can be complex and controversial. While the basic mandate of acting in the best interests of the client seems straightforward, in practice, it can require challenging professional assessments and judgment calls, and is thus subject to debate and conflicting interpretation. The issues are further complicated by the various legal standards and requirements related to patient issues. Practitioners must be firmly grounded in their professional standards and clearly demonstrate their continued commitment to serving the psychological well being of their clients, even when, or more precisely, especially when, difficult ethical dilemmas arise.
Berrsoff, D. N. (2008). Ethical conflicts in psychology, 4e. Washington, DC: American Psychological Association.
Chaimowitz, G. A. (2000). The duty to warn and protect: Impact on practice. http://www.psychdirect.com/forensic/PsychLaw/warn/duty_impact.htm
Corey, G., Corey, M. and Callahan, P. (2002). Issues and ethics in the helping professions (6th ed.). Pacific Grove, CA: Brooks/Cole Publishing Company.
Tribbensee, N. E. & Claiborn, C. D. (2003). Confidentiality in psychotherapy and related contexts. In W. O’Donohue & K. Ferguson (Eds.). Handbook of professional ethics for psychologists: Issues, questions and controversies. Thousand Oaks, CA: Sage Publications