Читать книгу Introduction to Abnormal Child and Adolescent Psychology - Robert Weis - Страница 64

Confidentiality refers to the expectation that information that clients provide during the course of treatment will not be disclosed to others. The expectation of confidentiality serves at least two purposes. First, it increases the likelihood that people in need of mental health services will seek treatment. Second, it allows clients to disclose information more freely and facilitates the therapeutic process (Koocher & Campbell, 2018).

In most cases, confidentiality is an ethical and legal right of clients. Therapists who violate a client’s right to confidentiality may be sanctioned by professional organizations and held legally liable. Many psychologists consider protecting clients’ confidentiality the most important ethical standard (Sikorski & Kuo, 2015).

Although clients have the right to expect confidentiality when discussing information with their therapists, clients should be aware that the information they disclose is not entirely private. There are certain limits of confidentiality that therapists must make known to clients, preferably during the first therapy session (DeMers & Siegel, 2018).

First, if the client is an imminent danger to self or others, the therapist is required to break confidentiality to protect the welfare of the client or someone he or she threatens. For example, if an adolescent tells his therapist that he plans on killing himself after he leaves the therapy session, the therapist has a duty to warn the adolescent’s parents or guardians to protect the adolescent from self-harm. The psychologist’s duty to protect the health of the adolescent supersedes the adolescent’s right to confidentiality.

Second, if the therapist suspects child abuse or neglect, the therapist is required to break confidentiality to protect the child. For example, if during the course of therapy a 12-year-old girl admits to being maltreated by her stepfather, the psychologist would have a duty to inform the girl’s mother and the authorities to protect the child from further victimization.

Third, in exceptional circumstances, a judge can issue a court order requiring the therapist to disclose information provided in therapy. For example, a judge might order a psychologist to provide information about an adolescent client who has been arrested for serious criminal activity.

Fourth, therapists can disclose limited information about clients in order to obtain payment for services. For example, therapists often need to provide information about clients to insurance companies. This information typically includes the client’s name, demographic information, diagnosis, and a plan for treatment. Usually, insurance companies are the only parties who have access to this information.

Fifth, therapists can disclose limited information about clients to colleagues to obtain consultation or supervision. It is usually acceptable for psychologists to describe clients’ problems in general terms in order to gain advice or recommendations from other professionals. However, therapists only provide information to colleagues that is absolutely necessary for them to receive help, and they avoid using names and other identifying information.

Therapists also have a duty to protect children and adolescents from harm when they know youths are engaging in potentially dangerous behaviors. Frequently, ethical dilemmas arise when the therapist’s duty to protect children comes into conflict with the therapist’s responsibility to protect confidentiality. Consider Renae, a girl who is testing the limits of confidentiality.

When therapists face decisions about confidentiality, they must weigh two factors: (1) the frequency, intensity, and duration of the potentially harmful or maladaptive behavior and (2) the importance of maintaining the therapeutic process (Sullivan, Ramirez, Rae, Razo, & George, 2010). In general, therapists are more likely to break confidentiality as the risk of harm increases. For example, if Renae’s decision to have sex was made freely and if she was at low risk for pregnancy or illness, most therapists would respect her confidentiality. However, if we learned that Renae’s “boyfriend” was a 25-year-old man that she met online, we would need to take steps to protect her from harm. In any case, therapists place considerable importance on maintaining the therapeutic relationship. Would Renae ever trust her therapist (or any other therapist) if the therapist disclosed this information to Renae’s parents? What might the implications of disclosure be on Renae’s long-term mental health?