What is confidentiality? Why is confidentiality an important aspect of the therapeutic relationship? How is confidentiality related to the APA Ethics Code?
Let's take a closer look. I also included two excerpts to expand on this response.
1. What is confidentiality?
Confidentiality is about imposing "a boundary on the amount of personal information and data that can be disclosed without consent. Confidentiality arises where a person disclosing personal information reasonably expects his or her privacy to be protected, such as in a relationship of trust... However confidentiality can be countered, when there is a public interest in others being protected from harm." (http://www.ucel.ac.uk/rlos/confidentiality/index.htm) In other words, there are exceptions to confidentiality i.e. where the client makes threats to harm others, where the therapist think they need to share information with other professionals, or if the legal system asks to see the reports concerning legal issues. It is also the therapist's "ethical duty to protect clients who may be a harm to themselves due to mental illness". (See excerpt below that described these exceptions more fully)
The most well-known limit to confidentiality-but one that still needs to be explained to clients-is that the therapist may decide to break confidentiality in cases where the client makes threats to harm others. In 1974, the California Supreme Court ruled in the Tarasoff case that a psychotherapist has a duty to warn third parties who have been threatened by a client being seen in therapy (Felthous, 1989). In 1976, the court issued a different holding that resulted in a broader, more robust announcement. The court held that the therapist's duty was to protect the intended victim, rather than to warn (Bednar et al., 1991). Although the Tarasoff doctrine only applies in the state of California, many states have adopted similar laws, and therapists must have knowledge of their current state laws (Knapp & VandeCreek, 1993).
Similarly, although there may be no legal duty to do so in a particular state, therapists have an ethical duty to protect clients who may be a harm to themselves due to mental illness. In terms of preventing harm, Furrow (1980) discussed the duty to prevent suicide in a hospital, the duty to control dangerous conduct, and the duty to protect. A therapist must exercise reasonable care to prevent foreseeable harm or danger that may result from a client's mental or physical incapacity (Furrow, 1980). The courts have upheld that an additional duty to protect a client is established when the client is a danger to themself (Bongar, 1991). The duty to protect has been upheld by the courts many times for clients who were hospitalized (Bongar, Maris, Berman, & Litman, 1992). It has been more difficult to hold a therapist responsible for the actions of an outpatient client (Furrow, 1980).
In addition, there are instances when the therapist may need to share client information with others. In these instances, Remley and Herlihy (2001) suggested that the "umbrella" of confidentiality be extended to cover other people. Potentially, clerical staff and other employees may handle confidential client information. In ...
This soltuion discusses aspects of confidentiality as it relates to the therapeutic relationship and the APA Ethics Code. References are provided.