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Ethics... Exoploring Privacy and Confidentiality: Gray Areas
Ethics: Exploring Privacy & Confidentiality - Gray Areas!

Section 3

CEU Question 3 | Ethics CEU Test | Table of Contents
Counselor CEUs, Social Worker CEUs, Psychologist CEs, MFT CEUs, Nurse CEUs

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The correct answer is A, say "hello" to the client and continue walking. Did you come up with something different? Well, here is my thinking...This one involves a judgment call.

C, act as if you do not see the client, could be a correct answer if the therapist and client have previously discussed what to do if this situation should arise. However, this previous agreement was not indicated in the question.

A, say "hello" to the client and continue walking, is a better answer, because it could apply whether or not such previous discussion has been held.

B, say "hello" and ask how Mildred feels about this accidental meeting and

D, carefully observe the client's social functioning in this community setting, blur the boundaries of a professionally distant relationship, and both of these answers involve the possibility of revealing to others the nature of the therapist's and client's relationship. A does not do so because even total strangers might exchange a simple, friendly greeting in the mall if their paths crossed or if they make eye contact.

The Tarasoff Decision
Now from our preceding section, one's first inclination might be to argue that we should never override the privacy rights of our clients, but the following section will show, as you well know, that sometimes you must. In situations that involve criminal activity or the well-being of the client or others, a conflict of obligations occurs. Does the action override your client's right to confidentiality for the purpose of guarding well-being?

Ethics necessarily entails, then, two types of respect, a respect for the law and a respect for the other.

In 1974 the California Supreme Court established the principle that requires physicians and psychotherapists to warn intended victims of dangerous patients. This is known as the Tarasoff decision. It brought to widespread attention the legal principle known as the "duty to warn."

Key provisions of the duty to warn were elaborated in a 1976 court decision containing the following statement:

When a therapist determines, or pursuant to the standards of his profession should determine, that his patient presents a serious danger of violence to another, he incurs an obligation to use reasonable care to protect the intended victim against such danger. The discharge of this duty may require the therapist to take one or more of various steps, depending upon the nature of the case. Thus, it may call for him to warn the intended victim of the danger, to notify the police, or to take whatever other steps are reasonably necessary under the circumstances.

The Tarasoff decision is not a specific law. It is a legal principle based on an interpretation of laws and precedents. Therefore, the duty to warn is an evolving principle.

Note that the Tarasoff Decision ruled that the therapist should have warned the intended victim or the police. Subsequent decisions, however, have required notification of both the intended victim and the police. Also, note that the Tarasoff Decision involved a threat to commit murder. It is not clear how much violence, short of murder, requires a duty to warn.

♦ Six Principles in Carrying out Duty to Warn:
1. Carefully assess the severity of the threat and the likelihood of its being carried out.
2. Consider using any available means for reducing the violence threat, whether or not a duty to warn is involved.
3. If a client explicitly threatens to murder an identifiable victim, there is a clear duty to warn the victim and the police. If the client implies a threat of violence other than murder, the therapist should weigh the violence versus (a) the risk of violating confidentiality and (b) the risk of unduly frightening the warned individual.
4. Release no more information than is needed for the intended victim's protection.
5. Document your risk assessment and actions taken. Document judgment about the balance between risks and benefits involved.
6. Obtain the client's cooperation or consent in warning the third party if at all possible.

- Rothstein, M. A. (2014). Tarasoff Duties after Newtown. Journal of Law, Medicine & Ethics, 42(1), 104-109.

Peer-Reviewed Journal Article References:
Erickson Cornish, J. A., Smith, R. D., Holmberg, J. R., Dunn, T. M., & Siderius, L. L. (2019). Psychotherapists in danger: The ethics of responding to client threats, stalking, and harassment. Psychotherapy, 56(4), 441–448.

Franeta, D. (2019). Taking ethics seriously: Toward comprehensive education in ethics and human rights for psychologists. European Psychologist, 24(2), 125–135.

Goldstein, N. E. S., Gale-Bentz, E., McPhee, J., NeMoyer, A., Walker, S., Bishop, S., Soler, M., Szanyi, J., & Schwartz, R. G. (2019). Applying the National Council of Juvenile and Family Court Judges’ resolution to juvenile probation reform. Translational Issues in Psychological Science, 5(2), 170–181.

Huey, S. R. (2015). Tarasoff’s catch-22. American Psychologist, 70(3), 284–285.

Perloe, A., & Pollard, J. W. (2016). University counseling centers’ role in campus threat assessment and management. Journal of Threat Assessment and Management, 3(1), 1–20.

Tipples, J. (2018). Caution follows fear: Evidence from hierarchical drift diffusion modelling. Emotion, 18(2), 237–247.

Online Continuing Education QUESTION 3
You may reveal confidential information in order to prevent a significant threatened danger, but only if...
a. the client consents
b. care is taken to determine the information's validity
c. the client was instructed earlier about the limits to confidentiality
d. the client has a serious and persistent mental illness
To select and enter your answer go to Ethics CEU Test.

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