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Clinical Supervision: Models, Role, Legal & Ethical, & Transference
Exceptions to Confidentiality
Do you feel, like I, that it is important that you emphasize the following ambiguity with your supervisee? 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 supervisee’s client's right to confidentiality for the purpose of guarding well-being? Ethics entails two types of respect; a respect for the law and a respect for the client.
Tarasoff "Duty to Warn"
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.
I think it is important that the supervisee is aware that 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 warn 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:
Outline of Discussion for Reviewing the Preceding Content
You may reveal confidential information in order to prevent a significant threatened danger, but only if...
The correct answer, of course, is B, care is taken to determine the information's validity. The duty to warn, as I just mentioned, known as the Tarasoff Decision, overrides client's right to give consent.
Answer C, the client was instructed earlier about the limits of confidentiality, is false because the duty to warn applies even if the client was not previously instructed about it. C describes what would be a good practice, but it's not required.
What are your thoughts about providing supervisees with structured exercises to teach thought preocess-type materials.
Regarding HIV/Aids and Duty to warn, the following is a reprint of an excerpt from The New Social Worker journal.
Duty to Warn and Protect in HIV/AIDS Cases
Melchert and Patterson (1999) discuss how being HIV-positive may pose a different situation from that of the Tarasoff case. Mental health professionals do not have the legal right to disclose that a person is HIV-positive to another person. This is at the discretion of physicians in many states. However, social workers and mental health professionals must struggle with this legal situation if a client insists on potentially harming another person through risk of transmission of HIV.
Granich, Steven, LCSW, MPA, DSW. Duty to Warn, Duty to Protect, The New Social Worker, Winter 2012.
Ethical Issues of Child Abuse and Confidentiality
You are about to finish a session with Nancy and her daughter Olivia. You feel Nancy has pent up hostility towards her daughter. You also notice that as Olivia reaches for her school books to leave, her sleeve pulls up to reveal a cut and large bruise on her arm. It seems to me that there are 4 possible ways to deal with this situation.
Here is an example of how I would present the thought process to my supervisee. The best option would be to ask the child in private how the cut and bruise happened. Do you agree? If confronted, Nancy, as a mother, may feel pressured to lie about the injury if, in fact, abuse is involved. I feel the best situation is to ask the Olivia when Nancy is not present. If that is not a choice, my thinking is that it would be better to either extend the session and discuss it immediately, or consider making it an agenda item at the next meeting. What is your opinion on how to handle this situation? Also, what is your opinion about presenting this to a supervisee?
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