Curious about confidentiality

[scienceisbeauty]

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So if someone in therapy, says to a Psychologist, Psychiatrist ..."I did something bad/I'm thinking of doing something bad" "But I can't tell you want it is because if I tell you, you'd have to break confidentiality".

What does the therapist do? I mean, that client, they're pretty much admitting to suicide plans/plans to kill someone/child abuse/ or something right? Or ...wrong?

Let's assume that the client was well-versed in confidentiality and when it had to be broken...so you can assume that it is indeed something like that. Is there any procedure for that?

Very curious!

 

[erg923]

Well, this statement doesn't necessarily mean SI, HI, or child abuse, in and of itself. I would be very curious about the motivation behind this statement as well. If they told you that much, there could be an attention seeking ulterior motive, OR its likely a cry for help of some type. If its the latter, I would expect a more concrete explanation would come out during the hour of the therapeutic hour. Second, just because someone has SI doesn't mean you automatically break confidentiality. This is the last resort. Assuming you have a good working rapport with a patient, I would encourage the client to tell me more about this statement, and again remind them that confidentiality is only broken in the cases where there is NOT another option for safety. I would then review our options with the client if this were indeed a self harm issue. If they refuse to address the question directly, I would be able to get a feel for the mental/emotional state during the course of the session, and I would use alot of indirect queries/questions, etc to get at this issue. If you remain suspect of SI due to additional statements during the session and their observed behavior, consult with a supervisor and Document, Document. The laws (in California) for reporting of child and elder abuse specifically require a reasonable suspicion.

 

[myelin]

I agree with Erg.

That kind of statement, to me, has attention seeking written all over it. "I don't want to come out and tell you what I'm going to do, I want you to want to know what I'm going to do." Careful not to fall into a Tarasoff situation though. If I have a feeling that the client is going to harm themself or others, I'd be forced to break confidentiality. Before it reaches that point, I'd push for voluntary hospitalization. As well, contract for safety.

 

[deleted176373]

So if someone in therapy, says to a Psychologist, Psychiatrist ..."I did something bad/I'm thinking of doing something bad" "But I can't tell you want it is because if I tell you, you'd have to break confidentiality".

What does the therapist do? I mean, that client, they're pretty much admitting to suicide plans/plans to kill someone/child abuse/ or something right? Or ...wrong?

Let's assume that the client was well-versed in confidentiality and when it had to be broken...so you can assume that it is indeed something like that. Is there any procedure for that?

Very curious!

They didn't admit to anything and even more salient is your assessment of the actual risk. Some will say things they don't really mean, for instance if someone is delusional from either a substance or a mental illness, will you break confidentiality if time or medication will resolve the issue? Probably not. While confidentiality is a thorny issue for all psychologists, you should look at what military psychologists are up against.

For us military psychologists, it's far more convoluted. APA is stating one thing and the US Government contradicting it. Do we violate APA and risk loss of licensure, or do we violate the US Government and risk loss of our jobs and potentially our freedom because of our desire to adhere to our professional ethics code?

This is one area that may sometimes call for peer consultation and a tough call by the individual therapist. It's important to set clear guidelines with your patients so that you can defend your position regarding confidentiality.

Mark

 

[PinkSoil]

Well, you certainly can't rely on the statement alone, particularly when it is that ambiguous.

Like Markp said, the assessment is signifcant. When you assess for SI or HI, certain answers make the risk level increase or decrease. Of course, we can never be 100 percent sure what our clients are going to do, or not going to do.

However, if someone says, "I have suicidal ideation, a plan of how I would do it, but no intent..." then that is high risk situation, but not as risky as someone who actually admits intent. If someone implies that they are going to "do something bad," you really need to assess the risk.

Like Erg said... lots of direct questions... starting with... what does "something bad" mean? It is important to remember that you can have 39 clients who all use the same term, and that same term can take on 30 different meanings. "Something bad" can mean suicide or homicide to one client... it can also mean having an affair, having sex before marriage, stealing something, etc.

 

[Mayhem]

Hey guys, sorry to resurrect this thread but it is the most relevant thing my search turned up. During a discussion in class today, we got in an argument about whether you can break confidentiality for past crimes. That is to say if a patient tells you that they killed someone 10 years ago, can you disclose this info.

I said no, because as far as I know breaking confidentiality is only allowed where there is imminent risk of harm to self or another. In this case the harm has already occurred and provided the patient doesn't express intent to repeat the act then I don't think you'd have grounds to disclose. Plus, I thought about all the prison psychiatrists I know. If we could disclose past crimes then nobody would ever talk to then for fear of self-incrimination.

Anyway, I was pretty confident in my answer until everyone else in the room (including the FP teaching us) took the opposite view. I decided not to push the issue at the time because frankly, I had no evidence to back up my position but I still think my answer makes more sense. So, can someone tell me who is right?

 

[Rapunzel]

Mayhem, I think you are generally right. It seems to be the intent of whether or not to break confidentiality to assess whether someone is at risk and needs to be protected in the present.

But then, it may depend on what the past crime is and what likelihood there is that someone may need to be protected. We are mandatory reporters in cases of child abuse, etc. If the crime is child abuse, most likely we have to report it. And I would speculate that it is because child abuse runs in cycles and the risk that there is still someone being victimized somewhere in the cycle or system is pretty high. I have heard of adult clients reporting in therapy that they were abused as children, and therapists including that under mandatory reporting.

Also, we can be subpoenaed and required to break confidentiality. It seems that the requirements of confidentiality are stronger between a lawyer and their client, where the lawyer needs to know what actually happened in order to defend the client, than between a therapist and client, where we can't treat very easily what we don't know about, but should it really be our job to assauge someone's conscience when they have legitimate guilt?

So, I would consult a lawyer to find out what your obligation truly is in the specific circumstance, because I think it is not a simple yes or no. And I would probably try to encourage the client to confess before breaking confidentiality. It will probably go better for them if they step up to take responsibility.

Oops, you specified a crime of murder. That's a big one, but not the same as child abuse. I still think it is not so cut and dry, and, without revealing any more details than necessary, I would consult a lawyer. But I think that if it is pretty clear that nobody is presently at risk, that probably falls under confidentiality.

 

[PsyDGrrrl]

Even if someone reports a past murder, you cannot break confidentiality. The ONLY times that you are legally protected in breaking confidentiality are if the patient is imminent danger of harming themselves or someone else, or if they report child abuse (even if they are not the one being abused or doing the abusing). I have been in this situation (a client telling me about a crime they had committed) and while it is morally trying, it is UNETHICAL to make any reports of any past crimes.

 

[PsyDr]

SIB: there really is no confidentiality issue in your example. Nothing has been said to break confidence. You should probably inquire, as a good practice.




Markp,

there is something in the ethics code that states if you inform your boss that your ethics code prevent you from doing something and they state you will be fired if you do not do so, then you are allowed to break the ethics code. I forget where that is, but it might be something you would want to do in writing to CYA.

 

[Mayhem]

Even if someone reports a past murder, you cannot break confidentiality. The ONLY times that you are legally protected in breaking confidentiality are if the patient is imminent danger of harming themselves or someone else, or if they report child abuse (even if they are not the one being abused or doing the abusing). I have been in this situation (a client telling me about a crime they had committed) and while it is morally trying, it is UNETHICAL to make any reports of any past crimes.

Thank you.

Learned something about child abuse too.

 

[cara susanna]

I hope you guys don't mind, but I have another mandated reporting question. It might be obvious, but I wanted to make sure.

If a therapist sees a patient who is a sexual abuse victim but the abuse is no longer going on and the patient does not wish to report it to the authorities, is the therapist still required to report it?

Thanks!

 

[BorntoRun]

I hope you guys don't mind, but I have another mandated reporting question. It might be obvious, but I wanted to make sure.

If a therapist sees a patient who is a sexual abuse victim but the abuse is no longer going on and the patient does not wish to report it to the authorities, is the therapist still required to report it?

Thanks!

Is the patient under 18? If not, I'm pretty sure it's a definite no. If the person is a minor, I think you may have to, depending on the specifics.

 

[KillerDiller]

Is the patient under 18? If not, I'm pretty sure it's a definite no. If the person is a minor, I think you may have to, depending on the specifics.

I know that in my state, at least, a psychologist would not have to report this as long as the minor was currently in a safe environment.

 

[drjean]

This link might help some of you with this.
http://www.smith-lawfirm.com/mandatory_reporting.htm

In Florida, if a MINOR child reports abuse, even "past" it needs to be reported. Remember, you are only reporting in good faith. THEY verify it or not.

You never know when a child is still being abused. Some will try to protect the person, or try to "hide" it while wanting you to know about it. Err on the side of safety?

Jean

 

[cara susanna]

Thanks! So I guess it varies by state?

 

[mlwg1]

there is something in the ethics code that states if you inform your boss that your ethics code prevent you from doing something and they state you will be fired if you do not do so, then you are allowed to break the ethics code. I forget where that is, but it might be something you would want to do in writing to CYA.

Maybe you're talking about clause 1.02 of the APA Ethical Principles of Psychologists and Code of Conduct:

"1.02 Conflicts Between Ethics and Law, Regulations, or Other Governing Legal Authority
If psychologists' ethical responsibilities conflict with law, regulations, or other governing legal authority, psychologists make known their commitment to the Ethics Code and take steps to resolve the conflict. If the conflict is unresolvable via such means, psychologists may adhere to the requirements of the law, regulations, or other governing legal authority."

http://www.apa.org/ethics/code2002.html