The ethical dilemma of disclosure

Discussion in 'Psychology [Psy.D. / Ph.D.]' started by RayneeDeigh, May 30, 2008.

  1. RayneeDeigh

    5+ Year Member

    Joined:
    Feb 4, 2007
    Messages:
    1,346
    Likes Received:
    1
    Status:
    Psychology Student
    I'm wondering how much you guys disclose about your clients to your friends/family. I'm sure this is addressed in every grad program in the world, but I've heard everything from "never say anything about anyone to anyone else" to "stories with details changed are fine". Where do you guys stand? Has it ever been difficult for you to choose what you will share with your loved ones and what you won't? Have they ever been offended by how little disclosure there is about what you do everyday?
     
  2. JockNerd

    5+ Year Member

    Joined:
    Mar 28, 2007
    Messages:
    1,810
    Likes Received:
    9
    Status:
    Psychology Student
    I never told any friends or family members about clients I saw when I worked crisis drop-in in undergrad, and I don't intend to talk about anyone I see as a grad student counselor. It seems to me that it would almost a futile topic to broach anyway, since it would most likely result in a barrage of "oh, why don't you do this that and the other unethical, ineffective, or ridiculous thing with them to fix them right up?"

    I guess the exception might be talking to a friend/family member about your own feelings about a client could be useful, if you have some "countertransference" or whatever people want to call it.

    Even discussions with other therapists should be looked at carefully, I think. I think it's both appropriate and necessary to discuss some aspects of clients with other therapists, including other beginning therapists for those of us in grad school. However, I've overheard more than one conversation between grad students that was really more "listen to THIS client's story" or "listen to the clever thing I did in session," which I think is super inappropriate.
     
  3. cmuhooligan

    10+ Year Member

    Joined:
    Jan 15, 2005
    Messages:
    312
    Likes Received:
    2
    Status:
    Psychologist
    I routinely discuss past clients while teaching, of course bearing in mind not to disclose identifying information, or intimate details about the clients. I find that it is a very effective way of teaching to both undergrad and grad students.
     
  4. Cosmo75

    Cosmo75 Post-Doctoral Fellow
    2+ Year Member

    Joined:
    Feb 25, 2008
    Messages:
    443
    Likes Received:
    0
    Status:
    Post Doc
    I too discuss past clients while teaching, while of course removing the identifying info.

    As for friends/family? That's tricky. I have mentioned very vaguely some information about a particularly interesting incident during a day or the like. I leave out everything possible in identifying info, beyond what I would for teaching. I don't even mention gender. So something like "my client and their partner..." for example. I don't discuss clients very often, it's usually if I've had a particularly long/trying day and just need to get some things off my chest. And the people I do talk to about it are either my husband or a couple of very close friends. Nobody has been offended if I don't discuss things, and I've never had anyone I know well ask me directly for information.
     
  5. michalita

    michalita New Member
    2+ Year Member

    Joined:
    Aug 25, 2006
    Messages:
    134
    Likes Received:
    0
    Status:
    Post Doc
    I talk about *my experiences* (so the details aren't important and are for the most part left out) with my husband, and then only sometimes. He's not very interested, which helps ;) His attention span is something like 5 minutes so I wouldn't be able to get in any detail even if I wanted to (which I don't)!

    I do share important interactions with the treatment team on a need-to-know basis because that is part of the expectation of my job. And of course it's all documented.
     
  6. RayneeDeigh

    5+ Year Member

    Joined:
    Feb 4, 2007
    Messages:
    1,346
    Likes Received:
    1
    Status:
    Psychology Student
    Awesome, thanks guys.

    So if for example I was to say to one of my immediate family members "a kid (my clients are currently juveniles) asked me today if I was Portuguese" because I thought it was cute given that I don't look Portuguese at all, would that be a breach of any ethics code?

    I ask because a secretary overheard me say something to that effect while I was on the phone and she confronted me about it two seconds later and said that my "homework" was not to mention clients ever again. I consulted with a colleague when I got home from work and she didn't seem to think I'd done anything wrong, but I wanted to get some more opinions before I see my supervisor on Tuesday.
     
  7. shock-me-sane

    shock-me-sane RN, PhD to come
    2+ Year Member

    Joined:
    Apr 14, 2006
    Messages:
    144
    Likes Received:
    0
    Status:
    Psychology Student
    I don't have an experience in the psych area but a ton in the hospital and HIPAA. I figure there is no or slight difference in the privacy aspect.

    Basically any identifying info is a no go. I have learned to speak in generalities about things. And your example is totally fine and honestly has nothing to do with your patient. I many times told the story of the woman in the hospital who called me a f-ing c*** because I couldn't give her the pain medication she wanted 4 hours early.
     
  8. cara susanna

    10+ Year Member

    Joined:
    Feb 10, 2008
    Messages:
    5,400
    Likes Received:
    1,570
    Status:
    Psychologist
    In my counseling class, I learned to basically say nothing. Even without giving identifying information, it's still breaking confidentiality.

    But I'm only an undergrad, mind you.
     
  9. paramour

    7+ Year Member

    Joined:
    Jan 16, 2007
    Messages:
    1,979
    Likes Received:
    7
    Sounds like your secretary is being a bit overzealous. I think that one must certainly be careful of revealing information about one's clients, even when one believes that he/she has adequately de-identified such information. There is always the possibility that either a) the person can still be identified because it is a small population, very few people would be in the described situation, etc. or b) another individual may assume that they know the person (whether they actually do or not) and spread the information further, which may cause problems in and of itself. Either way, unless your client goes around asking everyone if they're Portugese, then the probability that this client could be identified from your simple statement is likely quite low. I certainly would not have thought twice about it had I overheard it.
     
  10. paramour

    7+ Year Member

    Joined:
    Jan 16, 2007
    Messages:
    1,979
    Likes Received:
    7
    Not really--my partner doesn't really care to hear about the 'clients' I've reviewed in the past due to the population, so other than a general statement every now & again, he remains for the most part blissfully ignorant. I suspect that he would be more upset if I did fully disclose with him the details of certain cases than if I disclosed nothing to him. Furthermore, he wouldn't be able to complain anyway since he's used the "confidentiality" argument himself regarding his own work in the past and he's not in the mental health area.
     
  11. Cosmo75

    Cosmo75 Post-Doctoral Fellow
    2+ Year Member

    Joined:
    Feb 25, 2008
    Messages:
    443
    Likes Received:
    0
    Status:
    Post Doc
    I don't think there are any ethics code violations whatsoever to say a kid asked me today if I was Portuguese. We don't operate in a bubble.

    I realize the APA ethics code is different than that of MD's, but I listen to docs talk about pts allllllllllll day. I've had docs come in and tell me about a patient they just saw, so I could easily figure out who they were talking about if I wanted to. Grant it I'm part of the "treatment team" since we're integrated into the practice, but it's very informal and 9 times out of 10 I never end up seeing that person.

    The ethics code is conveniently vague and open to interpretation in many areas, which is why you're getting varied responses. Some think it should be followed exactly. For example: "4.04(b) Psychologists discuss confidential information obtained in their work only for appropriate scientific or professional purposes and only with persons clearly concerned with such matters." Is referring to your child client as "a kid" and then saying what he casually thought about your ethnicity confidential information? Some would say yes, since pretty much everything is considered confidential in session.

    But then you have this part to the code: "Psychologists do not disclose in their writings, lectures, or other public media, confidential, personally identifiable information concerning their clients/patients, students, research participants, organizational clients, or other recipients of their services that they obtained during the course of their work, unless (1) they take reasonable steps to disguise the person or organization, (2) the person or organization has consented in writing, or (3) there is legal authorization for doing so."

    So there's the loophole. It then comes down to personal ethics and preference. I think it's a good idea to not discuss things as a general rule, but I'd say it's practically impossible to not talk to others about your clients (especially colleagues).
     
  12. JockNerd

    5+ Year Member

    Joined:
    Mar 28, 2007
    Messages:
    1,810
    Likes Received:
    9
    Status:
    Psychology Student
    Oh. That's stupid. Obviously that's fine. Does the secretary think saying "I see clients at my practicum" is a breach too?:rolleyes:

    I always thought my profs just made up convenient illustrative client stories.
     
  13. MaddieMay

    2+ Year Member

    Joined:
    Feb 25, 2008
    Messages:
    599
    Likes Received:
    2
    Status:
    Psychology Student
    Warning: I may be totally projecting. :)

    I'm getting a possibly inaccurate vibe that the secretary may have thought that perhaps the level to which you were disclosing on the phone was just the tip of the iceberg to which you disclose to friends at home/the bar/at parties/on the rapid transit, whatever.

    She may have been thinking, "If this is what she discloses on the phone, blatantly in front of me, what might she be disclosing to people in the aforementioned situations?"

    In a perfect world, she was just trying to make sure you weren't disclosing unethical things to other people in private, when she heard you disclose a very borderline-private thing over the phone. Or, maybe she was just feeling superior and snarky.

    If she truly thought you were being inappropriate, the right thing to do would be to mention it to your supervisor. However, maybe at the risk of going over the top, she may have just thought she'd plant a seed without "ratting you out."

    Giving you "homework" was WAY over the snarky line, however. Way over. Dang. Having worked in admin support for dozens of different kinds of businesses, I have learned a lot about how lots of types of businesses work, but she was in no position to try to pull rank on you or tell you what to do.

    Giving her the benefit of the doubt, it's also possible that she is extra sensitive about disclosure issues because she or a loved one is in therapy herself/themselves.

    This is probably totally unrelated, but I'll share anyway. I've been doing a little receptionist work on the side this year at a very fancy Mercedes-Benz dealership on the weekends. Hardly anyone calls the dealership on a Saturday because service is closed on the weekends (how do you like that!) so I was able to read and do research while getting paid a little bit. However, it was impossible for me to not hear the things that the salespeople said about customers and their fellow salespeople.

    It is an interesting position to be in, because everyone assumes I do not have a high school education, and am therefore unable to understand anything. Booya. :)

    Goofball salesperson, "So what are you reading there, War and Peace??"

    Me "This is the DSM-IV-TR. I'm actually in graduate school for psychology. It's fascinating. <insert 'can you read my mind' comments here.> :)

    Me "Oh, reading minds are for psychics. But you must use a lot of psychology here at the dealership to sell cars."

    Goofball "Oh yeah, people want MB because of the status, not because of reliablility or a good repair record."

    Me "Wow, interesting. Does anyone come in wanting a certain, make, model and year of car that Consumer Reports says is the most reliable, and won't settle for a make, model or year that was considered by CR to not be reliable?"

    Goofball "Huh? No. People want these cars for status, not for quality. Besides, Consumer Reports is totally biased, so is Kelly Blue Book."

    Eek!! :) :scared:

    Sometimes people think the receptionist is blind, deaf and mute, when in fact I came to understand a lot about the business of selling cars. I never gave a word of advice, however, because I knew I knew nothing about selling potentially unreliable cars to people who want to look superfly. Yuck.

    As I said, this is probably unrelated, but perhaps interesting. There is element of psychology in every business. I can imagine that if a person had worked as a receptionist for the dealership full time and had some kind of agenda, I can imagine they might give some unsolicited advice. WRONG. Read your job description. Do your job to the best of your ability. Learn if you can, but don't assume you know what's going on from hearing one side of a telephone conversation.

    Hearing this and that, here and there can make some people think they know everything. Sounds like that was what was going on in your case.

    It might make sense to mention it to a superior, up to you and your judgment and if she ever does it again. Especially concerning the word "homework." Condescending.

    Anyway, I hope she had the best of intentions and won't be eavesdropping in the future. Yeah, right.

    Now you know which phone NOT to make calls from. :)
     
  14. haloeffect

    haloeffect Aonakeypad

    Joined:
    Jun 2, 2008
    Messages:
    4
    Likes Received:
    0
    Status:
    Other Health Professions Student
    Maybe all this confidentialty will one day be adopted by staff members towards staff members...no fun I guess! :D
     
  15. RayneeDeigh

    5+ Year Member

    Joined:
    Feb 4, 2007
    Messages:
    1,346
    Likes Received:
    1
    Status:
    Psychology Student
    Maddie, that's what I was thinking too... that maybe she's afraid I go home and go "oh my god guess what _____ said today!" which would definitely be a problem. In any case, she could have just asked me that instead of sitting me down, saying "I have some homework for you" and communicating the message in the most condescending way I've ever seen. I have a feeling it was because my supervisor was away for the week and she maybe felt responsible for me. Though I want to believe she was going straight to me instead of ratting me out, I think it was more of a rank thing (since she reminded me a few days ago that I'm the "bottom of the totem pole.") Maybe I'll talk to her when I'm back tomorrow and explain that I do know what the ethical guidelines are and I don't go home and broadcast the problems of my clients to my family. I'm also going to ask that any concerns she has about me go through my supervisor since I want everything out on the table. If I'm doing something wrong I'd rather know about it and I'd definitely rather hear it from a supervisor since that's his job.

    The funny thing is that I was sitting in the corner of a different room so she would have had to actually put in effort to eavesdrop

    I have definitely learned a valuable lesson at least. From now on I'll be using my cell phone to call home despite the fact that it's from a city 8 hours away - the charges are worth avoiding the hassle. I'm also going to be saying nothing about clients unless I'm in a soundproof room with my mom and I can be sure that the info would pass the secretary test.
     
  16. RayneeDeigh

    5+ Year Member

    Joined:
    Feb 4, 2007
    Messages:
    1,346
    Likes Received:
    1
    Status:
    Psychology Student
    Haha what a concept! I think it would be funny to adopt confidentiality for everyone I meet. "whoops sorry I can't tell you who I had dinner with last night, that would be against my code of ethics!"
     

Share This Page