Confidentiality

Practitioner Ethics and Clinical Considerations

Confidentiality is a cornerstone of ethical practice. Basic ethical principles regarding respect for the worth, dignity, and right of self-determination of individuals in treatment inform and guide the process of establishing and maintaining a confidential treatment relationship. Professional trade groups specify confidentiality requirements in the ethics codes that articulate professional standards of care and practice (e.g., American Psychological Association; American Psychiatric Association; NAADC, the Association for Addiction Professionals; National Association of Social Workers). Practitioners use these standards to guide the resolution of confidentiality questions and dilemmas.

Clinically, confidentiality is a foundation for the development of an atmosphere of trust and safety in treatment. During the course of treatment, patients disclose personal, emotionally painful information and may report behavior that is socially stigmatized and illegal. A careful informed consent process at the outset of treatment explains confidentiality to new patients. Counselors define, discuss, and ensure that patients understand confidentiality and the limits of [Page 226]confidentiality. A discussion about confidentiality also initiates the development of a treatment relationship. In situations that require reporting treatment progress as a condition of treatment (e.g., patients referred by the criminal justice system), a clear understanding at the outset of treatment about information that will and will not be released can help promote clear expectations and trust.

During the course of treatment, counselors may receive information that they are required to report, such as information regarding suspected child abuse. Treatment programs usually have established procedures for mandatory reporting. Mandatory reporting is a difficult situation in which the patient's treatment needs, the safety of others, and compliance with law must all be balanced. Clinically, it is important to discuss with patients what, how, to whom, and why it is necessary to disclose this information. It is also appropriate to engage patients in the process to the extent possible. This engagement may include seeking the patient's consent to release the information in addition to explaining that treatment professionals are required to report it regardless. In other cases, it is helpful to all parties involved to encourage patients to voluntarily participate in the reporting process. Skillful clinicians use these situations to strengthen a sense of clinical trust.

...