Clarifying confidentiality with the ethical practice model.

Replies to comments (see record 2008-14338-012) on the author's original article Protecting confidentiality rights: The need for an ethical practice model (see record 2007-19520-001). The important issues raised by Pipes, Blevens, and Kluck illustrate the complications that can arise in discussing confidentiality and making decisions about it: First, they noted that the term client consent is used by psychologists to mean two quite different things about confidentiality: (a) acknowledgement of its limits and (b) consent to disclose specific information. Second, Pipes et al made several comments about laws, one of which referred to Behnke's (2004) "doors" model. Third, Pipes et al elicited my personal thoughts about the current APA Ethics Code (APA, 2002). Finally, Pipes et al expect the ethical practice model to be used in psychology training programs. The current author hopes it will provide the next generation of psychologists with a clear ethical framework for considering confidentiality issues. Meanwhile, as in this exchange, it can facilitate conversation among colleagues not only about ethical and legal questions but also about cultural issues, personal values, and professional standards that affect our approach to confidentiality. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Confidentiality, ethics, and informed consent.

Comments on the article Protecting confidentiality rights: The need for an ethical practice model by Mary Alice Fisher (see record 2007-19520-001). In Fisher's excellent and much-needed article, she rightly implied that when discussing ethical dilemmas, psychologists may find themselves saying "consult an attorney" almost as often as they find themselves saying, "consult a fellow psychologist." Fisher's article was meant to turn the ship so to speak, by providing psychologists with a foundation for thinking clearly about confidentiality issues--a foundation that does not use legal arguments as primary building blocks. The above being said, we offer comments about four issues that we hope will add to the fine ideas expressed by Fisher. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Protecting confidentiality rights: The need for an ethical practice model.

All psychologists must uphold the same ethical standards about confidentiality even though each state imposes different legal limits on their ability to protect clients' confidences. The resulting ethical-legal confusion is exacerbated by legally based confidentiality training that treats legal exceptions as if they were the rule and fosters the impression that attorneys are now the only real experts about this aspect of practice. This article provides an ethics-based confidentiality practice model that clarifies the ethical rule and puts its legal exceptions into ethical perspective. Like the Confidentiality section of the American Psychological Association's (2002) Ethical Principles of Psychologists and Code of Conduct, this outline would apply to all psychologists regardless of state laws, but the details of its implementation would vary according to role and setting. It can be used as a universal training outline, a consultation and supervision tool, a guide to professional practice, and a basis for clearer ongoing conversation about the ethics of "conditional confidentiality." Psychologists can use this practice model to regain their status as experts about the confidentiality ethics of their own profession. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ethical Issues in Couple and Family Research.

Federal regulations, ethical standards, and state laws governing ethics do not adequately address important issues in couple and family research. Including multiple family members, particularly dependent minors, in research requires the special application of fundamental ethical issues, such as confidentiality, privacy, and informed consent. The sensitive, commingled nature of couple and family information necessitates clear policies about data ownership and disclosure. Researchers need to have respect for the family as a unit and to evaluate benefits versus harms for the family as well as for individuals. This article highlights areas of potential concern and ambiguity related to abuse reporting and Certificates of Confidentiality and also addresses ethical issues with observational data, intervention studies, longitudinal designs, and computer-assisted research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

In the public eye: The ethical practice of media psychology.

Psychologists are frequently asked to work with the media in responding to current events or educating the public about psychological issues. This can run the gamut, from an occasional interview with a reporter to a weekly gig as a radio call-in host. Many psychologists have little or no training in media psychology, but it is critical to obtain such training before entering the quicksand that working with the media can easily become. There are many ethical dilemmas inherent in media work, and this article enumerates many, including competence and confidentiality. Psychologists must educate themselves about the topic being discussed, often with a “heads-up” from the reporter in advance. Reporters will often ask for clients to be provided as examples to add depth to the story. The confidentiality and welfare of the client must be considered. It is important to think clearly about many ethical issues to make working with the media a positive professional experience and an important public service. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Balancing confidentiality: Protecting privacy and protecting the public.

Confidentiality is a primary obligation for psychologists. Yet confidentiality has been subjected to legal and professional balancing tests, in which the need for a confidential relationship is balanced and then gives way to other societal or professional needs. The protection of children, prevention of violence, professional training, and treatment coordination have been given priority over maintaining confidentiality. In the process, psychologists seem increasingly inclined to disclose confidential information or seek opportunities to disclose confidential information even when there are other clinical or legal options. This article takes the position that any disclosure of confidential information should be a last resort and that psychologists must push back and limit the growing list of mandatory and permissible disclosures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ethical and legal aspects of survey research.

Sample surveys have been received as legal evidence since 1940. Judges have given weight to sample survey research in reaching decisions. Among the problems involved is the legal pressure to disclose names of respondents—a violation of the principle of confidentiality and anonymity under which much survey research is conducted. "It is the purpose of the present paper to call to the attention of relevant professional associations the need for guidance on this ethical and legal issue." Under what conditions should names of respondents be disclosed? Major sections are: The scientist in court, The dilemma, Estimating reliability, A case study. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ethical dilemmas in sport psychology: A dialogue on the unique aspects impacting practice.

[Correction Notice: An erratum for this article was reported in Vol 41(3) of Professional Psychology: Research and Practice (see record 2010-11935-001). Due to a production error, the name of Amy B. Stapleton was substituted for the name of Jeffrey E. Barnett as the editor of the Focus on Ethics section in the April issue of Professional Psychology: Research and Practice, 41, 2, 143–152.] The multidisciplinary field of applied sport psychology, a specialty area of psychology practice, has been acknowledged as a proficiency area by the American Psychological Association (APA, 2007). This unique discipline often requires the psychologist to work outside the realm of traditional practice. In doing so, sport psychologists frequently encounter unique ethical dilemmas. In an effort to promote awareness and dialogue, this article describes some of the more commonly faced ethical considerations in applied sport psychology. Issues related to developing and maintaining competence in the field, confidentiality, and boundary issues are discussed, and case examples are provided to illustrate the relevant ethical consideration. Subsequently, three applied sport psychology experts respond to the lead article’s discussion and offer poignant reflections on ethical issues presented. In addition, suggestions for successfully resolving ethical dilemmas related to competence, confidentiality, and boundary issues in sport psychology are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Focus on ethics April 2010 correction.

Reports an error in "Ethical dilemmas in sport psychology: A dialogue on the unique aspects impacting practice" by Amy B. Stapleton, Douglas M. Hankes, Kate F. Hays and William D. Parham (Professional Psychology: Research and Practice, 2010[Apr], Vol 41[2], 143-152). Due to a production error, the name of Amy B. Stapleton was substituted for the name of Jeffrey E. Barnett as the editor. (The following abstract of the original article appeared in record 2010-06890-009.) The multidisciplinary field of applied sport psychology, a specialty area of psychology practice, has been acknowledged as a proficiency area by the American Psychological Association (APA, 2007). This unique discipline often requires the psychologist to work outside the realm of traditional practice. In doing so, sport psychologists frequently encounter unique ethical dilemmas. In an effort to promote awareness and dialogue, this article describes some of the more commonly faced ethical considerations in applied sport psychology. Issues related to developing and maintaining competence in the field, confidentiality, and boundary issues are discussed, and case examples are provided to illustrate the relevant ethical consideration. Subsequently, three applied sport psychology experts respond to the lead article’s discussion and offer poignant reflections on ethical issues presented. In addition, suggestions for successfully resolving ethical dilemmas related to competence, confidentiality, and boundary issues in sport psychology are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The application of the Canadian Code of Ethics for Psychologists to teaching: Mandatory self-disclosure and alternatives in psychology courses.

In recent decades, we have made significant progress in the area of the ethical conduct of research. However, it appears that parallel progress with respect to our ethical responsibilities in the teaching arena has not kept pace with that made in the research area. The focus of this article is on the use of self-disclosure as a mandatory component of psychology courses. Issues such as competence, perceived coercion, confidentiality, conflict of interest, and others are addressed. Our Canadian Code of Ethics for Psychologists is examined with a view to arriving at decisions on these issues that will be beneficial to most students and not endanger some other students. Viable alternatives to mandatory self-disclosure are presented. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

"Clinicians, microcomputers, and confidentiality": Correction to Bongar.

Reports an error in "Clinicians, microcomputers, and confidentiality" by Bruce Bongar (Professional Psychology: Research and Practice, 1988[Jun], Vol 19[3], 286-289). In this article, the address given on p. 286 for correspondence to the author is incorrect. The paragraph should read as follows: Correspondence concerning this article should be addressed to Brace Bongar, Department of Psychology, College of the Holy Cross, Worcester, Massachusetts 01610. (The following abstract of the original article appeared in record 1988-33962-001.) Despite the microcomputer's ever-increasing popularity, one of its greatest strengths, the ability to store enormous quantities of text and data on small, concentrated types of magnetic media, could turn out to be an important structural weakness in the wall of client confidentiality that psychologists have so carefully constructed over the years. In this article I examine the possibilities for such breaches of confidentiality when psychologists use microcomputers in their practice or research. Examples illustrate the ease and rapidity with which the microcomputer's magnetic media can be duplicated, damaged, or destroyed. Recommendations are made for guidelines and techniques to ensure and maintain the confidentiality of clinical and research information when one is using a microcomputer. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinicians, microcomputers, and confidentiality.

[Correction Notice: An erratum for this article was reported in Vol 19(4) of Professional Psychology: Research and Practice (see record 2008-10700-001). In this article, the address given on p. 286 for correspondence to the author is incorrect. The erratum includes the correct address.] Despite the microcomputer's ever-increasing popularity, one of its greatest strengths, the ability to store enormous quantities of text and data on small, concentrated types of magnetic media, could turn out to be an important structural weakness in the wall of client confidentiality that psychologists have so carefully constructed over the years. In this article I examine the possibilities for such breaches of confidentiality when psychologists use microcomputers in their practice or research. Examples illustrate the ease and rapidity with which the microcomputer's magnetic media can be duplicated, damaged, or destroyed. Recommendations are made for guidelines and techniques to ensure and maintain the confidentiality of clinical and research information when one is using a microcomputer. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Practicing psychology in the era of managed care: Implications for practice and training.

Beginning with the HMO Act of 1973, managed care, a system for controlling health care costs, rapidly expanded and gained influence as the main vehicle for health care delivery in the United States. Implementation of managed care principles in the mental health arena has generated much debate, particularly with respect to issues of quality of care. The authors briefly trace the development of managed care and evaluate its impact on the practice of psychology. The extant literature is reviewed with specific attention to issues of quality of care, confidentiality of patient information, and shifting practice patterns of clinicians. Finally, the future of professional psychology within the context of managed care is examined, and the implications of newly created mental health roles for practitioners, training programs, and organized psychology are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factors contributing to breaking confidentiality with adolescent clients: A survey of pediatric psychologists.

A common ethical dilemma experienced by professional psychologists involves deciding whether to break confidentiality with risk-taking adolescent clients. However, our understanding of the factors that contribute to this decision-making process is limited. The present study surveyed 200 pediatric psychologists (resulting in 74 usable surveys) and identified several items that are perceived to be important to clinicians when they consider the decision to break confidentiality in order to report potentially dangerous behaviors to the parents of adolescent clients. The present study also used exploratory factor analysis to identify 2 underlying factors--Negative Nature of the Behavior and Maintaining the Therapeutic Process--as crucial to the decision-making process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Practice wise: You and your personnel record.

Personnel policy and standards should promote quality service, but they also provide protection for both the employer and employee. In dealing with issues of standards and ethics, client records--content, security, confidentiality, and client accessibility--have received a great deal of attention. There appears to be less concern about the content of employee records, and written standards and auditing mechanisms may not exist. An employee may have more than one file-an official personnel record in a central location and an unofficial one in the unit or centre of employment. The official record is more likely to adhere to standards than the unofficial but both may contain questionable material. Some examples of questionable materials are presented in this article. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Response to Faustman.

Faustman (1982, see record 1982-28927-001) is incorrect when he states that "practitioners who choose to sue clients to recover fees are openly inviting countersuit by the client", (p. 213). I urge colleagues in other states to examine their confidentiality statutes for similar exemptions, and I admonish Faustman for not sufficiently investigating the legal issue. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Erosion of Confidentiality and Privacy.

The recent study on sexism in graduate admissions by Lunneborg and Lillie (see record 1990-57047-001) raised what I believe to be an increasingly frequent ethical problem: the erosion of confidentiality and privacy in the name of data collection. As a departmental chairman, I write perhaps more than my share of letters of recommendation to a variety of graduate schools, agencies, and employers. In nearly every case, the accompanying form or request contains the assurance that the letter and its information will be held "in confidence." It is not my understanding of confidence for "two experienced Testing Bureau raters" to transcribe or code such letters from confidential folders, much less to reproduce one in its entirety in the pages of a journal, complete with disparaging footnote. Perhaps the writer did not mind the surprise of seeing his letter so reproduced; perhaps he did. But I am willing to assume that he had not written it with any such expectation. Continued practices of this nature can only make us increasingly willing to include only the most uncontroversial statements and bland observations in our written responses to requests for recommendations and other information. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Confidentiality: Ethical perspectives and clinical dilemmas.

Reviews the book Confidentiality: Ethical Perspectives and Clinical Dilemmas (2003), edited by Levin, Furlong, and O'Neill. This book consists of 20 chapters arranged into 4 sections addressing first a broad overview of confidentiality concerns and then training and research problems, clinical issues, and a concluding section on ethics and law. The reviewer believes that the only regrettable aspect of this fascinating text is its seemingly rather narrow origins, which concern psychoanalysis and (presumably) most psychoanalytically derived or informed psychotherapy. Its editors emphasize treatment methods that rely on transference-countertransference phenomena. In turn, these treatment methods emphasize a clear-cut recognition of irrational sources of patient behavior, including the giving (or not giving) of "consent" to therapist disclosures. However, this book deserves to reach all therapists, not just those committed to a single school of thought. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

To accept or not to accept: Referrals and the maintenance of boundaries.

Psychotherapists of all disciplines are confronted with many dilemmas in accepting or declining referrals from colleagues and patients, as well as referrals that may entail contact outside the office. The authors explore countertransference, confidentiality, boundaries, and ethics related to referral sources. Case material illustrates clinical dilemmas. Some suggestions are offered to help therapists critically examine the conscious and unconscious influences affecting their decisions about whether to accept a referral. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emerging Patterns of Practice in the Era of Managed Care: Reply.

Responds to the comments of Crespi (2004), Suarez (2004), and Salyer (2004) concerning the authors' original article (see record 2003-03405-005) examining the implications for psychological practice and training in the era of managed care. In response to Crespi, the authors agree that school psychology is an important area of practice, given the contention that schools are responsible for providing 75% of mental health services to children. Reimbursement within educational contexts was not reviewed, largely because the relevant information was not available within the literature. However, the authors encourage efforts to continue to disseminate information regarding a largely unexplored issue that may have important implications for children. The authors also agree with Suarez and Salyer that the value of direct and personal experience should not be overlooked. Those in private practice may indeed face challenges in dealing with managed care with which the current authors do not have personal experience. However, it should be clear that the aim of the original research was to critically evaluate the current literature and to determine what is known and unknown about managed care and to point out alternative views and systems worthy of consideration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)