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11 Cards in this Set
- Front
- Back
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Models of confidentiality |
1. Absolute confidentiality - no information can be revealed (no exceptions) 2. Limited confidentiality - others can access the information 3. Contractual confidentiality - confidentiality requirements are outlined in a set of rules 4. Discretionary confidentiality - up to the clinician's discretion whether they disclose confidential information or not |
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Contractual confidentiality |
- In the APS code it is strongly recommended that the psychologist work together with the client to come to an agreement on the nature of confidentiality within their relationship - This contract should based on the needs of the client - This contract should be created as part of the informed consent process - The contract should include the following: 1. Purpose and rationale for the service 2. Estimated duration of the service 3. Likely costs of the service 4. Extent of the client's involvement 5. Potential risks and benefits involved 6. Whether a report will be written 7. The professional qualifications of the person providing the service 8. The client's right to privacy 9. Details about the complaints procedure 10. Limits to confidentiality Also include information about: - What sort of information you will be collecting - Purpose of collecting that sort of information - How information will be stored - Who will have access to the information - The client's ability to access their personal information |
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Circumstances where disclosure is permitted by the APS Code |
1. When there is legal obligation to do so: a) If the psychologists is subpoenaed b) Child abuse 2. Upon request of the client or legal authority 3. If there is an immediate and specified risk of harm to identified person(s) which can be averted by the disclosure 4. When consulting with a colleague, provided that: a) the client's identity remains confidential b) the client has provided consent |
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Laws relevant to confidentiality |
1. The Privacy Act 1998 2. Evidence Act 1958 - psychologist must comply if they are subpoenaed 3. Drugs, Poisons and Controlled Substances Act 1981 - psychologist must report if their client is showing substance use dependence 4. Children, Youth and Families Act 1988 - psychologist legally mandated to report child abuse. |
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Factors that need to be considered when breaching confidentiality |
- Circumstanced that warrant a breach of confidentiality - The level of risk of harm that is imposed on others or the client - Who the best person to inform is - How much information should be disclosed - Can the information be de-identified> |
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The Tarrasoff Case - clash between confidentiality and duty to warn |
- A ruling that was created in Califronia in 1978 after an incident involving a psychologist at a university counselling centre and a student (Mr Poddar) who disclosed to the psychologist he had plans to kill Tarasoff. - The psychologist informed the police, but the police let Mr Poddar go because his mental state seemed ok - Mr Poddar later killed Tarasoff - Tarasoff's parents filed a suit against the school and the psychologist for not warning Tarasoff - The Supreme court held that a "duty to warn" overrode client confidentiality when a client threatened to kill another person |
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Alternatives to disclosure |
1. Increasing intensity of therapy 2. Hospitalisation 3. Directly attempt to control the situation (e.g., gain possession of the weapon) |
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Subpoena (APS, 2011) |
- A court order written by a solicitor and delivered to a psychologist that requests the psychologist produce client files or to appear in court (witness summons) - Psychologists are confronted by this process and this can be due to a lack of knowledge in what is required of them - It is important to assess the validity of the subpoena - The psychologist must comply with the subpoena by law (under the Evidence Act 1958), however they are able to object on the basis of their concerns with how the breach of confidentiality will affect the client, or if they feel the information will not help the case - The objection might no be accepted - It is important the psychologist inform the client about the subpoena - they are not able to withold information purely because the client has asked them to - Psychologist cannot withold information at their own discretion - this is a criminal offence that is subject to penalty. |
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Record Keeping |
- Standards regarding record-keeping are outlined in section B.2 of the APS code - 'Records' refer to: Notes taken about the client Dairy entries Appointment times Correspondence between the psychologist and client Any document that contains information relating the psychological service provided to the client |
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Main points of Kampf et al (2008) |
1. Australian psychologists lack clear understanding of their legal and ethical requirements regarding client confidentiality 2. A duty to disclose is very different from being permitted to disclose 3. Vast majority of psychologists believe the APS code imposes a duty to warn, when in reality the code does not explicitly state this, it merely permits disclosure 4. Psychologists are more clear about the ethical requirements around disclosure than the legal requirements 5. Psychologists are more willing to disclose information than what is legally and ethically required of them 6. Disclosure if more likely if the client has a history of substance abuse, violence, command hallucinations and psychosis 7. 64% of psychologists believed there was legal obligation to disclose information in the case of imminent danger |
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Main points of Duncan et al (2011) |
1. Psychologists are confused about when to breach confidentiality with adolescent clients 2. Research shows that adolescents (from 14 to 15 years of age) are equipped with the psychological capacity to understand the psychological service provided to them and provide informed consent 3. Adolescence is a period of heightened risk-taking behaviour, this poses issues surrounding confidentiality of information regarding risk-taking behaviour - this may increase their safety (responsibility to safeguard the client vs. confidentiality and client autonomy) 4. Adolescents value confidentiality highly and are more likely to withhold information if confidentiality is not assured 5. Psychologists' most frequent considerations when deciding whether or not to disclose confidential information are: - The severity of the risk-taking behaviour - Apparent seriousness of the behaviour - Desire to protect the adolescent |
