Laws and Ethics Course > Chapter 7 - Exercises in Confidentiality

Chapter 7: Exercises in Confidentiality

Exercises in Confidentiality

You have probably already had to deal with situations where you questioned the extent you should go in keeping certain information confidential, and how much information should you reveal.Remember that a client may reveal some information you are required to reveal and report to proper authorities, but that does not give one license to be excessive.Indeed, one may argue that a provider should not reveal a greater amount of information than is expedient to fulfill their responsibilities as a mandated reporter.The following exercises are provided for you to consider how to handle different confidentiality dilemmas that may come up in the course of practice. There are doubtless as many situations as there are clients, so you cannot predict every situation that may come up. These situations (Hepworth and Larsen, 1986) generally address many of the possible scenarios and thinking them through may be of real assistance down the road.

For each situation consider the following:

1. How can you best discharge your ethical responsibilities in the situation?

2. Do you experience conflicting pulls regarding possible courses of action?

3. In situations that involve legal ramification, how would you handle it with the client in the event your planned action would be contrary to the client's request?

Situation 1. A male client confided in an individual marital therapy session several weeks ago that he is a practicing homosexual, although his wife does not know this.The client's wife, who you have also seen conjointly with him, calls you today, troubled over the lack of progress in solving marital problems, and asks you point-blank whither you think her husband could be homosexual.

Situation 2. A client with whom you have had several sessions in a family agency confides to you that he is wanted by legal authorities for repeatedly ignoring court orders to pay child support to his wives from two previous marriages.The client, who has eluded authorities by assuming a false name and changing addresses frequently, also indicates that he has been warned he will be incarcerated if he is apprehended. With respect to such situations, you were recently advised by legal counsel in a staff meeting that withholding information regarding fugitives from the law also makes you culpable.

Situation 3. You are forming a group for youth in a state correctional facility. You know from the past experience that youth sometimes make references in the group to previous offenses that they have committed without being apprehended. You also know that they may talk about plans to run form the institution or about indiscretions or misdemeanors they (or others) may have committed or plan to commit within the institution, such as smoking marijuana or stealing institutional supplies or property from peers or staff.

Situation 4. In conducting an intake interview with a client in a family agency, you observe that both of her young children are withdrawn. Further, one of the children is badly bruised, and the other, an infant, also appears malnourished. Throughout the interview, the client seems defensive and suspicious and also ambivalent about having come for the interview. At one point, the client states that she feels overwhelmed with her parenting responsibilities and is having some difficulty in coping with her children.She also alludes to her fear that she may hurt them but then abruptly changes the subject. As you encourage her to return to the discussion of her problems with the children, your client says she had changed her mind about wanting help, takes her children in hand, and leaves the office.

Situation 5. You have seen a husband and wife and their adolescent daughter twice regarding relationship problems between the parents and the girl. The parents are united in their approach to the problem; both extremely negative and blaming in their attitude toward their daughter, feeling that their troubles would be over if she would just "shape up." Today, during an individual interview with the girl, she breaks into tears and tells you that she is pregnant and plans to "go somewhere" with her boyfriend this weekend to get an abortion. She pleads with you not to tell her parents, who she feels would be extremely angry if they knew.

Situation 6. In a mental health agency, you have been working with a male client who has a past history, when angered, of becoming violent and physically abusive.He has been under extreme psychological pressure lately because of problems relating to a recent separation from his wife.In an interview today, he is extremely angry, clenching his fists as he tells you that he has heard that his wife has initiated divorce proceedings and plans to move to another state. "If this is true," he loudly protests, "she is doing it to take the kids away from me, and I'll kill her rather than let her do that."

Situation 7. A colleague and close friend sees you at a casual event and remarks that she knows you are seeing a friend in therapy. She begins to talk about problems she knows your client is experiencing and then asks you whether it is true that the client has been hospitalized previously for depression.

Situation 8. In the last several interviews, a 15-year-old girl has seemed troubled, but despite repeated inquiries and expressions of concern, she did not confide in you. In the course of today's interview, however, she blurts out that her brother-in-law has been making sexual advances and pressuring her to have intercourse with him. Your client, who has been living in the home of her brother-in-law and her sister, indicates that she has resisted the man's sexual attempts thus far, but it is evident that she is frightened and perplexed. Although embarrassed and guarded about disclosing details of the situation, she indicates strongly that she does not want her sister to know about this problem.After exploring the problem to the extent your client is willing and able, you discuss and role-play approaches she can take to confront her brother-in-law and quell his advances. But in view of her fright and the difficulty she has in rehearsing assertive behavior, you are worried that she may be unable to manage the situation if the brother-in-law were to intensify his pressure.

( pp72-73)

Each of these scenarios creates a type of dilemma regarding confidentiality, without being absolutely clear cut. The framework already provided from Reamer, and a solid knowledge of your professions code of ethics would be helpful in making decisions for each of these scenarios.Another resource to be seriously considered is that which has also already been discussed?a consultant.
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Question No.28. The resources that would be helpful to the healthcare practitioner In resolving ethical dilemmas:

a. The framework developed by Reamer
b. Professions code of ethics
c. A consultant
d. All of these
 
Laws and Ethics Course > Chapter 7 - Exercises in Confidentiality
Page Last Modified On: October 10, 2015, 03:52 AM