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Zero tolerance

According to Wheeler (2014), irrespective of the type of psychotherapy provided, group or individual, the basis of a strong therapeutic client/provider relationship is established through a trusting relationship where the client feels comfortable sharing private information with the provider.  Both individual and group therapy have laws and regulations that guide their confidentiality and privacy. According to McClanahan (2014), legal and ethical issues are seen with both group and individual therapy, due to the complications that accompany navigating legal and ethical concerns while balancing the goal of maintaining a therapeutic relationship with the clients. In a therapeutic relationship with the client, it is of utmost importance that the provider ensures transparency and be protective with the client’s confidentiality, as well as the limits of confidentiality. According to Koocher and Keith–Spiegel (1998), “confidentiality refers to a general standard of professional conduct that obliges a professional not to discuss information about a client with anyone”. In addition to an ethical obligation to protect information, therapists also have to comply with legal protections of confidential information. Legally, this type of privacy is covered by the concept of privileged communication, which states that in specific types of relationships, information is protected from disclosure in legal proceedings (Lasky and Riva, 1996). The two primary principles underlying confidentiality are autonomy and fidelity (Welfel, 1998); the principle of autonomy entails the acknowledgement of a person’s right to have his or her own beliefs, choices, and actions based on personal values (Beauchamp & Childress, 2001). “The right to privacy follows from the assumption that autonomous individuals have the right to make decisions about their own lives and the information relevant to it, including to whom the information is confided”. (p.26).Confidentiality is based on this respect for the client’s ability to make reasonable choices about what he or she discloses and how that disclosure impacts his or her life. The second ethical principle related to confidentiality, fidelity, refers to the therapist’s faithfulness and loyalty to keep promises, as well as honesty and trustworthiness when making promises (Kitchener, 2000). Ethical therapists promise to be faithful in not disclosing information clients reveal to them. At the same time, they are honest and open about the limits of confidentiality so that clients can make a reasonable, informed, and voluntary decision about entering into and engaging in treatment (Beauchamp & Childress, 2001).

Breskin (2011) recommends that, in group therapy, group members enter into a signed contractual agreement at the start of group therapy to address issues of confidentiality, privacy, alcohol, and drug abstinence, refraining from exclusive relationships and prohibiting intimidation of group members. Furthermore, clients who participate in the group therapy expect confidentiality similar to those who participate in individual therapy and many states have laws that exclude the privilege of information obtained in group therapy to be used to testify against other group members in a court of law (McClanahan, 2014).

As mental health nurse practitioners and other mental health professionals, the issues of confidentiality and privacy and ethical dilemmas are issues that we will have to face on a regular basis. It is our responsibility to familiarize ourselves with the law of wherever we practice and have a good understanding of it and also ensure our patients are aware of it. This will help serve as a guide to our practice to ensure our patients are protected and that we are also protected.

References

Beauchamp, T.L., & Childress, J.F. (2001). Principles of biomedical ethics (5th Ed.). New York: Oxford University Press.

Breeskin, J. (2011). Procedures and guidelines for group therapy. The Group Psychologist, 21(1).

Retrieved from https://www.apadivisions.org/division-49/publications/newsletter/group-psychologist/2011/04/group-procedures.aspx

Kitchener,K.S.(2000).Foundationsofethicalpractice,research,andteaching in psychology. Mahwah, NJ: Lawrence Erlbaum.

Koocher, G.P., & Keith–Spiegel, P. (1998). Ethics in psychology: Professional standards and cases. New York: Oxford University Press.

Lasky, G. B., & Riva, M. T. (2006). Confidentiality and privileged communication in group psychotherapy. International Journal of Group Psychotherapy, 56(4), 455-476.

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