Ethical Concept of Psychologist
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.
Proponents of absolute confidentiality have always emphasized the clinical consequences of placing conditions on the protection of confidences. (See, e.g., Bollas & Sundelson, 1995; Siegel, 1976). But conditional confidentiality also has important ethical consequences. Many of the 'conditions' now placed on confidentiality allow psychologists to avoid risks to themselves. For example, when psychologists obey reporting laws, they thereby avoid the legal and financial risks of civil disobedience; but this simply transfers the risk to the clients whose confidences are betrayed. Similarly, when psychologists disclose information against a client's wishes in a court case, they avoid a contempt citation, a financial penalty, and incarceration; the risk is borne instead by the client whose confidential information becomes public information.
Initially, the ethical obligation was unambiguous. The first APA Ethics Code (APA, 1953) required psychologists to "guard professional confidences as a trust" (p. 55). The next three Ethics Codes (APA, 1959 [p. 280], 1963 [p. 57], 1968 [p. 358]) retained that concept of guarding
confidences: "Safeguarding information about an individual.. . is a primary obligation of the psychologist." Clearly, the profession was not ambivalent about what constituted ethical behavior.
By the 1970s, however, there was significant disagreement within APA about how to respond to the new child abuse reporting statutes and duty- to-protect laws. Many within the profession were concerned that the legal demands for disclosure meant a lowering of the ethical standard (Siegel, 1976).
That stance, albeit commendable, created an unfortunate stalemate. Unable to agree on a new ethical standard, the profession maintained the status quo: The 1979 APA Ethics Code, although significantly revised in other respects, had nothing new to say about confidentiality (Pope & Vetter, 1992). This left psychologists ethically responsible for upholding confidentiality standards enacted two decades earlier, during a very different legal era.
The profession's ethicists had difficulty deciding what to say about confidentiality in the 1970s, and 30 years later, psychologists still have difficulty understanding their ethical obligations about it. Psychologists will "reach for the ethical ceiling" about confidentiality only if they have a sturdy ethical floor on which to stand. This ethics- based organizing schema can serve that purpose.
Conversations about confidentiality can be enhanced by the existence of an ethical outline that applies to all psychologists regardless of state laws, practice settings, or professional roles. Psychologists can use this practice model to place legal mandates into ethical perspective, to frame ethical questions more clearly, to seek consultation more confidently, and to protect clients' confidentiality rights more effectively. In short, psychologists can use this practice model to reclaim their status as experts about the confidentiality ethics of their profession.
"Whenever there is a simple error that most laymen fall for, there is always a slightly more sophisticated version of the same problem that experts fall for."
--Cognitive psychologist Amos Tversky (1937-1996)--
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.
Proponents of absolute confidentiality have always emphasized the clinical consequences of placing conditions on the protection of confidences. (See, e.g., Bollas & Sundelson, 1995; Siegel, 1976). But conditional confidentiality also has important ethical consequences. Many of the 'conditions' now placed on confidentiality allow psychologists to avoid risks to themselves. For example, when psychologists obey reporting laws, they thereby avoid the legal and financial risks of civil disobedience; but this simply transfers the risk to the clients whose confidences are betrayed. Similarly, when psychologists disclose information against a client's wishes in a court case, they avoid a contempt citation, a financial penalty, and incarceration; the risk is borne instead by the client whose confidential information becomes public information.
Initially, the ethical obligation was unambiguous. The first APA Ethics Code (APA, 1953) required psychologists to "guard professional confidences as a trust" (p. 55). The next three Ethics Codes (APA, 1959 [p. 280], 1963 [p. 57], 1968 [p. 358]) retained that concept of guarding
confidences: "Safeguarding information about an individual.. . is a primary obligation of the psychologist." Clearly, the profession was not ambivalent about what constituted ethical behavior.
By the 1970s, however, there was significant disagreement within APA about how to respond to the new child abuse reporting statutes and duty- to-protect laws. Many within the profession were concerned that the legal demands for disclosure meant a lowering of the ethical standard (Siegel, 1976).
That stance, albeit commendable, created an unfortunate stalemate. Unable to agree on a new ethical standard, the profession maintained the status quo: The 1979 APA Ethics Code, although significantly revised in other respects, had nothing new to say about confidentiality (Pope & Vetter, 1992). This left psychologists ethically responsible for upholding confidentiality standards enacted two decades earlier, during a very different legal era.
The profession's ethicists had difficulty deciding what to say about confidentiality in the 1970s, and 30 years later, psychologists still have difficulty understanding their ethical obligations about it. Psychologists will "reach for the ethical ceiling" about confidentiality only if they have a sturdy ethical floor on which to stand. This ethics- based organizing schema can serve that purpose.
Conversations about confidentiality can be enhanced by the existence of an ethical outline that applies to all psychologists regardless of state laws, practice settings, or professional roles. Psychologists can use this practice model to place legal mandates into ethical perspective, to frame ethical questions more clearly, to seek consultation more confidently, and to protect clients' confidentiality rights more effectively. In short, psychologists can use this practice model to reclaim their status as experts about the confidentiality ethics of their profession.
"Whenever there is a simple error that most laymen fall for, there is always a slightly more sophisticated version of the same problem that experts fall for."
--Cognitive psychologist Amos Tversky (1937-1996)--
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