Healthcare Training Institute - Quality Education since 1979
Psychologist, Social Worker, Counselor, & MFT!!

Section 1
Track #1 - Ethical vs. Legal

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Welcome to the Home Study Course sponsored by the Healthcare Training Institute, homestudycredit.com.  This course is entitled, How to Ethically Set Client Confidentiality Boundaries

Our primary intent for this home study course is to provide quality education to foster your professional growth.  The Institute has provided quality education since 1979.
 
We appreciate that you have chosen us as a vehicle for you to earn your Continuing Education Credit.

The purpose of the course is to assist you in increasing your knowledge regarding ethical confidentiality boundary setting.  As each case study is given, if the concepts seem to be applicable to your situation, I encourage you to turn your CD player off and make a few notes regarding the application of the principle to your setting.  However, these notes are for your purposes only and are not to be sent to the Institute.  Also each track is very content dense.  So feel free to replay the track to review the content either for your own purposes, or if you feel appropriate play the track in an individual or group session for client education.  Also permission is granted to reproduce this CD.  We encourage you to duplicate and give copies of this CD to colleagues, clients, etc. as you deem appropriate. We feel the information on our CD's is valuable.  Thus, we have an interest in distributing CD's in as many ways as possible, to benefit the greatest number of people, who have a need and are receptive to this practical information.

The questions in your Answer Booklet are sequential and deal with the section of content that preceded it.  For this reason, to facilitate the answering of each question, you might read the question from the Answer Booklet prior to listening to that CD track.  By knowing what the question is ahead of time, you will then know the content to listen for that contains the answer.  So just a hint, after you write down the answer to a question in your Answer Booklet, read on to the next question in order to give you a “heads up” to listen for the content that contains the answer to the next question.

Merely write the correct letter on the corresponding blank line in your answer booklet. Each answer is only used once. Keep in mind there is nothing tricky or hard about these questions.  They are merely intended to verify the playing of this CD.

For the purpose of brevity, most generally, I will use the term “therapists” or “mental health professional.”  However, don’t let these terms deter you from applying the concepts to your situations.  When you hear the word “therapists,” if your job title is social worker, psychologist, marriage and family therapist, mental health counselor, professional counselor, resident director, program assistant, etc. merely substitute the appropriate term that is the most meaningful to you. In short, don’t let my use of the term “therapists” cognitively set you off track from hearing the content because your job title is school counselor, for example.  I will also use the term “client” for the purposes of brevity.  However, if you deal with patients, residents, students, consumers, etc., transpose “client” for the term that is the most meaningful to you in your work setting. 

On this CD set we will discuss such topics as: ethical vs. legal; self-harming clients; consulting colleagues; controversy; proper procedures; children; and strategies for legal subpoenas.

So  let’s get started

To start this discussion of ethics as it relates to ethics and confidentiality boundaries, I would like to get three very basic but crucial issues out of the way first.  On the rest of this track, we will examine three important aspects of ethical vs. legal issues.  These three aspects include:  ethically improper situations; legally binding situations; and walking the tightrope.

#1 Ethically Improper Situations
The first aspect of ethical vs. legal issues for the mental health therapist to consider are ethically improper situations.  “Ethically improper” refers to situations in which, legally, the therapist’s actions were not reprehensible, liable, or in the wrong.  However taken in the context of confidentiality issues may be construed as unethical.  These situations include discussing confidential and privileged information about a client with another colleague in a public place such as restaurants or other crowded areas.  Even if the client’s name is not mentioned, the specifics of a case may be enough for an acquaintance within hearing distance to identify the client.  The reason why I bring this to your attention is one of my colleagues, who I will call “Sue”, joined me in line one day at a restaurant.  She began to tell me about a case she had that morning, specifically, a woman who had AIDS and didn’t want anyone to know.  Sue also said that it will be hard to keep that quiet because her client had three children and a stay-at-home husband.  In this small disclosure, Sue has put her client’s confidentiality in great risk in several ways.  First, I may have seen this woman going into her office and may know her, since this is a small town.  Second, with the details of the case, such as the rare stay-at-home husband and three children, a listener may easily identify this woman, who wanted to keep her medical state a secret.  According to Codes of Ethics, “mental health professionals should protect the confidentiality of all information obtained in the course of professional services, except for compelling professional reasons.”  Although consulting a colleague about a correct course of action is not improper, doing so in a public place is.  Some Ethics Codes even list certain public places which are not ethically sound for the disclosure of information.  Think of your colleagues.  What places would be ethically proper for the confidential disclosure of information regarding a difficult client of yours? 

#2 Legally Binding Situations
The second important aspect of ethical vs. legal is legally binding situations.  In certain circumstances, and this is especially true in regards to minors, healthcare professionals may be legally obligated to break the boundaries of confidentiality in order to be in keeping with the law.  If not done so, you or your colleagues may be subject to legal action and retribution.  As you are aware, in most cases, the breaking of confidentiality occurs in cases of client sexual or physical abuse or client’s threats to harm themselves or another person.  Very often, in cases with minors, the parents may need to become involved for the benefit of the client depending on the age.  The younger the client, the less he or she can be allowed to be self-determinate in the disclosure of his or her information. 

Jill, age 15, had been sent to Carol, her school counselor, for outbursts of rage and aggression towards teachers and other students.  At first, Jill was unwilling to disclose any information to Carol, but eventually, Jill began to talk about her home life.  Apparently, her mother, Francine, is rarely at home to care for Jill.  When Francine is not home, she is out at the bars where she constantly meets new men and brings them home.  When her mother’s current boyfriends raped Jill, she began to stay out of the house whenever her mom brought home a new man.  Jill stated, “That whore let it happen!  She doesn’t give a damn about anyone but herself, and she can rot in hell!”  Because Jill had been raped, Carol reported the incident to child protective services.  The man was arrested, convicted, and sentenced.  Also, because her mother was convicted of neglect, Jill was moved into her aunt’s house.  Jill stated, “I’m glad I’m with my aunt, I guess.  She’s not my mom, but she’s better, you know?  I wish my mom could work her shit out first, which she’s trying to do, but I’m glad she can do it without me now.”  The point of this breaking-the-boundary-of-confidentiality case study is sometimes, it benefits the client’s wellbeing to break confidentiality and report circumstances to legal authorities.  Think of your Jill.  Would breaking confidentiality and alerting authorities benefit or hurt the client-counselor relationship?

#3 Walking the Tightrope
In addition to ethically improper and legally binding, the third aspect of ethical vs. legal is walking the tightrope.  In some cases, the correct course of action may not be clear, and the consequences may not always be positive.  “Walking the Tightrope” refers to that time period during which you are uncertain about the right move to make and you haven’t completely committed yourself to anything.  At some point, however, a choice must be made and the fall off of the tightrope is inevitable. 

Carly, age 14, told Julie, her social worker, that her father, Paul, had been molesting her.  Carly, embarrassed by the circumstances and led to believe that the abuse was her fault, expressly asked Julie not to tell anyone about the abuse.  However, Julie explained she was legally bound to report incidences of abuse.  However, the judge ruled that Carly would have to give her testimony in court in front of her father and the rest of the family, who believed she was lying.  Faced with this pressure, Carly recanted and the charges were dropped.  In addition to this, the relationship between Carly and Julie deteriorated.  Carly was angry that Julie had betrayed her trust and became belligerent and angry in their sessions together.  Eventually, Carly was referred to another case worker.

On this track, we discussed three important aspects of ethical boundaries related to ethics versus the law.  These three important aspects include:  ethically improper; legally binding; and walking the tightrope.

QUESTION 1
What are three aspects regarding ethical boundaries related to ethics versus the law? To select and enter your answer go to Answer Booklet