Can You Keep a Secret Confidential i ty in Psychotherapym.docx

Can You Keep a Secret? Confidential i ty in Psychotherapy
m
Jeffrey N. Younggren and Eric A. Harris
American Psychological Association Insurance Trust
Confidentiality is the secret-keeping duty that arises from the
establishment of the professional relationship psychologists
develop
with their clients. It is a duty created by the professional
relationship,
it is set forth in the American Psychological Association’s
(2002)
Ethical Principles and Code of Conduct, and it is codified in
many state
regulations. However, the difference between confidentiality
and
legal privilege; how, why, and when it can be violated; and the
reasons for so doing are not well understood by many
practitioners.
While on the surface confidentiality might seem to be an easy
concept to apply to professional practice, in fact it is quite

complex
and filled with exceptions that frequently differ from
circumstance to
circumstance and from state to state. A lack of respect for and a
lack
of familiarity with the significance of these exceptions could
have dire
professional consequences. This article reviews the ethical
imperative
of confidentiality and then provides examples of legal cases that
help
to better understand its complexity. Then, we offer strategies
designed to help metal health practitioners when they are
confronted
with questions regarding confidentiality and privilege. & 2008
Wiley
Periodicals, Inc. J Clin Psychol: In Session 64: 589--600, 2008.
Keywords: confidentiality; privilege; informed consent;
psychotherapy
If asked by a patient if they can keep something shared with
them in a professional
relationship secret, most psychotherapists would answer the
question with a
resounding, ‘‘Yes, of course!’’ This is because confidentiality
is the key to most

models of effective psychotherapy. Without this privacy, clients
cannot be expected
to reveal embarrassing, sometimes personally damaging,
information in treatment.
Further, the privacy of the consulting room and the
confidentiality of the therapeutic
The opinions expressed in this article do not reflect the official
position of the American Psychological
Association Insurance Trust.
Correspondence concerning this article should be addressed to:
Jeffrey N. Younggren, 827 Deep Valley
Drive, Suite 309, Rolling Hills Estates, CA 90274; e-mail:
[email protected] or Eric A. Harris,
111 Rockville Pike, Suite 900, Rockville, MD 20850; e-mail:
[email protected]
JOURNAL OF CLINICAL PSYCHOLOGY: IN SESSION, Vol.
64(5), 589--600 (2008) & 2008 Wiley Periodicals, Inc.
Published online in Wiley InterScience
(www.interscience.wiley.com). DOI: 10 .1002/ jc lp .20480
relationship facilitate trust, empathy, and the working alliance.
Confidentiality is the
duty to protect client privacy that comes from the fiduciary
nature of the
professional relationship. It also is a fundamental standard in
the Ethical Principles
of Psychologists and Code of Conduct (hereafter the Ethics
Code; American
Psychological Association, 2002) and other regulatory
documents. The importance
of confidentiality to effective therapy was emphasized by the
Supreme Court of the

United States in its landmark decision, Jaffee v. Redmond
(1996). In that opinion, the
Court said:
Effective psychotherapy, by contrast, depends upon an
atmosphere of confidence
and trust in which the patient is willing to make a frank and
complete disclosure of
facts, emotions, memories, and fears. Because of the sensitive
nature of the problems
for which individuals consult psychotherapists, disclosure of
confidential commu-
nications made during counseling sessions may cause
embarrassment or disgrace.
For this reason, the mere possibility of disclosure may impede
development of the
confidential relationship necessary for successful treatment.
Exceptions to Every Rule
However, as important as privacy is, there are numerous
exceptions to it, and
disclosing those limits, both as part of your informed consent
contract and
integrated into the treatment itself, is now ethically required
(Pope & Vasquez, 2007).
Our experience is that many practitioners are not fully informed
about these limits,
and this can place both the therapy and the therapist at
significant risk (Bennett et
al., 2007).
To complicate matters, there are two sets of rules about
confidentiality exceptions.
One set involves under what circumstances a psychologist can
or must release

confidential information without patient consent. These include
abuse reporting,
protecting clients and their potential threatened victims,
collecting unpaid treatment
bills, and defending oneself from inappropriate or threatening
client behavior. The
second set of rules involves under what circumstances
information learned in the
professional relationship must be submitted as evidence in a
trial or in another type
of legal proceeding. Every state has passed legislation creating
a ‘‘privilege’’ that
allows psychotherapy patients to block admittance of
information that would
constitute relevant and material evidence in a court or
administrative proceeding;
however, all these statutes have differences, and all are subject
to judicial
interpretation.
In reality, there are many exceptions to secret keeping in
psychotherapy, and a
professional who is unfamiliar with these can be placed at
significant professional
risk. To be most effective, psychotherapists not only need to
know what the
enunciated exceptions are in their particular jurisdiction but
also to understand the
reasoning by which these exceptions are created.
In general, exceptions are created in two basic ways. First,
exceptions are created
when confidentiality conflicts with another important
governmental policy. For
example, every state has decided that protecting the welfare of
children who have

been or are at risk for abuse is more important than protecting
the privacy of
patients. As a consequence, various professionals are required
to report suspected
abuse in some fashion to protect those children. Second,
exceptions occur when a
person behaves in a way that is inconsistent with the reasons
that his or her privacy is
protected in the first place or when there is no legitimate
expectation of
590 Journal of Clinical Psychology: In Session, May 2008
Journal of Clinical Psychology: In Session DOI: 10.1002/jclp
confidentiality. For example, you are allowed to breach
confidentiality in a limited
fashion to collect an overdue account or in a much broader
fashion when a patient
places his or her mental health at issue in a legal proceeding.
In this article, we examine how courts have balanced privacy
and disclosure in
specific cases. These cases consider the differences between
confidentiality and
privilege and the impact of those differences on professional
practice. In light of
these cases, psychotherapists need to know how they develop
the legal duty to keep
patient confidences, what legal privilege is, what the
differences between
confidentiality and privilege are, what happens to
confidentiality when a patient
dies, and what rights minors have to confidentiality. We also

discuss legal opinions in
each of these areas and then review strategies to deal with
confidentiality in ways that
avoid violations of confidentiality and privilege.
Confidentiality and Privilege (United States v. Chase, 2003)
Gene Chase, a man who struggled with episodes of rage and
excessive rumination
against certain people, began seeing psychiatrist Kay Dieter in
1997. During this
treatment, Mr. Chase stated that he had thought about killing
some individuals
whose names were on a list in his day planner. The list included
two FBI agents who
had investigated Mr. Chase in the past. On the advice of her
lawyers, and consistent
with state law in California establishing the responsibility to
breach confidentiality to
protect potential victims specifically threatened by one’s
patients, Dr. Dieter
contacted the authorities and began communications with the
FBI about Mr.
Chase’s threats. In the interim, Mr. Chase also made two threats
to kill ‘‘FBI
marshals’’ to the switchboard operators in the clinic where Dr.
Dieter worked. As a
consequence of this conduct, Mr. Chase was arrested and
prosecuted. During the
trial, the prosecution demanded that Dr. Dieter testify about the
threats Mr. Chase
had made during his treatment sessions. Mr. Chase’s attorneys
objected, stating that
this would violate Mr. Chase’s privilege. It was their position
that the Tarasoff
(Tarasoff v. The Regents of the University of California, 1976)

allowed a psycho-
therapist to breach confidentiality to protect identified potential
victims of Mr.
Chase, but once the protective purpose was accomplished, the
reason for the breach
no longer existed. Therefore, the attorneys argued Mr. Chase’s
privacy rights were
restored and that his privilege could be claimed. The trial court
ruled that the
previous disclosure negated the privilege and overruled the
objection. Dr. Dieter
proceeded to testify about what had transpired during the
treatment sessions. Gene
Chase was convicted.
Mr. Chase appealed the decision. The 9th Circuit Court
subsequently reviewed the
case and agreed with the position of the defense that there was
no privilege exception
in federal law that would allow Dr. Dieter to testify. It was the
position of the court
that in essence, once she had fulfilled the requirements of the
state law by notifying
the authorities of the threat, his communications with her were
privileged. The court
opined that
The Tarasoff duty is justified on the ground of protection y By
contrast,
ordinarily testimony at a later criminal trial focuses on
establishing a past act. There
is not necessarily a connection between the goals of protection
and proof. If a patient
was dangerous at the time of the Tarasoff disclosure, but by the
time of trial the
patient is stable and harmless, the protection rationale that

animates the exception to
the states’ confidentiality laws no longer applies. (p. 11)
591Confidentiality in Psychotherapy
Thus, Dr. Dieter, once she had fulfilled the confidentiality
exception created by
Tarasoff, should not have been allowed to testify; it was a
violation of privilege.
Confidentiality and privilege can be a source of confusion
because of their
conceptual overlap. The duty of confidentiality occurs when a
psychotherapist
delivers professional services to a client; it refers to the right of
a client to not have
the information that was shared with the therapist disclosed
without proper
authorization or release. Many times, states have codified
confidentiality require-
ments in explicit statutes that make confidentiality into state
law. In addition, many
state psychology licensing laws incorporate documents such as
the American
Association of State and Provincial Psychology Boards Code of
Ethics (2005) or the
Ethics Code (American Psychology Association, 2002) into
their respective licensing
laws. Each of these documents contains a detailed section that
outlines the
importance of confidentiality in the delivery of psychological
services. They also

outline some of the exceptions to blanket confidentiality, and
the responsibility
psychologists have to address these exceptions appropriately.
Testimonial privilege, a statutory rule of evidence, defines how
confidentiality
operates in the judicial arena. Every state has a
psychotherapist–patient privilege
statute, although there are considerable differences among them.
The need for
confidentiality in psychotherapy was definitively enunciated by
the United States
Supreme Court in Jaffee v. Redmond (1996), which established
testimonial privilege
in the federal court system. The language of the Jaffee case is
so strong and clear that
it almost appears as if the court would decide that there are no
competing policy
grounds that would justify an exception; however, since Jaffe,
federal court judges
have carved out a number of exceptions that are consistent with
the exceptions
provided by many state statutes. As Simon and Shuman (2007)
noted, courts are
‘‘typically loathe to recognize privileges and quick to find
exceptions or waiver of
privileges’’ (p. 45). This is due to the fact that privilege
prevents the introduction of
information that might be useful in a trial, potentially making
the proceeding much
more cumbersome and inefficient, and in some cases, resulting
in a less fair outcome.
While every state has a privilege, major differences exist both
in the scope of the
privilege and in the enumerated exceptions. In most states, the

privilege applies to
both criminal and civil proceedings, but a small number of
states (e.g., Texas) restrict
the privilege to civil cases, and several states provide an
exception in cases of
homicide. Most states limit privilege to situations involving
diagnosis and treatment,
but a substantial minority extend privilege to all professional
relationships. Some
states also grant judges the right to create exceptions where
‘‘justice demands it.’’
Consequently, practitioners need to fully understand the law in
the state in which
they practice so that they can help clients avoid situations in
which what they say in
psychotherapy might be used against them in a court of law. In
addition, privilege
law is complex; it is always wise to suggest that clients consult
with lawyers about
their own situation.
Legislatures and licensing boards also have carved out
numerous exceptions to
confidentiality. Some of these exceptions, such as child abuse
reporting, require that
confidentiality be breached. Others, such as collection of
overdue accounts, are
completely within the psychotherapist’s discretion. The duty to
protect a potential
victim from threatened patient violence is usually discretionary,
but there is a
consequence (i.e., a malpractice suit) for failure to do so. Some
exceptions to
confidentiality are created by client behavior deemed
inconsistent with the
expectation of confidentiality. For example, if a client threatens

a psychologist’s
life, the psychologist can breach confidentiality to protect him-
or herself from the
threat, including going to court to get a restraining order using
client data as
justification (Ensworth v. Mullvain, 1990).
The case of Gene Chase is a prime example of the potential
confusion when
confidentiality and testimonial privilege collide. Tarasoff
(Tarasoff v. The Regents of
the University of California, 1976) was a legal ruling that
created an exception to
therapeutic confidentiality when it was necessary to warn a
potential victim about a
client’s threatened harm. Interestingly, this was the first
situation where mental
health professionals were determined to have a professional
duty to someone other
than a client. Eventually, this duty was expanded to include
taking actions to protect
the client from threatened harm. This change not only allowed
the psychotherapist
to warn an intended victim but also allowed the therapist to take
other actions such
as notifying the police or hospitalization to insure the safety of
the third party.
The Tarasoff doctrine has been adopted by a number of courts
in different

jurisdictions. Many state legislatures passed legislation to more
clearly enunciate the
duty, to define how it should be met, and to provide immunity
from suit to
professionals who acted in compliance.
As applied to the case of Gene Chase, Kay Dieter fulfilled her
Tarasoff obligations
by reporting Mr. Chase to the authorities, who in this case also
were the potential
victims. This appropriate breach of confidentiality did not alter
Mr. Chase’s privilege
rights, although it took an appellate court to make that
determination. This is a
situation where a patient did not have privacy outside the
courtroom, but was
determined to have privacy in court.
Children’s Rights to Confidentiality (In re Daniel v. Daniel O.
H., 1990)
Daniel was a 6-year-old who, caught in the middle of a custody
war between his
parents, alleged that his father had sexually abused him. A
psychologist had been
appointed to evaluate Daniel and determined that he had been
abused by his father.
The family was ordered into psychotherapy, and the mother was
given custody of
Daniel. Subsequently, another hearing was held because Daniel
had alleged that his
father had repeated the abuse. The same psychologist was
initially involved in the
evaluation of the second accusation. In response to this
allegation, the court

appointed a child advocate for Daniel and ordered no contact
between the father
and Daniel. Arguments about the first psychologist’s objectivity
resulted in the
appointment of another psychologist to independently evaluate
the second
allegation. Concurrently, Daniel began individual
psychotherapy with another
psychologist, his second therapist.
The father denied the abuse and requested that Daniel’s current
therapist testify
since it appeared that both this therapist and the previous one
had differing opinions
regarding the accuracy of the allegations. The current therapist
wrote the court and
stated that he did not want to testify because it would
‘‘jeopardize his therapeutic
relationship with Daniel’’ (p. 6). The court concurred.
During the trial, both evaluating psychologists testified, and the
second evaluator
had the opinion that Daniel had been sexually abused by his
father. Daniel’s first
therapist testified, proffering a differing opinion about the
alleged acts, and noted
that the fighting between the parents was impacting Daniel. The
court permitted
Daniel to live with his mother and denied the father visitation
rights. The father
appealed, saying that the trial court had improperly excluded
the testimony of his
current treating therapist, thereby violating his due process
rights.

The Sixth District Court of Appeals in California reviewed the
matter and
determined that Daniel had privilege rights that were
independent of his parent’s
guardianship and that it was appropriate that the lower court
had allowed the
therapist not to testify. The Court also concluded that the father
did not necessarily
have access to information about Daniel simply because he was
a parent, exercising
parental rights. The court concluded that under certain
circumstances, a ‘‘minor
child is entitled to the privacy granted by the privilege’’ (p. 8).
The conflict between the right of minors to confidentiality and
privilege and the
right of their parents to information about their child is often
difficult for
psychotherapists to navigate. Since parents are responsible for
caring for their
dependent children, the default position of the law is to give the
parents access to
healthcare information so that they can utilize it in their
children’s best interest.
Children are perceived as not competent to understand their
healthcare and make
wise decisions based on it. In addition, many states have laws
which provide access
to healthcare information to noncustodial parents.
However, decision makers have become increasingly aware that
psychotherapy is

different than other medical services and that complete parental
access to
information can damage the psychotherapeutic relationship.
This is particularly
true when the parents are involved in the contentious custody
battles that often
occur in divorce cases.
States and the federal government have dealt with this
conundrum in different
ways.
Many states have exceptions to blanket parent access and
control written into the
law, exceptions that allow minors of a certain age limited rights
both to consent to
treatment and/or to protect the confidentiality of treatment
information. These
statutes have been enacted in recognition of circumstances
where the minor’s need
for privacy outweighs the parent’s needs for information. For
example, Ohio allows
minors age 14 years and older to consent to confidential mental
health services on an
outpatient basis. Providers of such treatments may not notify a
parent or guardian of
the minor’s treatment without the minor’s consent unless the
provider believes that
such notification is necessary (and the minor is notified), such
as would occur if the
adolescent is actively suicidal or homicidal. Psychotherapy
sessions are limited to six
sessions or 30 days until parental consent is obtained (Ohio
Revised Code, 1989,
5122.04). California has a variety of special provisions in the

law that allow minors
from the age of 12 years to consent to ‘‘mental health
treatment’’ if they have been
the alleged victim of incest or child abuse (California Family
Code, 2007, 6924 B) or
if they are receiving treatment relating to the diagnosis and
treatment of a drug- or
alcohol-related problem (California Family Code, 2007, 6929
4b). In addition,
parents do not have to be informed of this if the professional
delivering the service to
the minor believes that such a contact was inappropriate.
At the federal level, the Health Insurance Portability and
Accountability Act of
1996 (HIPAA; Pub. L. No. 104–191, 1996) allows mental health
professionals to
refuse to give parents access to their minor child’s records if:
they have reasonable
belief that the child may be/has been subject to abuse or doing
so would endanger
child and the psychologist decides, through exercise of
professional judgment, it is
not in the child’s best interest to do so.
The preceding examples clearly indicate that while parents
generally do have rights
to information regarding their children, those rights can be
limited when conflicting
with the child’s best interests or privacy. Regarding In re
Daniel v. Daniel O. H.,
(1990), the Sixth District Court of Appeals noted that:

While we agree that parents may have some rights, because of
the parent–child
relationship, to obtain information concerning the medical
treatment or condition of
their minor children, we believe that disclosure is not required
in all cases y We
believe that, except in special circumstances, if the disclosure
would harm the
therapist–patient relationship or have a detrimental effect on the
minor’s
psychological well being, a parent should be denied access not
only to the records
of the minor child’s psychotherapist, but to the therapists
testimony’’ (p. 9).
Other states have supported this perception of a child’s rights in
their own rulings
(Berg v. Berg, 2005). Massachusetts has arguably gone the
furthest in this area. To
determine whether a child’s privilege should be upheld in a
contested divorce case,
courts must appoint a special guardian ad litem to investigate
and advise the court
on whether the privilege should be waived or upheld.
What is clear from this review is that while both ethics and law
generally support
the rights of parents to decide whether their child receives
treatment and to access
records of that treatment, that is not always the case for a
variety of reasons. For
example, when parents are not necessarily acting in the best
interests of the minor or

when the minor is viewed as mature enough to make these
decisions, the rights of
parents are reduced. When this occurs, the right choice for the
psychotherapist can
become unclear. This potentially places the psychotherapist in a
risky position of
advocacy for the privacy of the minor patient—advocacy that
may be adverse to the
intentions of the parents.
Even when there is no active court case, conflicts between
parental requests for
information and the privacy of a child’s therapy present real
risks. Divorced parents
frequently place the therapist in the middle of the parental
dispute. If a parent
requests information and a therapist refuses to provide it to
protect the child’s
privacy, the parent can end the child’s treatment and may file
licensing board or
ethics charges. In our risk-management consultations, this
situation arises
frequently. Therefore, no matter what the law is in the
particular jurisdiction,
confidentiality and access to information about a minor child
should be discussed
with parents. The results of the discussion should be spelled out
in a written, signed
agreement among the psychotherapist, the parents, and where
appropriate, the child
(Bennett et. al., 2007; Licht & Younggren, 2006).
Confidentiality and Marital Therapy (Wichansky v. Wichansky,
1973)
Mr. and Mrs. Wichansky began marital therapy with Daniel

Sugarman, a
psychologist. The couple eventually decided to divorce, and Mr.
Wichansky
subpoenaed Dr. Sugarman to testify about conversations that
took place in the
marital therapy sessions. Dr. Sugarman attempted to quash this
subpoena,
contending that they were privileged under the statutes of the
State of New Jersey.
Mr. Wichansky asserted that the privilege could not be invoked
because the
psychologist was not a marriage counselor and because both he
and his wife
employed the services of the psychologist.
In making its ruling, the Superior Court of New Jersey opined
that the confidential
communications between a licensed psychologist and clients
have the same status as
those communications that occur between an attorney and a
client. Making further
reference to generic state regulations that addressed marital
therapy, the court
argued that communications made in therapy were protected
from unilateral
disclosure because the participants must be able to talk freely
concerning their
problems without threat of later discovery. To change the right
to confidential

communication because a spouse was present would have a
‘‘chilling effect on the
vital freedom of communication between the parties and the
therapisty’’. The court
decided to quash the subpoena from Mr. Wichansky, thus
upholding Mrs.
Wichansky’s privilege rights and thereby preventing Dr.
Sugarman from testifying.
Confidentiality can become exceedingly complex through the
introduction of
another party into the treatment setting. Conducting couples
therapy, family therapy,
or group therapy magnifies confidentiality concerns and thereby
magnifies profes-
sional risk (Bennett et al., 2007; Pope & Vasquez, 2007; Simon
& Shuman, 2007). We
emphasize the need for all individuals to know their roles and
rights in the treatment
process and the rules that regulate the management of treatment
information.
In the case of couples therapy, as indicated by the Wichansky
decision, the couple
is usually viewed as the patient of the psychotherapist, and
access to the information
about what happened in therapy must come through the
authorization of both
parties. This information usually cannot be introduced into
court or released to any
other party without mutual consent of the couple, unless the
release of information is
authorized by specific state law. In fact, there is strong legal
argument for the fact
that the mere knowledge that one is in couples therapy also is
privileged and

confidential (Smith v. Superior Court, 1981; Weisbeck v. Hess,
1994). The mere
statement by a psychotherapist that someone was in couples
therapy or that couples
therapy was conducted usually reveals the identity of the other
party and thereby
violates that person’s rights to privacy. Thus, even a redacted
summary of treatment
that only refers to what one party did in couples therapy could
still be a violation of
the other person’s confidentiality.
Conjoint family therapy evidences many of the same problems
found in couples
therapy. Here, the family is in therapy, and the release of
information about the
family arguably requires the consent of all parties who hold the
legal right to
consent. Great caution should be undertaken to protect the
participants’ identities
since the psychotherapist owes a professional duty to each.
Consequently, when a
request comes in from one party to family therapy for
information about family
therapy, the treating psychotherapist may, once again, be placed
in a potentially
adversarial position of denying that request because it violates
the privacy rights of
the other individuals in treatment.
Group therapy presents similar confidentiality problems, but
these differ
significantly from the previous two types. All members of a
psychotherapy group
have a right to confidentiality, but information about group
therapy does not require

a release from the other participants unless that information
contains confidential
information about the other members. In essence, an individual
member can consent
to the release of confidential information as long as that
information is sanitized to
insure that it contains nothing revealing about the other group
members that could
be tied to their identities. In some states, group therapy does not
have privilege
protection because of the voluntary disclosure of the
information of the other
members of the group, all of whom could be subpoenaed and
required to testify.
Confidentiality and the Deceased Patient (United States v.
Hansen, 1997)
In a federal trial, Linda Hansen was a defendant charged with
the murder of a
patient of Dudley Dana, M.D. She claimed self-defense and
alleged that the mental
and emotional condition of the deceased patient was a central
element to her claim.
Dr. Dudley asserted privilege on behalf of the deceased,
claiming that the
information being sought by the defendant was protected by the
psychotherapist–-
patient privilege. The court agreed with Dr. Dudley that the

communications being
sought were actually privileged by federal law, but concluded
that in this case the
privilege did not apply because the information being sought
from Dr. Dudley was
central to the defense. It also concluded that the deceased had
little private interest in
preventing disclosure because he was deceased. The court
acknowledged that the
public did have an interest in preventing disclosure since
persons in need of
psychotherapy may be less likely to enter treatment if they fear
their innermost
thoughts might become public. With respect to this, the court
concluded that the
defendant’s need for the information outweighed this interest.
In this case, the court used a balancing test to evaluate the
common law privilege in
federal courts as established by Jaffee v. Redmond (1996)
against other social policy
issues. The court arrived at a conclusion that the importance of
the social policy
prevailed over privilege.
What happens to confidential information upon the death of a
patient tends to be
problematic for the psychotherapist. Questions that arise in this
area are complex
and run the risk of putting professional and personal ethics into
conflict with the law.
For example, what happens to the privilege upon the demise of
the holder of the
privilege? What if a patient revealed personal information
during psychotherapy that
he or she never wanted to be released or made public? Does the

psychotherapist have
an obligation to keep this information from others who now
want access to the
records, contrary to state law? What if the patient was a victim
of a criminal act? Do
the authorities have a right to access the records of the patient
even though it violates
the patient’s privilege? If so, what are the limitations, if any,
placed upon revealing
this type of information?
These are very complex questions that may argue for very
limited disclosure of
confidences after a client’s death. On the other hand, if the
legal representative of an
estate cannot gain access to the decedent’s medical record, how
can he or she fulfill
his or her obligation to investigate potential claims on behalf of
the estate (e.g.,
providing the information necessary to access the proceeds of a
life insurance policy
in the face of a claim for suicide)? To deal with this conundrum
prior to the advent of
HIPAA, many state privilege statutes provided access to
information to the legal
representative only if it was to be used in a legal proceeding on
behalf of the estate.
Sadly, the previous questions still do not always have clear
answers for a variety of
reasons. First, the answers can differ because the laws differ
from state to state, and
finding the correct answer requires familiarity with these state
laws. In most states,
the privilege survives the death of the patient; however,
particularly after the advent

of HIPAA, the privilege passes to the personal (or legally
appointed) representative
of the deceased, who can authorize release of the information.
However, in some
states (e.g., Georgia and arguably Minnesota) upon the demise
of the patient, no one
inherits the privilege, and in essence the privilege dies with the
patient. In addressing
the conundrum created by the inconsistency among states on
this matter, Simon and
Shuman (2007) stated:
Unless there is a specific court decision or statute providing for
the release of
patient records after death y, (stating that the representative of
the patient may
receive the information), the duty to maintain confidentiality
that existed in life
follows the patient in death. (p. 39)
The problem of what can be revealed upon the death of a patient
is only made
more complex by HIPAA. This act is founded on two primary
principles of moral
philosophy: privacy and autonomy. Patients’ access and review
of their records is a
key component of the act, and HIPAA states that the personal
representative of the
patient does have access to the records upon the death or

incapacity of the patient.
This is wrapped around the view that patients, their legal
guardians, or their
personal representative either have the right to the record
(excluding psychotherapy
notes) or inherit that right upon the demise of the patient.
HIPAA also includes a
preemption provision that states that it replaces all state laws
that are not more
protective of privacy than is HIPAA. In this situation, one can
argue that the privacy
of a deceased patient and access by his or her legal
representative are in conflict;
however, many commentators believe that the clear intent of the
law is to provide
access in this situation (American Psychological Association
Insurance Trust, 2006).
This question will not be resolved for certain until there is a
court case that
specifically addresses this matter.
If information can be legally and ethically revealed, how much
should be revealed?
Psychotherapists confronted with legal requirements to reveal
confidential informa-
tion should do everything that they can to minimize the amount
of information
revealed and still comply with the request. Relevancy is key
(Simon & Shuman,
2007). In legal matters, the amount of record made public can
be reduced, thereby
protecting some of the privacy rights of the deceased. By
minimizing intrusion into
the deceased’s private information, the psychotherapist truly
attempts to respect the
value of confidentiality. For example, in some states the coroner

has rights to the
records of the deceased, but the rights to these records is
usually limited to cause of
death and related issues and thus does not give the coroner or
other legal authorities
the right to review the whole record.
If the psychotherapist believes that a request for information
about a deceased
person runs contrary to the deceased’s intentions and if the
request for this
information is legal, the psychotherapist is truly in the middle
of a collision of ethics
and law. While the ethical answer to this conundrum may be to
not turn the
information over, not doing so may be seen as an illegal act. In
these situations, the
psychotherapist might choose to not release the information
until the records, which
would include the psychotherapist’s concerns about why they
should not be released,
have been reviewed by a judge. At this point, it is unlikely
(although not impossible)
that insisting on a court order before releasing the full record
would be construed by
the court as contempt. The complexity of these situations and
the probability of
professional risk that follows almost always requires that the
practitioner obtain
legal consultation prior to taking any action.
Practice Recommendations
The reviewed four areas clearly demonstrate that fulfilling
confidentiality require-
ments can be quite daunting. Because this ethical requirement

overlaps with the law,
answers must be predicated upon an understanding of both
ethics and law, and if
necessary, legal consultation. Of course, psychotherapists can
analyze ethical
dilemmas created by a confidentiality question and arrive at
ethically solid answers
consistent with the law. In that spirit, we would like to make the
following
recommendations, which will significantly minimize
professional problems that
could arise in this area.
Many of the problems regarding confidentiality and privilege
can be avoided
through the appropriate use of written informed consent. By
outlining the rules of
treatment at the outset of the establishment of the professional
relationship,
psychotherapists can essentially form contracts with their
clients about how the
treatment information will be used. Such documentation can
define who the patient
is, who can release the information, and for what the
information is intended.
Written informed consent forms also can include the reporting
requirements of each
respective state and a review of the exceptions to privilege that
would waive the

patient’s rights to prevent the information from being included
in a legal matter.
Patients should be encouraged to ask questions about the
informed consent
procedure, and the review of any questions about informed
consent should be noted
in the patient’s chart.
If confronted with a confusing question about confidentiality,
psychotherapists
should refrain from action until they have secured answers
through consultation
with peers with expertise in ethics and law, or with an attorney.
Psychotherapists
should not accept legal advice given to them by attorneys
representing other
individuals in a matter since they cannot represent the interest
of the psychothera-
pist. Legal consultations may be available through a state
psychological association
or a malpractice carrier.
When more than one person is involved in treatment,
practitioners should outline
the rules of psychotherapy, defining who the patients are and
who controls the
information. They should separate patients from collaterals (i.e.,
individuals who
assist in treatment but to whom there is no duty).
Psychotherapists must outline for
collaterals their roles in the therapy process and the
professional responsibilities to
them, including how their information will be used. Finally,
psychologists also
should make use of a collateral informed consent (American
Psychological

Association Insurance Trust, 2007; see
http://www.apait.org/apait/download.aspx)
if they want to keep a signed record, but at a minimum, the
discussion of
responsibilities to and the use of the information from
collaterals should be noted in
the patient’s chart.
Psychotherapists should outline for both children and parents
the limits that exist
on confidentiality when treating minors. They should contract
with the parents to
protect the privacy of their minor child in a way that fulfills the
parents’ needs to
understand what is generally going on in treatment without
violating the minor’s
confidentiality rights.
If a psychotherapist believes that parents are not acting in their
child’s best
interests, they should obtain legal consultation on how to
prevent parental access to
information about the treatment of their child. The importance
of obtaining
competent legal advice in these situations cannot be overstated.
If a psychotherapist believes that a request for records violates
confidentiality, he or
she should assert the privilege on behalf of the client and let the
respective court resolve
it. Depending upon the laws of each state, a psychologist may
be required to allow the
presiding judge to review these materials en camera, which
means in the confidentiality
of his or her chambers. Again, one should never do this without
legal advice.

References
American Association of State and Provincial Psychology
Boards. (2005). ASPPB code of
conduct. Available at:
http://www.asppb.org/publications/model/conduct.aspx.
American Psychological Association. (2002). Ethical principles
of psychologists and code of
conduct. American Psychologist, 57, 1060–1073.
American Psychological Association Insurance Trust. (2006).
HIPAA for psychologists:
Questions and answers. Available at:
http://www.apait.org/apait/resources/hipaa/faq.aspx.
American Psychological Association Insurance Trust. (2007).
Sample outpatient services
agreement for collaterals. Available at:
http://www.apait.org/apait/download.aspx.
Bennett, B.E., Bricklin, P.M., Harris, E., Knapp, S.,
Vandecreek, L., & Younggren, J.N.
(2007). Principles of risk management: A patient-oriented

approach. Washington, DC:
APAIT.
Berg v. Berg, 152 N.H. 658, 886 A.2d 980 (N.Ha. S. Ct., 2005).
California Board of Psychology Laws and Regulations. (2007).
Extracted from Family Code
(y 6924, p. 198). Charlottesville, VA: Matthew Bender &
Company.
California Board of Psychology Laws and Regulations. (2007).
Extracted from Family Code
(y 6929, p. 200). Charlottesville, VA: Matthew Bender &
Company.
Ensworth v. Mullvain, 224 Cal. App. 3d 1105; 274 Cal. Rptr.
447 (October 1990).
Health Insurance Portability and Accountability Act of 1996.
Pub. L. No. 104–191, 104th
Cong. (1996).
Jaffee v. Redmond (95–266), 518 U.S. 1 (1996).
Licht, M., & Younggren, J.N. (2006). Guidelines for treating
children in high conflict divorce.
The California Psychologist, 39(5), 31–34.
Ohio Revised Code, y 5122.04, Outpatient services for minors
without knowledge or consent
of parent or guardian (07–01–1989).
Pope, K.S., & Vasquez, M.T. (2007). Ethics in psychotherapy

and counseling. San Francisco:
Jossey-Bass.
Simon, R.I., & Shuman, D.W. (2007). Clinical manual of
psychiatry and law. Washington,
DC: American Psychiatric.
Smith v. Superior Court, 173 Cal. Rptr. 145 (Cal. Ct. App.
1991).
Tarasoff v. Regents of the University of California, 17 Cal. 3d
425; 551P.2d 334 (Cal. Rptr.,
14, 1976).
United States v. Chase, 340 F.3d 978 (9th Cir. 08/22/2003).
Weisbeck v. Hess, 523 N. W. 2d 363 (S.D. 1994).
Wichansky v. Wichansky, 126 N.J. Super. 156, *; 313 A 2d 222;
1973 N.J. Super. (1973).
I n f o r m e d C o n s e n t t o P s y c h o t h e r a p y : P r o t e
c t i n g t h e D i g n i t y
a n d R e s p e c t i n g t h e A u t o n o m y o f P a t i e n t s

m
Celia B. Fisher and Matthew Oransky
Fordham University Center for Ethics Education
Well-implemented informed consent procedures demonstrate
psy-
chotherapists’ respect for clients’ right to self-determination
and can
initiate meaningful contributions to treatment through
enhancing
mutual trust, building rapport, and facilitating a sense of
ownership.
This article details key components of informed consent to
psychotherapy by placing them within real-world psychotherapy
scenarios. We provide information on client–therapist
discussions of
the nature and course of therapy, fees and payment policies, the
involvement of third parties, confidentiality policies, and new
and
untested treatments. In addition, this article addresses informed
consent procedures for individuals with impaired cognitive
capacities
and under the Health Insurance Portability and Accountability

Act of
1996 (HIPAA) regulations. & 2008 Wiley Periodicals, Inc. J
Clin
Psychol:In Session 64: 576--588, 2008.
Keywords: Informed consent; psychotherapy; ethics; HIPAA
Providing clients with the opportunity to make an informed
decision about engaging
in psychotherapy communicates respect for personhood and
reflects the collabora-
tive nature of psychotherapy. In this vein, informed consent to
psychotherapy not
only satisfies the ethics of professional conduct but is integral
to the formation of a
balanced and healthy therapeutic relationship. For example, by
asking for voluntary
participation, informed consent demonstrates respect for a
client’s autonomy and
right to self-determination. Furthermore, informed consent
procedures emphasize
the patient’s role in making treatment decisions, increasing a
sense of ownership over
the process. Indeed, therapies that emphasize and employ the
agency and self-
direction of the patient tend to have more successful outcomes
than therapies that do
not (Beahrs & Gutheil, 2001; Draper, 2000; Pope & Vasquez,
2007). Informed
Correspondence concerning this article should be addressed to:
Celia B. Fisher, Department of
Psychology, Fordham University, Bronx, NY 10458; e-mail:
[email protected]

JOURNAL OF CLINICAL PSYCHOLOGY: IN SESSION, Vo l .
6 4 ( 5 ) , 5 7 6 -- 5 8 8 ( 20 0 8 ) & 2008 Wiley Periodicals,
Inc.
Published online in Wiley InterScience
(www.interscience.wiley.com). D O I : 1 0 . 1 0 0 2 / j c l p . 2
0 4 7 2
consent procedures also can establish the therapist and patient
as partners working
toward a common goal, decreasing the likelihood that patients
will put the therapist
on a pedestal and become overly or dangerously dependent
(Beahrs & Gutheil,
2001). Finally, informed consent procedures can reduce a
patient’s anxiety by
demystifying the therapeutic process.
The American Psychological Association’s (APA; 2002) Ethical
Principles of
Psychologists and Code of Conduct (hereafter the Ethics Code)
recognizes the
importance of informed consent procedures as an aspirational
principle (Principle E:
Respect for People’s Rights and Dignity) and as required
behavior. The Ethics
Code’s enforceable standards relevant to informed consent to
psychotherapy are
embodied both under the broader Standard 3.10 Informed
Consent and the more
specific Standard 10.01 Informed Consent for Therapy. This
article details the ethical
rationale for the Ethics Code’s standards on informed consent
and places them
within the context of real-world psychotherapy scenarios.

General Requirements of Informed Consent
Informed consent is often seen as the primary means of
protecting the self-
determination and self-governing rights of those with whom
psychotherapists work.
To this end, informed consent to therapy is invaluable as it
ensures that a patient’s
decision to take part in psychotherapy is informed, voluntary,
and rational. Whether
in written or oral presentation, psychotherapists must make
every effort to use
consent language that is understandable to the patient. For
different clients, this may
require familiarity with literature on the communication needs
of individuals varying
in age, language, cultural background, and other individual
characteristics.
Case 1: Cultural Expectations
A client who had recently immigrated to the United States from
China told a
psychotherapist that his general practitioner had referred him to
her for treatment
for his trouble falling and staying asleep. After she listened to
the man’s presenting
problem, the therapist briefly explained that she applied a
cognitive-behavioral
treatment technique to working through insomnia with patients.
The patient was
rather quiet during the session, and when at the end of the
session the clinician asked
if he had any questions, the patient asked what kind of
medication she would be

prescribing. In response, the therapist carefully explained how
her cognitive-
behavioral treatment differed from standard pharmacological
care.
Clinician red flag. Psychotherapists may assume that most
patients seeking
treatment are familiar with the basic goals of and practices
involved in
psychotherapy. For those living in large metropolitan areas, this
may be even
more true. However, familiarity based on pop-culture
representations of
psychotherapy (e.g., on television shows, TV commercials,
movies, novels) often
misrepresent, simplify, or exaggerate the therapeutic process.
Thus, it is important
that psychotherapists do not assume that new clients truly
understand the nature of
psychotherapy (Fisher, 2003a).
Competency to Give Consent Capacity
The rights of minors and adults who are legally incompetent to
give consent are
protected by Ethics Code Standard 3.10b. Issues related to the
treatment of minors
are examined in detail in Koocher’s (2008) contribution to this
issue. Here, we focus
577Informed Consent to Psychotherapy

on adults with persistent, transient, or increasing cognitive
impairments, including
those with mental retardation, schizophrenia, or Alzheimer’s
disease. Although a
legally appointed guardian may be officially responsible for
medical and mental
health care decisions, psychotherapists must nevertheless
provide patients with an
appropriate explanation of services, consider the patient’s
preferences and best
interests, and seek the patient’s assent.
Psychotherapists are well advised to view consent capacity not
as an all-or-none
ability but as a continuum (Bennett et al., 2006). Indeed, a
goodness-of-fit model of
the informed consent process (Fisher, 2003b; Fisher, Cea,
Davidson, & Fried, 2006)
recommends that psychotherapists design informed consent
processes to fit each
patient’s cognitive strengths, vulnerabilities, and decision-
making capacities and
styles. For example, adults with mild levels of developmental
disabilities may have
the cognitive abilities to understand the reasons for and nature
of therapy, but may
be at a disadvantage because they lack experience making
healthcare decisions on
their own (Fisher, 1999, 2002a, 2002b). Approaching the
consent conference in an
educational manner and encouraging patients to discuss
treatment decisions with
family members or other trusted care providers may enable them
to make more
informed decisions.
Therapists should not assume consent impairment simply based

on a diagnosis.
Indeed, studies of consent capacity consistently demonstrate
marked within-
diagnosis heterogeneity, with level of cognitive confusion or
distortion—particularly
verbal and executive functioning skills—a more reliable
predictor of consent capacity
than diagnostic criteria (Howe et al., 2005; Jeste & Saks, 2006).
Psychologists also
may draw upon assessment instruments such as the MacArthur
Competence
Assessment Tool for Treatment (MacCAT-T; Grisso et al.,
2001; Palmer et al., 2005)
to evaluate consent capacity (for adaptation of the MacCAT-T
for adults with
mental retardation, see Cea & Fisher, 2003).
Clinician red flag. Questions of consent capacity most likely
arise when a patient
refuses treatment that the psychotherapist, family members, or
other healthcare
providers believe to be the best course of action. It is important
that clinicians not
assume that a client lacks the reasoning skills necessary for
consent capacity just
because he or she disagrees with the expert opinion about the
necessary course of
treatment. Likewise, it would be dangerous for clinicians to
assume that a client
possesses the capacity to consent merely because he or she
agrees with the suggested
course of treatment (Fisher, 1999). Adults with a history of
mental disorders may
lack confidence in expressing their own opinions and may agree
to a course of

treatment simply because it is suggested by an authority figure.
Informed Consent Timing
As written in Standard 10.01 of the Ethics Code, psychologists
should strive to
present each client with the information necessary for informed
consent ‘‘as early as
is feasible’’ in the therapeutic relationship. While informed
consent ideally would be
obtained in the first session, this is not always possible or
clinically appropriate. For
example, informed consent during the first meeting may be
contraindicated if the
patient is in a crisis that requires urgent therapeutic care
(Fisher, 2003a). In such
cases, consent should be obtained at the first possible
opportunity once the crisis has
subsided. Additionally, because insurance policies often dictate
the duration of
therapy, psychotherapists may be unable to accurately inform
clients about the
course of their therapy until they receive the necessary
information from the client’s
managed care organization (Fisher, 2003a).
Informed consent to psychotherapy is best conceptualized as an
ongoing process,
designed around a patient’s evolving treatment needs and the

subsequent treatment
plans to which he or she must consent (Fisher, 2003a). Survey
research among 130
practicing psychotherapists has confirmed the usefulness of a
‘‘process’’ model of
informed consent (Pomerantz, 2005). Indeed, while some parts
of the informed
consent process can reliably occur at the outset of therapy (e.g.,
confidentiality and
disclosure procedures, fees and payment options, cancellation
policies), more
substantive parts of the informed consent process may continue
into the second,
third, or even fourth session. Many therapists have reported that
information such as
the specific goals of the therapy, the techniques used, and the
estimated duration of
the therapy may not be clearly formed during the initial
meeting; in such cases, it is
neither in the best interest of the client nor the therapist to
establish such matters in
haste (Pomerantz, 2005).
Case 2: Responding to the Immediate Needs of Clients
During an initial therapy session, the client appeared quite
excited. Speaking rapidly,
he told the psychotherapist he was planning a gambling trip that
he was sure would
win him millions of dollars. After some probing, the therapist
learned that the
patient had recently stopped taking his medication prescribed
for bipolar disorder
because he had been feeling so happy. The therapist decided to
postpone discussions
of some elements of informed consent and focus the initial

session on helping the
client deal with his manic episode and the immediate crisis.
After assessing the
patient and deciding that he was not in immediate danger, at the
end of the session
the therapist and patient made a follow-up appointment for the
next day, and the
therapist gave him a referral for an appointment with a
psychiatrist with whom she
often consulted. During the second appointment, the practitioner
felt the situation
was stable enough to present the patient with informed consent
information,
including the anticipated nature and course of therapy as well as
a discussion of fees
and confidentiality policies.
Clinician red flag. Some treatment facilities and practitioners
require clients to
sign informed consent documentation before entering the
therapy room. In many of
these instances, the forms are handled by administrative staff
and may not be written
in plain language or adequately explained (Pope & Vasquez,
2007). The purpose of
such forms is often to release the institution from legal liability.
If clinicians are
unable to change these informed consent procedures, they still
should openly and
comprehensively discuss with their clients issues such as
payment, confidentiality,
involvement of third parties, and treatment goals, protocols, and
duration.
The Nature of the Psychotherapy

The movement to formalize informed consent procedures for
psychotherapy grew in
large part out of the fear that clinicians were negligent in
advising their patients
about treatment options other than their own (Beahrs & Gutheil,
2001). The
Osheroff v. Chestnut Lodge (1980) court case was instrumental
in popularizing the
notion of psychotherapist negligence. After undergoing a year
of extensive, but
unsuccessful, inpatient psychoanalysis for major depression,
Osheroff discontinued
therapy and began a course of antidepressant medications to
which he reportedly
responded well. In this case, the plaintiff asserted that had he
been told of this option
in advance, he could have been spared a year of severe
psychological distress and a
large financial burden. Although the case was settled out of
court—thus leaving no
legal doctrine or precedent—it shifted public attention to the
role of informed
consent in psychotherapy, specifically the therapist’s duty to
present clear
information regarding the nature of treatment and goals of
therapy, and when
appropriate, viable treatment alternatives (Beahrs & Gutheil,
2001). This emphasis
on full disclosure is representative of a societal shift from the

traditional paternalistic
medical model of healthcare to one that respects the autonomy,
agency, and self-
determination of patients (Fisher, 2003a).
Standard 10.01 of the Ethics Code requires therapists to inform
patients of the
nature and aspects of therapy that would reasonably be expected
to affect their
decisions to enter into therapy with the psychologist. This
information typically
includes, but is not limited to, appointment schedule, the
duration of each session,
and the general treatment objectives and therapeutic techniques.
Depending
upon the clinician’s treatment approach, the consent process
might inform patients
that treatment entails exposure therapy, dream analysis, detailed
developmental
history, conjoint family sessions, behavior contracts, homework
assignments, or any
other information relevant to making an informed decision to
engage in treatment
(Fisher, 2003a).
Case 3: Describing Potentially Anxiety Producing Components
of Therapy
During her first therapy session, a client tells the psychologist
that despite
having landed her dream job, she is feeling anxious and
stressed. She has developed
a crippling fear of elevators in the last several years, and her
new job is on the 30th
floor of a high-rise building. After listening to his new client’s
presenting

problem and establishing good rapport, the therapist explains
that a cognitive
behavioral treatment—involving relaxation techniques coupled
with gradual
exposure to elevators—has shown to be very effective in
overcoming specific
phobias and would be his treatment of choice. He explains that
to accomplish
the goals of therapy, he and the patient will need to meet on a
weekly basis
and that the patient will be expected to complete regular
homework assignments,
usually entailing practicing the relaxation technique. After
explaining that this
type of treatment usually takes about 3 to 4 months, the
therapist assures his patient
that the treatment pace will be matched to her comfort level. In
addition, the
therapist makes sure to encourage the patient to ask questions
about any concerns
she may have.
In the aforementioned example, knowing that patients suffering
from phobias may
become anxious when told about exposure therapy, the
psychologist fully discloses
the key elements of his therapeutic techniques only after he has
established a trusting
rapport. To provide the patient with sufficient information to
make a choice about
continuing therapy, he then makes sure to inform her about
activities that may make
her uncomfortable (e.g., getting in an elevator) and parts of the
process which she
will be required to do on her own (e.g., homework assignments).
He encourages her

to ask questions, which in turn helps to fortify a trusting and
collaborative
therapeutic alliance. Case 4 illustrates how well-intentioned, but
ethically and
therapeutically naı̈ ve, decisions to withhold information about
the nature of therapy
may create iatrogenic results.
Case 4: Avoiding Discussion of Potentially Anxiety Producing
Methods
A young man seeks therapy due to a dog phobia that has
significantly limited his
functioning. During the informed consent procedure, the
therapist explains that she
will begin the treatment by teaching the young man some
relaxation techniques that
he will then be required to practice at home. Once this has been
accomplished, she
will begin the next step of the treatment by showing him a slide
show of different
dogs. The day he is able to look at a picture of dogs without
hesitation, he feels
accomplished and relieved, and believes that his therapy is
coming to a close. At the
beginning of the next session, the therapist meets him at the
door to her office, gently
warning him that she has a live (but small) dog in the room. She
tells him that over
the course of the next three sessions, she wants him to be able

to pet the dog. When
the patient balks at the suggestion, she informs him it is the
only way to truly
conquer his fear and end his suffering. The patient feels as
though he has been misled
in his informed consent. He looks back at the consent process as
being full of ‘‘half-
truths’’ and finds it difficult to trust or feel safe with his
therapist again.
The psychotherapist in this scenario may have been well
intentioned. Perhaps she
thought that the idea of live contact with a dog would be so
anxiety producing that
the patient would outright refuse to join treatment. Perhaps she
did not want her
client to spend weeks worrying about his eventual contact with
a live dog. No matter
what the therapist’s intention, professional ethics and
collaborative practice require
practitioners to fully inform patients as early as feasible about
treatment goals and
techniques during informed consent. If the practitioner thought
that informing her
client about contact with a live dog would be too anxiety
producing during the initial
informed consent process, she could have waited until his
symptoms had decreased
rather than introducing the animal in an earlier session. This
decision would reflect
the evolving nature of consent to new stages of the treatment.
Anticipated Course of Treatment
Patients will be able to make the most informed decision about
participating in

treatment if they have information about the amount of time
treatment will take.
The anticipated course of therapy typically refers to the number
of sessions the
psychologists thinks will be necessary to treat the presenting
problem based on the
information presented by the patient and professional expertise
regarding a typical
course of treatment (Fisher, 2003a). Therapy, like informed
consent, is an evolving
process, and unanticipated patient needs may require
modifications in the course and
nature of therapy. As illustrated in Case 5, consent discussions
also should strive to
make clients aware of the possibility that the length of
treatment may be reassessed
and discussed again as the psychologist learns more about
treatment needs or unique
personality characteristics.
Case 5: Providing a Balanced Perspective on the Anticipated
Length of Therapy
A psychologist saw a new client who complained of depressive
symptoms and
relationship difficulties. As part of the informed consent
process, the therapist
explains her interpersonal therapy, highlighting the fact that it
is a manualized
treatment with demonstrated effectiveness in research studies
for the client’s
symptoms. She also describes the average number of sessions
after which clients
often feel some relief from their symptoms while making sure to
emphasize that each

person responds differently and that they will together reassess
her progress after a
specific number of sessions.
Clinician red flag. It may be frustrating for both patient and
psychotherapist when
treatment plans do not move according to a proposed schedule.
Treatment schedules
can be disrupted by patient resistance, unforeseen treatment side
effects or needs,
trauma or stressful events, or simple individual differences. In
reaction to such
uncertainty, therapists may avoid making predictions regarding
the length of treatment.
The Ethics Code Principle C: Integrity encourages psychologists
to promote accuracy,
honesty, and truthfulness in their practices and to avoid unwise
or unclear
commitments. For many disorders, psychologists can draw upon
a substantial body
of scientific knowledge and their own clinical expertise to
anticipate the average number
of sessions as well as to expect that such estimates will
probably evolve. Therapists
familiar with a client’s insurance plan also may be able to
estimate the degree of
progress that can be made within and beyond the number of
sessions covered. Honestly
sharing this information gives them the opportunity to make an
informed choice about

continuing in treatment and helps to maintain the therapeutic
alliance.
Fees and Financial Arrangements
As embodied in Ethics Code Standard 6.04a Fees and Financial
Arrangements,
psychologists are responsible to discuss with clients as early as
feasible information
about fees, payment options, and plans. Whenever possible,
therapists also should
inform a client of the fee for the initial session when the patient
calls for an
appointment. Barring an acute mental health emergency, a full
discussion of fees and
payment options usually takes place during the initial meeting.
Discussion of fees
most often includes the cost of the therapy, types of
reimbursement accepted
(e.g., checks, credit card payments, direct payment from
insurance companies), the
payment schedule (e.g., weekly, monthly), when fees may be re-
negotiated
(e.g., annual fee raises), and practitioner policies regarding
missed appointments
and late payments (Fisher, 2003a). In instances in which
therapists are unfamiliar
with a patient’s insurance plan, they can inform the patient that
(with the patient’s
written authorization) they will communicate with the insurer
and discuss coverage
and payment options at or before the next session. As soon as
they gather the
appropriate information, therapists should inform their patients
of the percentage of
therapy costs covered by their health insurance and any

limitations their health plan
may put on the number of sessions it will cover (Acuff et al.,
1999).
Case 6: Treatment Limits Imposed by Health Plans
Before coming in for her initial meeting, a patient made sure
that her psychologist
took her insurance plan. On the telephone, the psychologist
explained that the
insurance company would cover 50% of each session and that
the client would have
to pay the rest out-of-pocket. Once the therapy sessions began,
the patient received a
bill for her half of the therapy costs at the end of each month.
One month, the client
was surprised to receive a bill that was much higher than usual.
Certain it was a
mistake, she called her insurance company to inquire about the
error. A staff
member at the insurance company explained that based on her
therapist’s report of
the progress of her symptoms, her weekly therapy was no longer
deemed ‘‘medically
necessary’’ and that her psychotherapy benefits were
discontinued. The patient was
shocked that this was the first she was hearing about any such
limit.
Clinician red flag. Practitioners directly contracting with HMOs

may have
agreements that provide financial incentives to limit the number
of treatment
sessions. Ethical practitioners will ensure that such
arrangements do not affect their
objectivity or influence their treatment plans in ways that
jeopardize patient welfare
(Standard 3.06 Conflict of Interest). When legally permissible,
psychologists should
inform patients about such agreements (Acuff et al., 1999;
Fisher, 2003a).
Involvement of Third Parties
In some cases, a third party may be involved in paying for the
client’s treatment.
A third party can refer to legal guardians, employers,
organizations, insurance
carriers, medical companies, or other legal or governing
authorities. Standard 10.01
Informed Consent to Therapy requires psychologists to inform
patients of the
involvement of third parties. Clients should be informed if a
third party has
requested the therapy, is paying for the therapy, or if they are
legally or contractually
entitled to receive diagnostic evaluations or other information
regarding the therapy,
and to whom this information will go, providing written release
or authorization
from the client (Fisher, 2003a).
Case 7: Involvement of Third Parties in Financial Arrangements
A psychotherapist working as an outside consultant for an
assisted-living residence is

approached by the son of a resident requesting that she provide
psychotherapy for
his mother. He tells the psychologist that his mother was
diagnosed with moderate
depression and that her health insurance has approved payment
for only an
antidepressant medication; however, the patient’s son would
like her to receive
psychotherapy. He also tells the psychologist that his mother
does not have the funds
to pay for therapy and would refuse treatment if she knows that
her son would have
to pay for it. The man asks the psychologist if she would tell his
mother that
psychotherapy is included in the cost of the assisted-living
home. The psychologist
conducted a recent assessment of the resident as part of her
consulting duties and
concurred with the depression diagnosis, but found no evidence
that the woman
lacked the cognitive capacity to consent to her own treatment.
She informs the son
that while her professional code of ethics does not permit her to
hide such third-party
involvement from a patient, she would discuss the issue with his
mother during an
initial meeting and also explore with the mother whether it
might be beneficial to
have a family session.
Describing the Limits of Confidentiality
Maintaining patient confidentiality promotes the therapeutic
alliance and reflects the
profession’s respect for the privacy and dignity of persons. The
Ethics Code devotes

an entire section to standards on confidentiality protections;
however, the obligation
to respect patient autonomy sometimes conflicts with the
therapist’s obligation to
safeguard the welfare of patients and protect others from harm.
Recognizing this
dual obligation, the Ethics Code also permits disclosure of
confidential information
to protect the welfare of patients and others (Standard 4.05b
Disclosures).
Confidentiality and its exceptions in psychotherapy are detailed
in this issue in an
article by Jeff Younggren (2008). In this section, we focus on
informing clients about
the extent and limits of confidentiality.
Several standards within the Ethics Code mandate that clients
are told about the
extent and limits of confidentiality during informed consent.
Important information
to convey includes limits to confidentiality, such as disclosure
of child abuse, elder
abuse, or other state laws governing mandatory reporting, and
the therapist’s
policies for disclosing confidential information for professional
services, consulta-
tion, or to protect the patient or others from harm. In cases
involving minors or
adults with impaired consent capacities, psychotherapists
inform patients about

guardian access to records (Fisher, 2003a). Furthermore, when
working with
patients whose treatment will be covered by health plans,
psychotherapists typically
discuss what information will be made available to case
managers working at their
health company (Acuff et al., 1999). Due to the sensitive
information disclosed
during therapy, psychotherapists may want to remind clients
from time to time
about confidentiality policies.
Case 7: Confidentiality and Disclosure Related to Domestic
Violence
A man decided to enter therapy after separating from his wife of
many years. During
the initial session, he told the clinical social worker that he was
having difficulty
concentrating at work and controlling his sense of loss and
anger. During the
session, the clinician explained that while what the patient said
during the sessions
would be kept confidential, there could be exceptions if the
clinician believed that
there was an imminent risk that the client might harm himself or
someone else.
During the third session, the client was very agitated and
admitted to the social
worker that he had devised a plan to assault his wife and could
not stop thinking
about retaliation. After assessing the level of risk presented by
her patient’s violent
feelings, the clinician reminded the client of the disclosure
policies. They spent the
rest of the session discussing strategies for reducing the

husband’s agitation and
other risk factors known to be associated with domestic
violence. At the end of the
session, the client agreed to permit the social worker to arrange
short-term
hospitalization.
Implications of the Health Insurance Portability and
Accountability Act
Psychologists providing healthcare services must include in
their informed consent
procedure requirements of the Health Insurance Portability and
Accountability Act
of 1996 (HIPAA). HIPAA regulations cover any clinical
practice or healthcare
provider that electronically creates or receives protected health
information (PHI)
from insurance companies. HIPAA is not triggered with each
individual patient;
rather, if a psychotherapy practice has electronically transmitted
any PHI, the
psychologists are considered a covered entity in regards to each
client thereafter
(Fisher, 2003a). HIPAA mandates that each client receives a
Notice of Privacy
Practices, which includes a document detailing patients’ rights
to access and amend
their PHI, restrict uses and disclosures, and to receive an
accounting of disclosures
made by the provider to others during the past 6 years.
Additionally, psychologists
who are considered covered entities must demonstrate that
patients have received the
privacy notice and the information it entails. Psychologists
typically do this by

obtaining the patient’s signature in a format that demonstrates
that the privacy
notice has been read and understood. If a patient refuses to sign
the Privacy Notice,
psychologists should probably note this in their official records
(Bennett et al., 2006).
In cases in which a patient is unable to make his or her own
health-related decisions,
a personal representative must be appointed to receive and sign
the privacy notice.
Exceptions to this rule can be made if the psychologist suspects
that the personal
representative is abusing the patient (Fisher, 2003a).
Psychologists have traditionally sought permission from
patients to disclose
private health information to other professionals and managed
care organizations.
HIPAA has formalized the requirements for such permission.
For each request to
send information to a third party, a written document
authorizing the release of such
information must include a description of the information to be
disclosed,
identification of the specific person(s) to whom the
psychologist is authorized to
disclose information, a description of the purpose of the
disclosure, a statement
explaining the patient’s right to revoke the disclosure,

exceptions to the right to
revoke, an expiration date, and the patient’s signature (Fisher,
2003a). In most cases,
the patient receives a copy of the written authorization as well.
Importantly,
psychologists making such disclosures should disclose no more
than what is
sufficiently required for the third party to carry out its
responsibilities.
Clinician red flag. When making referrals to other treating
professionals, it is
often helpful to share PHI information with them so that they
can best treat the
patient. When working with a long-term, trusting client such as
the one described in
the next scenario, it may seem natural to both psychologist and
client to simply
contact the colleague and jointly discuss the case information.
Indeed, in
circumstances such as these, psychologists infer that the
particular client would
not object to such a discussion between his psychologist and
psychiatrist. However,
legal and ethical guidelines inform us that it is more prudent to
make sure that the
client has authorized, in a written document, the release of the
specific information
before it is shared.
Case 8: Authorizing Release of Information
A middle-aged man suffering from moderate anxiety has been in
psychotherapy for
over a year when he and his therapist decide it is time for him
to have a medication

consultation. They agree that the psychologist should send a
written report to a
psychiatrist who is on the patient’s health-coverage plan. The
patient trusts his
psychologist and thinks it is unnecessary to sign a form
authorizing her to transmit
the information. After discussing the protections that an
authorization provides, the
patient agrees to review and sign the authorization form.
Consent for New and Untested Treatments
For therapies to evolve and to be introduced into practice,
psychotherapists need the
freedom to employ experimental and alternative treatments
when preliminary
knowledge suggests that they may be helpful. At the same time,
when compared to
more traditional methods, the effectiveness and risks of such
treatments have not
been established. Since patients may assume that they will be
receiving treatments
supported by scientific research and widely accepted by
practitioners, it is especially
important to describe the nature of new treatments during
informed consent. Ethics
Code Standard 10.01b requires that psychologists who are
considering using a new
or experimental treatment inform their clients of this fact, the
potential risks of the
new treatment, describe alternative treatments that may be
available, and emphasize
that participation in the experimental treatment is voluntary
(Fisher, 2003a).

Case 9: Influencing Rather Than Informing Consent to New
Treatments
Frustrated with how his patients were responding to evidence-
based treatments for
generalized anxiety and dysthymia, a psychologist seeks out
workshops on
alternative treatments. Intrigued by a new yogic breathing
method, he decides to
implement the yogic teachings with his patients who are
suffering from anxiety and
depression. Rather than emphasizing the experimental nature of
the treatment to his
patients, the psychologist emphasizes the profound effect it has
had in his own life.
He encourages his clients to consent to such treatment without
discussing the
alternative established treatments that are available.
Clinician red flag. When an experimental treatment has worked
well with a
number of consecutive clients, it may be natural for the
clinician to no longer
conceive of it as an ‘‘experimental’’ treatment; however, until a
treatment is backed
by an acceptable body of scientific or clinical knowledge, it
should be presented to
each client as experimental.
When the Therapist Is a Trainee

Many organizations providing mental health services also
provide practicum and
internship experiences for trainees. When a trainee provides
psychotherapy, the
trainee’s supervisor is legally responsible for the trainee’s
decisions and actions.
Standard 10.01c requires that patients be informed that their
therapist is a trainee,
that the supervisor is responsible for the trainee’s therapy, and
that the trainee meets
regularly with the supervisor for guidance and advice.
Additionally, the trainee will
typically give the supervisor’s name and contact information to
his or her clients.
Importantly, this Ethics Code Standard does not apply to
licensed practitioners
receiving postdoctoral training (Fisher, 2003a).
Case 10: Advising Clients That the Therapist Is a Trainee
A trainee feels insecure about telling clients that she is not a
licensed practitioner.
She fears that they will reject her services or that they will
carefully monitor any
mistakes that she makes. She tells her supervisor that she has
held off mentioning her
trainee status during the initial session with two new clients so
that a trusting
therapeutic alliance can be formed. Although her supervisor
empathizes with her
discomfort, he explains that by not disclosing her trainee status
she may have in fact
undermined the future of the therapeutic alliance since they may
now question her
integrity and motives for not disclosing sooner. The supervisor
works with the

supervisee on ways in which she can introduce discussion of her
status at the next
session with these clients.
Clinical red flag. Predoctoral clinical trainees may find that new
clients begin a
session calling the trainee ‘‘Doctor.’’ Even when trainees
inform clients that they are
under supervision, some clients may feel it is respectful or feel
more comfortable
using the ‘‘Doctor’’ designation. When such circumstances
arise, the trainee should
work with the client to use a designation that is appropriate to
the trainee’s status.
Trainees should be aware that failure to take additional steps to
encourage the client
to use a correct designation is contrary to the intent of the
Ethics Code’s Standard
prohibiting false or deceptive statements about academic
degrees.
Conclusions
Informed consent procedures reflect the profession’s
commitment to respecting
clients’ self-determination and autonomy. Demystifying the
therapeutic process and
giving clients a sense of ownership—both of which can be
initiated through informed
consent procedures—can enhance rapport building, patient

enthusiasm, and clinical
outcome. The goodness-of-fit ethics approach to informed
consent highlights the
role that informed consent plays in the ethical provision of
psychotherapy, especially
when provided to those with impaired or limited cognitive
capacity. Fitting the
language, timing, and content of informed consent to the
client’s unique needs and
cognitive-emotional skills as well as to the nature of the
psychotherapy demonstrates
commitment to advancing human welfare, respecting client
autonomy, and
establishing relationships of trust.
References
Acuff, C., Bennett., B.E., Bricklin, P.M., Canter, M.B., Knapp,
S.J., Moldawsky, S., et al.
(1999). Considerations for ethical practice in managed care.
Professional Psychology:
Research and Practice, 30, 563–575.
Beahrs, J.O., & Gutheil, T.G. (2001). Informed consent in
psychotherapy. American Journal
of Psychiatry, 158, 4–10.
Bennett, B.E., Bricklin, P.M., Harris, E., Knapp, S.,
VandeCreek., L., & Younggen, J.N.
(2006). Assessing and managing risk in psychological practice:
An individualized approach.

Rockville, MD: The Trust.
Carpenter, W.T., Gold, J.M., Lahti, A.C., Queen, C.A., Conley,
R.R., Bartko, J.J., et al.
(2000). Decisional capacity for informed consent in
schizophrenia research. Archives of
General Psychiatry, 57, 533–538.
Cea, C., & Fisher, C.B. (2003). Health care decision-making by
adults with mental retardation.
Mental Retardation, 41, 78–87.
Draper, H. (2000). Anorexia nervosa and respecting a refusal of
life-prolonging therapy: A
limited justification. Bioethics, 14, 120–133.
Dunn, L.B., Lindamer, L.A., Palmer, B.W., Schneiderman, L.A.,
& Jeste, D.V. (2001). Enhan-
cing comprehension of consent for research in older patients
with psychosis: A randomized
study of a novel consent procedure. American Journal of
Psychiatry, 158, 1911–1913.
Fisher, C.B. (1999). Relational ethics and research with
vulnerable populations. Reports on
research involving persons with mental disorders that may
affect decision-making capacity
(Vol. II, pp. 29–49). Commissioned Papers by the National

Bioethics Advisory
Commission. Rockville, MD: National Bioethics Advisory
Commission. Available at:
http://www.bioethics.gov/reports/past_commissions/nbac_menta
l2.pdf.
Fisher, C.B. (2002a). A goodness-of-fit ethic of informed
consent. Urban Law Journal, 30,
159–171.
Fisher, C.B. (2002b). Respecting and protecting mentally
impaired persons in medical re-
search. Ethics & Behavior, 12, 279–284.
Fisher, C.B. (2003a). Decoding the ethics code: A practical
guide for psychologists. Thousand
Oaks, CA: Sage.
Fisher, C.B. (2003b). Goodness-of-fit ethic for informed
consent to research involving adults
with mental retardation and developmental disabilities. Mental
Retardation and
Developmental Disabilities Research Reviews, 9, 27–31.
Fisher, C.B., Cea, C.D., Davidson, P.W., & Fried, A. (2006).
Capacity of persons with mental
retardation to consent to participate in randomized clinical
trials. American Journal of

Psychiatry, 163, 1–8.
Grisso, T., Appelbaum, P.S., & Hill-Fotouhi, C. (1997). The
MacCAT-T: A clinical tool to
assess patients’ capacities to make treatment decisions.
Psychiatric Services, 48, 1415–1419.
Howe, V., Foister, K., Jenkins, K., Skene, L., Copolov, D., &
Keds., N. (2005). Competence
to give informed consent in acute psychosis is associated with
symptoms rather than
diagnosis. Schizophrenia Research, 77, 211–214.
Huthwaite, J.S., Martin, R.C., Griffith., H.R., Anderson., B.,
Harrell, L.E., & Marson., D.C.
(2006). Declining medical decision-making capacity in mild
AD: A two-year longitudinal
study. Behavioral Science and the Law, 24, 453–463.
Jeste, D.V., Depp, C.A., & Palmer, B.W. (2006). Magnitude of
impairment in decisional capacity
in people with schizophrenia compared to normal subjects: An
overview. Schizophrenia

Bulletin, 32, 121–128.
Jeste, D.V., & Saks, E. (2006). Decisional capacity in mental
illness and substance use dis-
orders: Empirical database and policy implications. Behavioral
Sciences and the Law, 24,
607–628.
Kim, S.Y., Caine, E.D., Currier, G. W., Leibovici., A., & Ryan.,
J.M. (2001). Assessing the
competence of persons with Alzheimer’s disease in providing
informed consent for
participation in research. American Journal of Psychiatry, 158,
712–717.
Palmer, B.W., Dunn, L.B., Appelbaum, P.S., Mudaltiar, S.,
Thal, L., & Henry, R. (2005).
Assessment of capacity to consent to research among older
persons with schizophrenia,
Alzheimer disease, or diabetes mellitus. Archives of General
Psychiatry, 62, 726–733.
Pomerantz, A.M. (2005). Increasingly informed consent:
Discussing distinct aspects of psycho-
therapy at different points in time. Ethics and Behavior, 15,
351–360.
Pope, K.S., & Vasquez., M.J. (2007). Ethics in psychotherapy

and counseling: A practical
guide. San Francisco: Wiley.
LASA 1: Ethical Case Study Analysis Paper 1
LASA 1: Analysis of Historical, Legal, and Ethical Issues 2
Ethical Case Study Analysis Paper
Name
University
PSY430-A01 Ethics in Psychology

Professor
April 20, 2016
Assignment 2: LASA 1: Ethical Case Study Analysis Paper
Case Study
James is a community counseling student who is interning with
the College Counseling Center at the local university. James is a
25 year-old Caucasian male, who attended a private high school
in a small rural town. In terms of being a counselor, James
admits that one of his challenges is that he has not experienced
much diversity in his relationships. He states that this is not a
significant issue because he plans on opening a private practice
in his hometown as soon as he graduates. Since he “knows the
town” he doesn’t feel that this is a big deal. Also, in terms of
finding clients, James states that he is sure he will be able to get
referrals because his father works for the town newspaper and
will run an ad as soon as he moves home.
James admits he has no clinical experience but is pleased, upon
arriving at his internship site, to see that his ex-girlfriend is
going to be his assigned clinical supervisor. Since they have not
seen each other in years, James figures that meeting once a
week will give them a good opportunity to catch up on “old
times”. James also figures that she could continue to supervise
him in private practice until he receives his license. James is
relieved because he knows she won’t mind, since he will be
graduating in nine months, if he puts her credential, Licensed
Professional Counselor, after his name since she is supervising
him.
After discussing private practice, James asks his ex-girlfriend if
he can begin to see clients right away because he is anxious to
get experience and begin working on his practice. Since she
figured he would be a pretty good counselor, she agreed and
paired him up with Lisa, a 21 year-old Latina female.
During the first session, James was running late and was unable
to fully cover all of the intake documents with Lisa. He put
them aside and said, “We don’t really need to review these. It is

just paperwork required by the Center. Please sign here.” As the
counseling session continued, James thought he might have
recognized symptoms associated with depression including
decreased motivation, loss of appetite and overall
dissatisfaction. He thought about bringing these up with his
supervisor but forgot once he left the session.
James continued to meet with Lisa. The first few sessions
focused mainly on her recent break-up with her boyfriend and
the resulting academic difficulties. She was very concerned that
her career dream of becoming a lawyer may be in jeopardy.
In the third session, Lisa casually mentioned that she began to
experience depressive symptoms as a child when her mother's
partner began to physically abuse her at the age of 5½ years.
Lisa told her mother about the abuse, but she did not intervene.
Shortly after the physical abuse began, the man began to also
sexually abuse her. Once again, Lisa reported this to her mother
and also to a teacher at her school, but nothing was ever done.
Lisa reported that when she was 7, she placed an unknown
prescription medication of her mother's into this man's alcoholic
drink. Later that same day, the man experienced a stroke and
was rushed to the hospital where he later died. Lisa also
reported learning that her mother's partner's stroke and
subsequent death were related to the combination of
prescription medication and alcohol. The client has never told
anyone other than James that she had placed medication in this
man's drink.
Directions:
· Read the case study provided and identify all three of the
ethical dilemmas presented.
· Describe the nature and all dimensions of the three ethical
issues.
· Identify the ethical code numbers and definitions of each issue
presented using both the APA and ACA codes.
· Discuss alternative courses of action that could be taken by
the counselor to rectify each dilemma.
· Describe the implications of each alternative action; lay out

the limitations and advantages of each alternative considered.
· Choose one course of action and provide a justification for
this selection.
· Describe the ethical decision-making model (from your course
materials) you used throughout the process to arrive at a final
decision (i.e., Forrester-Miller and Davis). Make sure you
outline each step.
You will be graded on the process you used to arrive at your
recommendations and the reasoning behind picking a specific
recommendation (and not the actual recommendation itself).
You should utilize and cite at least two peer-reviewed journal
articles to include in your research.
The body of the paper should be no less than 5 pages in length.
Your paper should be double-spaced, in 12 point Times New
Roman font, with normal 1-inch margins, written in APA style,
and free of typographical and grammatical errors. It should
include a title page with a running head, an abstract, and a
reference page.
Save the paper as
AU_PSY430_M3_A2_LastName_FirstInitial.doc and submit it
to the M3 Assignment 2 LASA 1 Dropbox by Wednesday, April
20, 2016.
Assignment 2 Grading Criteria
Maximum Points
Analyzed the case and identified all three of the ethical
dilemmas presented in the case study.
16
Described the nature and all dimensions of the three ethical
issues.
16
Identified the ethical code numbers and definitions of all issues
presented in the case study using both the APA and ACA codes.
28
Discussed alternative courses of action that could be taken by
the counselor to rectify each dilemma.
20

Described the implications of each course of action; laid out the
limitations and advantages of each alternative considered.
20
Chose one course of action and provided a justification for this
selection.
16
Described the ethical decision-making model (outline the steps)
used throughout the process to arrive at a final decision.
28
Included information from at least two external scholarly
references.
12
Writing components:
· Organization (12)
· Usage and Mechanics (12)
· APA Elements (16)
· Style (4)
44
Total:
200
Hi Class,
This week's Dropbox assignment is a LASA assignment,
meaning it is worth a large percentage of your overall grade
(LASA1 from this Module = 20%; LASA2 from Module 5 =
30%). Please plan ahead so that you have time to complete
the LASA1 assignment well, thoroughly, and by the deadline of
this Wednesday, April 20th.
This week's LASA1 assignment requires you to select an ethical
decision-making model and apply it to the case study. You will
need to refer back to an article presented in Module 1. I've
attached it here for your convenience. You can find additional
information about ethical decision-making models you can use
for this assignment here: List of Available Ethical Decision-
Making Models
(http://www.ryerson.ca/ethicsnetwork/resources/ethicaldecision/

)
Be sure to address each item in the rubric carefully, meet the
minimum page requirements, use the APA formatting template I
provided (also attached here) to you at the start of class, and
include citations of your sources (in-text citations and a
reference list).
I hope this helps! :-)
References:
American Counseling Association (ACA). (2014). Code of
ethics. Alexandria, VA: Author. Retrieved
from http://www.counseling.org/resources/aca-code-of-
ethics.pdf
American Psychological Association (2016). Ethical principles
of psychologists and code of conduct. Retrieved from
http://www.apa.org/ethics/code/index.aspx
Argosy Online (2016). Argosy University Module 3. Retrieved
from: http://myclassroomonline.com
Corey, Gerald, Corey, M. S., Callanan, P. (2011). Issues and
Ethics in the Helping Professions. [VitalSource Bookshelf
Online]. Retrieved from
https://digitalbookshelf.argosy.edu/#/books/1111738890/
Additional articles:
Fisher, C. B., & Oransky, M. (2008). Informed consent to
psychotherapy: Protecting the dignity and respecting the
autonomy of patients. Journal of Clinical Psychology, 64(5),
576. Retrieved from
https://login.libproxy.edmc.edu/login?url=http://search.proquest

.com/docview/236899996?accountid=34899
Younggren, J. N., & Harris, E. A. (2008). Can you keep a
secret? Confidentiality in psychotherapy. Journal of Clinical
Psychology, 64(5), 589. Retrieved from
https://login.libproxy.edmc.edu/login?url=http://search.proquest
.com/docview/236902904?accountid=34899

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