As often as not, clients seek counselling as a result of the urging of a close family member. This is a valid approach, as those in proximity may have a far more vivid sense of the impact of a client’s behaviour than does the client him/herself. One such client voiced this issue by stating, “People seem to be hurt by my comments, although I can never understand why.”
A confidentiality issue arises when the person who has arranged the counselling session /s, but not participated in them, subsequently phones up, in an effort to find out what the client has said.
The counsellor’s response that all information is confidential is met with an immediate “Yes”. Still, the dialogue does not cease. The persistent caller might linger, with pretexts such as, “I understand and respect what you have said, but can I just ask one question?” Or, “What should I do if “the client) …?”
This last query can prove difficult for the counsellor who has met the parent, partner or spouse, and believes the call to have been made through heartfelt concern, rather than from inquisitiveness, or a wish to eavesdrop on the private words of another. Nevertheless, the counsellor has no ethical choice but to refuse to divulge, even to the slightest degree, any client communication. This communication extends to subtle impressions gleaned from body language, posture, voice pitch and tone, grooming, or any of the manifold ways from which counsellors gain a sense of a client’s substrata of feelings.
After having received such a call, it is advisable to add a document to the file, ideally time-barred on a computer, setting forth the content of the conversation.
Avoid Being Sued.
While ethical concerns are primary, the counsellor must also be aware, especially in our litigious times, of the danger of being sued for an inadvertent act or omission. If a client can verify that a counsellor has violated, the duty of confidentiality, an ensuing lawsuit can be brought. This can result in loss to the counsellor, both in financial terms and more crucially, loss of the license to practice.
A few years ago, a lawsuit was brought against a counsellor, who, by greeting a client in a supermarket, allegedly indicated to that client’s companion that psychotherapeutic treatment had been commenced. This type of litigation underscores the need for the counsellor/client relationship to remain within the confines of the office, never to be acknowledged beyond its boundaries.
An exception occurs when a client specifically requests that a third party, perhaps a legal representative is to be given access to the material discussed. In such instances, the counsellor must obtain a signed statement from the client as to whom, and under what circumstances, the information is to be released. The counsellor should then write a letter to be kept on file, again time-barred on a computer, as to the client’s wish for the information to be made available to that specific party. The information can be released only upon the written request of that party.
Duty To Warn.
In extreme cases, the counsellor has an obligation to breach confidentiality, in order to protect the client or someone close to him/her. This is clear-cut when the client may harm him/herself: if self-mutilation or suicide is mentioned, and the counsellor deems the idea to be serious, there is an obligation to hospitalise the client.
A more precarious area arises when the client potentially poses a danger to others. Clients often vent anger in such statements as: “I could kill my boss” or “I wish (a family member, friend or partner) would drop dead.” As the psycho-therapeutic setting provides an escape-hatch for such venting, its expression should be accepted, encouraged. For the most part, such voicing is healthy. The release of feelings prevents their repression, which could result in a later explosion.
click here to find a counsellorThere are times, however, when such statements are more than mere words, foreshadowing an actual menace. When a counsellor believes this to be so, the duty to warn the potential victim supersedes the concern for confidentiality.
Two California cases help to define the parameters of counsellors’ duties. In the Tarassoff case, a university student sought psycho-therapeutic help in dealing with his obsessive love for another. The therapist notified the police, both verbally and in writing, of the homicidal threats of the patient, Mr Podar, towards Tatiana Tarassoff, following her rejection of him. After questioning Podar, the police had deemed him to be rational, and had ordered him to stay away from Ms Tarassoff.
Despite these efforts, when Mr Podar murdered Ms Tarassoff, her parents sued the psycho-therapist on the ground that he should have warned their daughter of her imminent peril. The therapist countered that he had had no duty to Ms Tarassoff, as Podar, not she, had been his patient. The US Supreme Court determined that therapists have a duty to warn intended victims, stating that the right to confidentiality ends where the probability of harm to a member of the public begins.
More recently, in the Ewing case, the father of a murder victim successfully sued both a psycho-therapist and hospital, after his son was killed by a patient, Geno Collelo.
In anguish, following the break-up of a long-term relationship, Collelo had told his father that he planned to kill Keith Ewing, his former girlfriend’s new partner. Collelo’s father alerted his psycho-therapist as to his intention. The therapist recommended hospitalization. Collelo’s father then brought his son to a psychiatric hospital, where he was admitted on a voluntary basis, and discharged soon thereafter.
Once discharged, Collelo killed first Keith Ewing and then himself. Ewing’s father claimed that both the doctor and hospital breached their duty to inform either the intended victim or the police force of the impending danger. The issue hinged upon whether the psycho-therapist is obliged to breach confidentiality, based upon the statement of a patient’s family member, in order to prevent grave bodily harm. The court’s decision was in favour of Ewing’s father, based on a commonsense evaluation. Given the seriousness of the threat conveyed by the father, the court found it to have been incumbent upon the therapist to have warned the victim.
Counselling is predicated upon commonsense. While acquainted with the theories of Freud, Jung and other psycho-analytic founders, counsellors operate upon a case-by-case, common sense basis. When do we hospitalise, notify law enforcement agencies, warn a potential victim of harm? There are no definitive answers. We rely on our training, our instincts, our hearts.
Confidentiality always comes first. If a threat should arise, we must be aware and attentive to all it implies, and then act according to ethics and principles, both for the client, others, and for ourselves. We must all be protected.
Colleen Swan is a counsellor in Dorset,UK. Colleen's Web Site