To Tell or Not to Tell: Breaching Confidentiality With Clients With HIV and AIDS

This article reviews some historical stereotypes and notes that society in general, and organized psychology in particular, have difficulty accepting and appreciating people who are different from traditional cultural and social norms. The history of Western civilization is written by the "winners" and usually does not capture the life and contributions of minority populations. This article suggests that psychology will be better served ethically when we recognize the biases of our discipline and give credence to the values of cultures other than our own.     

AIDS and confidentiality

ABSTRACT AIDS raises the moral problem of confidentiality because those in sexual contact with the patient may contract a life-threatening and incurable disease. Medicine has a tradition in which a patient's condition is regarded as confidential information held by the doctor alone. In this case there is a clear moral inclination to inform those at risk from the disease. In most cases no problem will arise but when it does the moral justification for a violation of confidentiality comes into question. Confidentiality is important because of our respect for certain human values and their importance to our patient. Where that patient acts so as to disregard the welfare of others with whom they are in close relationship, those values are lacking. This lack warrants a departure from our normal canons and provokes a suspension of normal moral privileges. The contention that any transgression, however slight, could be held to justify such a response posits a slope down which we, in fact, have no tendency to slide.     

Psychologists' perceptions of legal and ethical requirements for breaching confidentiality

This paper outlines the legal and ethical duties of psychologists in relation to preserving as well as breaching confidentiality in therapeutic relationships. It analyses the results of a questionnaire examining psychologists’ perceptions of the legal and ethical constraints on confidentiality and their likelihood of breaching confidentiality in different situations. The vast majority of participants indicated that the law permits them to disclose confidential information and that there is an ethical duty to disclose information to a third party when the patient is perceived to be dangerous. The results suggest that there is some uncertainty as to when confidentiality should be breached in practice and it is argued that the law is overly complex in this area and that guidelines are needed to assist psychologists in their clinical practice.     

To test or not to test: A clinical dilemma

This paper argues that clinicians are sometimes justified in not testing diagnoses or in not subjecting them to a full battery of tests. In deciding whether to conduct a test, a clinician may consider and weigh several different factors, including her confidence in her initial diagnosis, the specificity and sensitivity of the test, the consequences of making a false diagnosis, the pain, harm, and inconvenience caused by the test, and the costs of the test to the patient and society. This view suggests that diagnoses are fundamentally different from scientific hypotheses in that they are not always subjected to the same evidential standards.     

To B- or not to B- a relation

Philosophical Studies - In his seminal work, McTaggart (Mind 17(68):457–484, 1908; The nature of existence, Cambridge University Press, Cambridge, 1927) dismissed the possibility of...     

To be me or not to be me: About alienation

This article is about the experiential side of the concept of alienation and its relations to the stress process in the context of work and organization. We distinguish two kinds of alienation: primary alienation, the experience or feeling that something is different from normal, and secondary alienation, the absence of an experience of or feeling about something abnormal. After having gone into everyday reality and how it can be so disturbed that alienation ensues, we go further into the experiences involved in both kinds of alienation and their positive and negative consequences. Secondary alienation is described as a common final path in the second stage of a human stress process. In the discussion, we pay attention to the social scientific tradition of alienation as result of an evil societal influence, which has turned out to be an unfortunate approach. Instead, we advocate an approach that conceives alienation as the outcome of a personal choice. Lastly we indicate shortly what can be done about secondary alienation.     

Transition in the cotherapy dyad: To wait or not to wait

Transition within the cotherapy dyad is explored and examined in relation to institutional ethos and needs, the attitudes and needs of the psychotherapy group, and the attitudes and needs of the cotherapists. The timing of transition is discussed as are a variety of potential approaches to transition within the cotherapy dyad. Some significant dynamics which underlie the process of transition within the cotherapy dyad are examined and discussed in relation to their potential effects on the psychotherapy group and group process.This is a revised version of a paper presented at the 36th Annual Conference of the American Group Psychotherapy Assn., February, 1979, New York, NY.