Perceptions of Confidentiality Violations Among Psychologists

This study explored psychologists' perceptions of confidentiality violations. One hundred ninety-five psychologists answered questionnaires about a vignette regarding a male therapist accused of violating the confidentiality of a female client. The vignette varied on the following variables: (a) Confidential information was conveyed to either an insurance company or another client, (b) the therapist's account of the violation included either an excuse or a justification, and (c) scapegoating was included or not included in the account. The insurance condition and excuse condition produced more lenient judgments of the violation. However, excuses elicited more negative judgments of the therapist. Scapegoating generally elicited more negative judgments. Differences in the recipient of confidential information and the accounts given for violations have an impact on psychologists' perceptions of confidentiality violations.     

Ethics and Confidentiality for Psychologists in Academic Health Centers

Psychologists in academic health centers (AHC) face important ethical issues including confidentiality when working with a multidisciplinary team, sharing of information through the electronic health record, obtaining informed consent in a fast-paced healthcare environment, cultural competency in the medical setting, and issues related to supervision and training. The goal of this paper is to describe ethical issues for psychologists in AHCs in the context of case examples, and to consider ethical decision-making tools to enhance clinical care. Considerations for best practices in integrated care settings will be discussed, and the APA Ethical Standards will be referenced throughout.     

Breaking Confidentiality to Report Adolescent Risk-Taking Behavior by School Psychologists

School psychologists often break confidentiality if confronted with risky adolescent behavior. Members of the National Association of School Psychologists (N = 78) responded to a survey containing a vignette describing an adolescent engaging in risky behaviors and rated the degree to which it is ethical to break confidentiality for behaviors of varying frequency, intensity, and duration. Respondents generally found it ethical to break confidentiality when risky adolescent behaviors became more dangerous or potentially harmful, although there was considerable variability between respondents. Significant gender effects were found between male and female respondents for alcohol use, and a significant Form Type (i.e., male or female vignette) × Frequency/Duration interaction was observed for antisocial behaviors. School psychologists could benefit from further training in ethical decision making because these ethical dilemmas are not always clear-cut.     

Ethical Challenges for Military Psychologists: When Worlds Collide

Despite the mental health needs in the military and improved access to military psychologists, many in need do not seek psychological services. The military policies, culture, and environment pose considerable barriers to help seeking. In turn, military practices often conflict with the psychologist’s professional ethics, leading to a range of ethical dilemmas including multiple relationships, multiple agencies, and limited confidentiality. To address ethical concerns and encourage service members to seek mental health services, this article proposes maintaining an understanding of military rules, law, and professional ethics; identifying multiple relationships and establishing boundaries up front; and collaborating with the patient in disclosures of information.     

Breaching Confidentiality to Protect the Public: Evolving Standards of Medical Confidentiality for Military Detainees

Confidentiality is a core value in medicine and public health yet, like other core values, it is not absolute. Medical ethics has typically allowed for breaches of confidentiality when there is a credible threat of significant harm to an identifiable third party. Medical ethics has been less explicit in spelling out criteria for allowing breaches of confidentiality to protect populations, instead tending to defer these decisions to the law. But recently, issues in military detention settings have raised the profile of decisions to breach medical confidentiality in efforts to protect the broader population. National and international ethics documents say little about the confidentiality of detainee medical records. But initial decisions to use detainee medical records to help craft coercive interrogations led to widespread condemnation, and might have contributed to detainee health problems, such as a large number of suicide attempts several of which have been successful. More recent military guidance seems to reflect lessons learned from these problems and does more to protect detainee records. For the public health system, this experience is a reminder of the importance of confidentiality in creating trustworthy, and effective, means to protect the public's health.     

Ethical Dilemmas of Confidentiality With Adolescent Clients: Case Studies From Psychologists

Navigating limits to confidentiality with adolescent clients can be ethically and professionally challenging. This study follows on from a previous quantitative survey of psychologists about confidentiality dilemmas with adolescents. The current study used qualitative methods to explore such dilemmas in greater depth. Twenty Australian psychologists were interviewed and asked to describe an ethically challenging past case. Cases were then used to facilitate discussion about the decision-making process and outcomes. Interviews were transcribed and analyzed using interpretive content and thematic analysis. Three key findings are discussed. First, it is of little use to perceive confidentiality dilemmas as binary choices (breach/don’t breach) because psychologists described 5 distinct options. These can be conceptualized on a spectrum of varying degrees of client autonomy, ranging from “no disclosure” (highest client autonomy) to “disclosure without the client’s knowledge or consent” (lowest client autonomy). Second, confidentiality dilemmas often involve balancing multiple and conflicting risks regarding both immediate and future harm. Third, a range of strategies are employed by psychologists to minimize potential harms when disclosing information. These are primarily aimed at maintaining the therapeutic relationship and empowering clients. These findings and the case studies described provide a valuable resource for teaching and professional development.     

Professional Ethics of Psychologists and Physicians: Mortality,Confidentiality, and Sexuality in Israel

Clinical psychologists' and nonpsychiatric physicians' attitudes and behaviors in sexual and confidentiality boundary violations were examined. The 171 participants' responses were analyzed by profession, sex, and status (student, resident, professional) on semantic differential, boundary violation vignettes, and a version of Pope, Tabachnick, and Keith-Spiegel's (1987) ethical scale. Psychologists rated sexual boundary violation as more unethical than did physicians (p<.001). Rationale (p<.01) and timing (p<.001) influenced ratings. Psychologists reported fewer sexualized behaviors than physicians (p<05). Professional experience (p<.01) and sex (p<.05) were associated with confidence-violating behavior. Overall, 78% of the sample reported attitudes or behaviors associated with boundary violations. The behavior violations were correlated (r=.49). Actual violators rated vignette violators more leniently than did nonviolators (p<.01).     

Ethical and Professional Issues for Psychologists and Counselors Employing Biofeedback in Counseling Settings

Biofeedback training is a relatively new procedure that is being incorporated into the counseling services of psychologists and counselors. If the highest professional standards and the appropriate safeguards for clients' welfare are to be maintained, careful attention should be given to the ethical and professional issues involved. The American Psychological Association's (1977) ethical standards for psychologists are the basis of the discussion. It is hoped that the discussion will stimulate further consideration of ethical and professional issues of the clinical application of biofeedback among practitioners.     

Job Opportunities/Issues for Health Care Psychologists: The Coming of the Millennium

Job opportunities for psychology for the next decade are being influenced by ongoing shifts in our economic system and resultant general employment practices. As with many burgeoning fields, psychology is experiencing increasing diversification into subspecialities. Professionals in other fields are acquiring supplementary degrees in psychology to heighten their psychological knowledge and professional/organization skills. Thus, psychology is beginning to be viewed, like the MBA, as an important professional degree for many fields, not just mental health or teaching. Training programs are reflecting these diversification trends. Further, as professional applications at the doctoral level expand, there is increasing need for the master's-level technical competence to support the increasing specialities at the doctoral level. These changes represent the creative response of a young and vigorous profession to the challenges of changing market dynamics.     

Assessment and Evaluation Issues Regarding Native American Elderly Adults

This paper will detail assessment and evaluation issues with Native American elderly adults. Recommendations and implications of such assessment and evaluation follow and include areas such as general background factors, cultural and family issues that impact assessment, problems to overcome, and finally a look into neuropsychological assessment. These issues will converge on the notion that mental health and neuropsychological assessment issues are relevant to Native American elderly, not because of the paucity of research in this area, but because Native American elderly are a fast-growing population, most in need of such vital services.     

Social Justice and Multicultural Issues: Implications for the Practice and Training of Counselors and Counseling Psychologists

The authors discuss the historical and contemporary connection to social justice issues in the fields of counseling and counseling psychology via the multicultural counseling movement. In addition, the authors present ways in which social justice issues can be addressed in counselors' and counseling psychologists' work with clients from diverse cultural backgrounds and in graduate training programs.     

Confidentiality Revisited

This article challenges the importance and necessity of confidentiality, which are often taken for granted, and questions whether the default promise of confidentiality to all participants, particularly in educational research, could in fact be an unnecessary concern. This article begins by reviewing the difference in the way confidentiality is handled in different fields and the applicability of some underlying assumptions. This is followed by an explanation of why confidentiality is investigated in the sense of anonymity in this article. Then the article draws on an empirical study where original researchers and their original participants were interviewed about their views on anonymity. Lastly, the contradiction between the promises of confidentiality and the recognition of a participant’s contribution is highlighted. The article concludes with a call for more empirical observation and investigation into the importance of confidentiality.

Ethical Considerations for Psychologists Taking a Public Stance on Controversial Issues: The Balance Between Personal and Professional Life

Previous literature has documented the general issues psychologists often face while balancing their personal and professional lives. The struggle stems from attempting to satisfy the need to maintain a life outside of work while having the professional obligation to follow the American Psychological Association’s (APA’s) Ethical Principles of Psychologists and Code of Conduct (Ethics Code) to prevent their personal lives from interfering with their professional roles and relationships. The present article analyzes the subject of psychologists taking a public position on controversial public issues. Although the APA Ethics Code does not restrict how psychologists conduct themselves during their personal time, taking a public stance on a controversial issue could potentially strain professional relationships and inadvertently reflect negatively on the profession. The present article examines ethical issues that (a) should be taken into account before psychologists take a public position on a controversial issue and (b) are in conflict with APA’s Ethics Code or current research.     

Learning Experiences Contributing to Service-Delivery Competence in Applied Psychologists: Lessons for Sport Psychologists

The purpose of the present study was to compare learning experiences perceived to contribute to service-delivery competence in sport, clinical, and counseling psychologists. Twenty psychologists (11 female, 9 male; 28–70 years of age) participated in semistructured interviews. All participants emphasized the role of client interactions in learning service-delivery processes. In addition, clinical and counseling participants reported personal therapy and supervision as influential experiences. Applied implications for training include (a) regional supervision networks comprising peers and elders, (b) university-based sport psychology clinics, and (c) personal and professional development groups.     

Ethical Issues in Psychologists' Professional Practice: Agreement Over Problematic Professional Behaviors Among Spanish Psychologists

A sample of 703 Spanish psychologists completed an online survey containing 114 behaviors related to professional practice in different areas. The aim of the study was to learn which professional behaviors create ethical dilemmas most often for psychologists and how they respond to these issues. Findings suggest that psychologists who have actually faced a particular dilemma are less strict on judging the inappropriateness of a possible ethical transgression than those psychologists who have not experienced it. Also, four clusters can be identified according to the attitude of respondents toward the dilemmas, namely “rejection,” “aprioristic,” “utilitarian,” and “no conflict.”