Adolescents' attitudes toward confidentiality between the school counsellor and the adolescent client

It is increasingly acknowledged that confidentiality is relative rather than absolute in any counselling relationship. This is particularly the case for minors receiving counselling at school, where third parties such as parents and teachers frequently have access to information about an adolescent client. The Australian Psychological Society's Code of Professional Conduct (1986) states that minors are unable to provide voluntary, informed consent in consulting relationships, although current research does not necessarily support this view. The current study investigated adolescents' attitudes to confidentiality in situations that may commonly arise in school counselling. The study also investigated the third parties to whom adolescents believed information should be disclosed by a counsellor. Respondents were 303 male and 254 female students attending three single-sex nongovernment schools. Ages ranged from 13 to 18 years. Results suggested that the adolescents' attitudes to confidentiality generally corresponded with adult views. Many adolescents wanted more autonomy regarding disclosure of information obtained in a counselling situation than the APS code provides. Parents were the only third party to whom the adolescents generally believed disclosure should be made. There were few age differences, but a wide range of opinions were evident, with female adolescents consistently more strongly in favor of confidentiality than males.     

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.     

Confidentiality in psychological practice: a decrepit concept?

Although the principle of confidentiality in the relationship between psychologists and client has been vaunted, and is emphasised in the Australian Psychological Society's Code of Professional Conduct (the APS code; 1994), the confidentiality of this relationship is circumscribed by the absence of legal protections, the ethical beliefs of psychologists, institutional practices, and the provisions of the APS code itself. Lack of privilege in judicial proceedings, and statutory obligations to report certain types of behaviour, mandate breaches of confidentiality in some circumstances. Ethical beliefs of psychologists may support disclosure, especially where it is believed that there is danger of serious physical harm to the client or others. Multidisciplinary teams and institutional settings require the exchange of information for optimal delivery of services. Recent amendments to the APS code may require disclosure without the client's consent when a client is believed to be suicidal. Such developments, when considered at all, are typically regarded as exceptions to a general obligation of confidentiality. However, discussion of exceptions presupposes agreement on fundamental principle: the significance of, and rationale for, confidentiality in the psychologist-client relationship. It is argued in this paper that the obligation of confidentiality has been assumed rather than vigorously analysed and empirically explored. A critical examination of this obligation is the most appropriate starting point for the rehabilitation of contemporary principles of confidentiality in the psychologist-client relationship.     

Adolescents,Risk Behaviour and Confidentiality: When Would Australian Psychologists Breach Confidentiality to Disclose Information to Parents?

The protection of confidentiality in psychological practice is vital. However, confidentiality is not absolute and psychologists are permitted to breach confidentiality under particular circumstances. Ethical challenges surrounding confidentiality are complex with adolescent clients, as assessments often consider the risk that adolescents pose to themselves in addition to the risk posed to others. The current study documented situations in which Australian psychologists would breach adolescents' confidentiality to disclose information about risk behaviour to parents, with a focus on situations where adolescents posed a risk to themselves as opposed to other people putting adolescents at risk. A total of 264 Australian psychologists were surveyed online. They were each presented with 68 variations of a vignette about a 15‐year‐old boy who was engaged in risk behaviour and were asked whether they would breach confidentiality in each case. The vignettes covered six behavioural domains (smoking, sexual behaviour, drinking, drug use, suicide, stealing) and varied in behaviour intensity, frequency and duration. Consensus was reached about breaching confidentiality in 16% of cases (related to sexual behaviour, drug use, and suicide). Consensus was reached about not breaching confidentiality in 41% of cases (relating to smoking, sexual behaviour, drug use, suicide, and stealing). In the remaining 43% of cases, significant disagreement occurred (relating to all six behavioural domains). The findings suggest a high degree of variation in opinion about confidentiality with adolescents, emphasising the importance of transparent communication and informed consent. The findings also raise questions about how important consistency of psychological practice is across Australia.     

Parents’ Experiences of Their Child’s Disclosure of Child Sexual Abuse

A child’s disclosure of sexual victimization is a difficult experience for parents and has been associated with traumatization, disbelief, denial, self-blame, and clinical difficulties. To date, most studies on parents’ responses have been quantitative assessments of the psychological impact of disclosure on parents. A paucity of research has qualitatively explored mothers’ experiences of their child’s disclosure of child sexual abuse (CSA) and fathers’ experiences have been even further neglected. The current study seeks to characterize parents’ experiences of their child’s disclosure of CSA and to uncover the process-oriented nature of parental responses. This qualitative study, using a grounded theory approach to analysis, involved interviews with 10 mothers and four fathers whose children (3–18 years) had experienced sexual abuse. Three themes emerged from the analysis. The first theme—making sense of the abuse in retrospect—captured the process through which parents sought to make sense of their child’s disclosure, focusing on why their child had not disclosed the abuse to them earlier, and how they had noticed something was wrong but misattributed their child’s behavior to other factors. The second theme—negotiating parental identity as protector—reflected how parents’ identity as a protector was challenged, their perception of their world had been forever altered, and they now experienced themselves as hypervigilant and overprotective. The final theme—navigating the services—pertained to parents’ struggle in navigating child protection and police services, and feelings of being isolated and alone. These findings highlight the need for empathy and parental support following child disclosure of sexual victimization.     

Psychologists'' and teachers'' reactions to mental health and behavioral school consultation

School psychologists and elementary school teachers were shown videotapes of a psychologist consulting with a teacher, with the psychologist using either behavioral or mental health consultation techniques. Problem situations and teacher-consultee verbalizations did not differ across the two sets of videotapes. Afterwards, subjects judged the effectiveness of of the consultation and the personal attributes of the consulting parties. In general, teachers preferred behavioral consultation, while psychologists rated the mental health consultation as more effective. Implications of these findings for consultation reaearch and practice are discussed.     

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.     

Help-Seeking Behaviors in Non-Offending Caregivers of Abused Children in the Philippines

The help-seeking process among non-offending caregivers (NOCs) of abused children particularly in the non-Western context has yet to be elucidated. The objective of the current study was to investigate what proportion of Filipino NOCs of abused children sought professional support services within 12 months following child abuse disclosure (T1) and at 12 months (T2) follow-up in the Philippines. Two further aims were to investigate NOCs’ preferred service providers and settings and to explore barriers to help-seeking. A comparison group of Filipino parents without an abused child were also recruited to compare preferences and potential barriers to help seeking for child and family problems. A total of 47 NOCs and 70 comparison parents/guardians completed questionnaires, which assessed help-seeking preferences and barriers as well as parental stress. The majority of NOCs reported seeking help, which was perceived to be helpful. Almost two thirds of NOCs indicated preference for in-person counseling relative to the comparison group of parents. The majority of NOCs preferred seeking help from social workers and psychologists. Almost one third of both parental samples reported being judged as an unfit parent as a key barrier to seeking help for family problems. The findings have implications for psychological and allied health service providers in facilitating the adjustment for families of recently abused children.     

Ethical practice from the perspective of the forensic psychologist: Commentary on the uses and value of the Australian Psychological Society (2007) Code of Ethics

Forensic practice in Australia and around the world attracts a high level of public and judicial scrutiny. The way in which the forensic psychologist conducts him or herself in ethically challenging situations is important not only to the reputation of the individual practitioner, but to the profession more widely. This paper outlines some of the ethical issues that commonly arise in forensic psychology practice and discusses these in relation to the recently published Australian Psychological Society (2007) Code of Ethics. Four ethically challenging scenarios are described and discussed in terms of how the Code might be used to offer guidance to psychologists about how they might best respond.     

From posts to protection: Ethical considerations regarding forensic psychiatrists and a duty to warn based on social media

Increasing use of social media in forensic mental health evaluations will lead to new challenges that must be resolved by forensic practitioners and the legal system. One such dilemma is the discovery of information that would typically trigger a legal duty and professional ethics obligation for mental health professionals to breach doctor-patient confidentiality to promote public safety and prevent harm to vulnerable third parties. Although the law and professional organizations offer clear guidance for practitioners in the treatment role, there is currently no clarity from the law or instruction from professional organizations on what mental health professionals should do if they discover such information during a confidential forensic evaluation. For example, a forensic evaluator may find evidence on social media of an evaluee’s threats to seriously harm others, abuse of children and the elderly, or severely impaired driving. There are no clear guidelines for how a forensic psychiatrist should respond in these complicated situations. We review the legal concepts and historical evolution of confidentiality, privilege, and mandated reporter duties that forensic practitioners should consider in these legally ambiguous situations. Finally, we discuss ethics frameworks practitioners can implement to determine their most ethical course of action when faced with such dilemmas.     

The certificate of confidentiality at the National Institute of Mental Health: discretionary considerations in its applicability in research on child and adolescent mental disorders

Child and adolescent researchers must balance increasingly complex sets of ethical, legal, and scientific standards when investigating child and adolescent mental disorders. Few guidelines are available. One mechanism that provides the investigator immunity from legally compelled disclosure of research records is described. However, discretion must be exercised in its use, especially with regard to abuse reporting, voluntary disclosure of abuse, and protection of research data. Examples of discretionary issues in the use of the certificate of confidentiality are provided.     

Some Legal Issues in Counselling and Psychotherapy

Although substantial legal difficulties can face anyone trying to recover compensation from counsellors for breach of their legal duties, such claims can in principle succeed. Counsellors ought to take particular care to provide a physically safe setting for the counselling session. Advice given to the client can lead to liability both to the client and to third parties who may be affected. The impact of the client's actions on third parties can justify, and less often compel, departures from confidentiality. The importance of keeping client records has to be balanced against legal obligations imposed on counsellors in various situations to make such records available for inspection by the client or third parties.     

Exploring the Why of Psychologist Misconduct and Malpractice: A Thematic Analysis of Court Decision Documents

Objective: To identify reasons for misconduct and misconduct amongst Australian psychologists. Method: During the 5‐year period from 2008 to 2013, 42 psychologists across 41 cases were found guilty of misconduct and malpractice by civil and administrative courts across Australia. The court decision documents were analysed using Braun and Clarke’s ( 2006 ) qualitative methodology to explore themes relating to the court’s objective, the psychologist’s subjective, and the authors’ interpretive causal reasons transgressing psychologists engaged in misconduct and malpractice. Results: Explanations given by psychologists for misconduct and malpractice behaviours included the use and abuse of legal and illicit substances, addiction behaviours, and impairment due to mental disorder or unresolved trauma. A number of other reasons identified by the courts and by the authors from the evidence cited in the published court decision documents are also discussed. Possible contributing factors for why misconduct and malpractice behaviours occurred coalesced into three themes: the externalisation of responsibility for personal actions and behaviours, a lack of objectivity concerning why such behaviours occurred, and an inability to understand how personal circumstance affected the provision of ethical services to clients. Conclusion: (a) The complexity of situations and scenarios surrounding psychologist malpractice can be simplified for the benefit of designing interventions by applying Glass’ ( 2003 ) concept of the “slippery slope.” (b) Court records have benefit as detailed data, but could be augmented for greater value with a simple and easily completed additional coversheet of background and demographic data.     

School psychologists as perceived by school personnel: Support for a consultant model

Questionaires distributed by 12 school psychologists to school personnel with whom they had been consulting for six months were completed and returned by 73 teachers, counselors, and principals. The information provided by the respondents indicated the frequencies with which the school psychologists engaged in consulting and child study activities, the school personnel's evaluations of nine different school psychologist skills, and the preferences of the respondents for the different school psychologist functions in their schools. The data showed that: (1) school psychologists were doing more consulting than evaluations of individual children, (2) school personnel tended to perceive their psychologists as cooperative, knowledgeable, and skillful, though relatively inefficient and undependable, and (3) school personnel preferred consulting activities to psychometric activities. It was concluded that the consultant model had been shown to be operative and that it was more highly valued than the psychometric model by the consumers of psychological services.     

Promoting Parenting Plans:A New Role for the Psychologist as Expert in Custody Disputes

This paper argues that existing adversarial approachesto post-divorce custody rulings are neither in thebest interests of the child nor consistent withobligations to children under the United NationsConvention on the Rights of the Child. The traditionalrole of psychologists acting as experts in divorceproceedings has been to determine custody and accessarrangements by evaluating parental fitness. It isargued that this role should be altered and expandedto a process that is threefold. Specifically, it issuggested that the role of the psychologist acting asan expert in divorce custody proceedings should be to:(1) inform the courts about children's rights underthe Convention, (2) inform the courts about children'sneeds as identified in the developmental psychologyresearch literature, and (3) assist with methods ofjoint legal custody determinations that arechild-centered and constitute family reorganizationrather than family dissolution. It is suggested thatthe third role may be best accomplished through theuse of a Parenting Plan that allows custodialdecisions to meet the goals of child-centereddecision-making, continued meaningful involvement ofboth parents in the child's life, and reducedinter-parental conflict.     

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.     

Child Abuse and Adolescent Parenting

Abstract

Adolescent parents are commonly identified as an at-risk group in the child abuse literature. However, theoretical models specific to the area of child abuse and adolescent parenting are not well developed. This essay reviews established theories on child abuse, abusive parenting, and adolescent parenting to synthesize a proposed child abuse and adolescent parenting model. An ecological perspective is used to organize the theoretical model. The components of this model are supported by existing research on child abuse and adolescent parenting. The new synthesized model on child abuse and adolescent parenting should be viewed as an informed way to organize and conduct future research in this area. Further theory development on child abuse and adolescent parenting should be encouraged.     

The child abusing family: I. Methodological issues and parent-related characteristics of abusing families

Abstract

The physical abuse of children by their parents is a family matter and should be viewed within the context of the family unit. Unfortunately, few child abuse studies have directly examined the family unit. Rather, most studies focus on characteristics of individual members of abusing families or on dyadic relationships within abusing families. Therefore, the present paper examines the family-related variables that might contribute to child abuse. This review is divided into two parts. Part I discusses methodological considerations and parent-related aspects of abusing families, including: characteristics of abusing parents, childhood experiences of abusing parents, marital relationships of abusing parents and the perceptions and expectations that abusing parents have of their abused children. Part II of this review, which will appear in a later issue, will cover child-related aspects of abusing families, parent-child interactions in these families, environmental conditions associated with child abuse and typologies of abusing families.     

Assessment of ADHD: differences across psychology specialty areas

Child psychologists are frequently involved in the assessment of ADHD symptoms among school-aged youth. There is limited information regarding the extent to which psychologists adhere to recommended assessment practices and whether differences exist in assessment strategies among psychologists from different specialty areas (clinical, counseling, and school) and/or who practice in different settings (university, school, or outpatient clinic). A 3 (specialty area) x 3 (employment setting) between-groups design is used wherein 230 child psychologists completed surveys regarding diagnostic practice. Psychologists differ in adherence with Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision) diagnostic criteria, use of clinical interviews, and type of behavior observation. Only 15% of psychologists report using multiple methods consistent with recommended standards of best practice. Differences between groups of psychologists indicate that the diagnosis of ADHD in children is influenced by the type of psychologist conducting the evaluation and the setting in which the evaluation is conducted.     

An Exploratory Study: Perceptions of Ethical Behaviors Among Psychologists Practicing in the Caribbean

A sample of 44 psychologists who practice in the Caribbean completed a web-based survey containing 73 behavioral items related to ethical issues in professional practice. The aim of this exploratory study was to learn about perceptions regarding ethical behaviors that create ethical dilemmas and the level of agreement to their responses and to identify how demographic variables influenced their perceptions of ethical behaviors. Findings suggest that there was approximately an equal level of agreement on behaviors such as being an advocate for your client and being sexually involved with a current client rated as ethical and unethical, respectively. Several demographic variables and ethical behaviors such as level of degree and confidentiality issues were statistically significant. Finally, psychologists prefer the presence of a professional psychological association with an ethics committee.