Hey guys! Welcome to this video lesson on confidentiality within the counseling profession.
Counselors should understand that for a counseling relationship to work, it has to be built on trust. Most of the time, your client is not going to hand you their trust on a silver platter. Building trust takes time. Sometimes we think of building trust as starting on a neutral ground; neutral being this state of mind where your client is unsure about whether or not they can trust you. Well, this notion is probably too optimistic, depending on the situation. The reality, oftentimes, is that they don’t trust you. It’s not that they aren’t sure. They straight up do not trust you. So, instead of starting off at the level playing field of zero, you might be starting off somewhere on the negative end. Now this, obviously, can vary from person to person, but quite often you will see that you are having to work against the grain of distrust. Giving them a platform of appropriate privacy and confidentiality, while also upholding those terms of privacy and confidentiality, is the first step in building trust with your client. You, the counselor, should always clearly communicate to the client the parameters of confidentiality in a culturally competent manner.
There are seven things that are important to be familiar with when it comes to confidentiality.
1. Respecting Client Rights
As a counselor, you should always have awareness and sensitivity regarding cultural meanings of confidentiality and privacy. Be considerate to respect differing views toward disclosure of information, and you should always discuss with clients how, when, and with whom information is to be shared. A counselor should never ask for private information from clients unless it is beneficial to their growth in the counseling process. Be respectful of their privacy.
Never disclose information. The only reason a counselor should ever disclose information is when appropriate consent is given, or there is a sound legal or ethical justification. Be very clear with your client about when it is appropriate for you, the counselor, to disclose the information at initiation; as well as throughout the entire counseling process. Being upfront, and clear with your client will help you, the counselor, to gain credibility.
So, we just talked about never disclosing information, unless you have to. Well, the general requirement that counselors keep information confidential does not apply when disclosure is required to protect clients or identified others from serious and foreseeable harm; or when legal requirements demand that confidential information must be revealed. If you are unsure, never make the decision without seeking counsel from other professionals.
If you are considering being a counselor who provides services to terminally ill individuals who are considering hastening their own deaths, then you need to know that your client has the option to maintain confidentiality; depending on certain laws and their specific circumstances.
If a client lets you know that they have a disease commonly known to be both communicable and life-threatening, then you may be justified in disclosing information to identifiable third parties; but only if the parties are known to be at serious and foreseeable risk of contracting the disease. Before making a disclosure, always assess the intent of the client to inform the third party about their disease, or to engage in any behaviors that may be harmful to an identifiable third party. Laws may vary state to state, so make sure, whatever state you are in, that you are familiar with the laws concerning disclosure about disease status.
The only other time that it is okay to disclose a client’s private information is when a court tells you that you have to. If this happens, you should always seek to obtain written, informed consent from the client, or take steps to prohibit the disclosure; if that doesn’t work have it limited as narrowly as possible, because of potential harm to the client or counseling relationship. When you are trying to disclose the minimal amount, clients are informed before confidential information is disclosed, and are involved in the disclosure decision-making process.
3. Information Shared with Others
The counselor should make every effort to ensure that privacy and confidentiality of clients are maintained by subordinates, including employees, supervisees, students, clerical assistants, and volunteers. When services provided to the client involve participation by an interdisciplinary or treatment team, the client should be informed of the team’s existence and composition, information being shared, and how that information is being shared.
Where you share information also matters. Counselors should only discuss confidential information when they can ensure that the setting is safe and private. Even if your client is not the one paying for your services, you should never release information to the third-party payer unless your client has authorized such disclosure.
If you are transmitting the confidential information of your client, you should always take precautions to ensure the security of the transmission.
4. Groups and Families
In group work, you need to clearly explain the importance and parameters of confidentiality for that specific group. In couples and family counseling, counselors must clearly define who is considered “the client” and discuss expectations and limitations of confidentiality. Counselors should always seek agreement, and should document, in writing, such agreement among all involved parties regarding the confidentiality of information. Often times the couple or family is considered the client if they decide not to specify who is the “client.”
5. Clients Lacking Capacity to Give Informed Consent
If you are counseling minor clients or adult clients who lack the capacity to give voluntary, informed consent, you need to protect the confidentiality of information received—in any medium—in the counseling relationship as specified by federal and state laws, written policies, and applicable ethical standards.
You need to inform parents and legal guardians about the role of counselors and the confidential nature of the counseling relationship, consistent with current legal and custodial arrangements. You must be sensitive to the cultural diversity of families and respect the inherent rights and responsibilities of parents or guardians regarding the welfare of their children or charges according to law. Work to establish appropriate, collaborative relationships with parents or guardians to best serve clients.
Always seek permission from an appropriate third party to disclose information. In such instances, counselors should inform clients consistent with their level of understanding and take appropriate measures to safeguard client confidentiality.
6. Records and Documentation
Counselors should only create and maintain records and documentation that is necessary for rendering professional services. You must ensure that records and documentation are kept in a medium that is secure and that only authorized persons have access to them. You are required to obtain permission from clients prior to recording sessions through electronic or other means. If you plan on allowing anyone other than your client to observe the session, you must first obtain permission from your client.
It is also important to provide reasonable access to records and copies of records when requested by competent clients. The only time you would limit your clients access to their records, or portions of their records, is when there is compelling evidence that such access would cause harm to the client. Counselors need to document the client’s request and the rationale for withholding some or all of the records in the files of clients. In situations involving multiple clients, counselors provide individual clients with only those parts of records that relate directly to them and do not include confidential information related to any other client.
If a client has requested access you, the counselor, should provide assistance and consultation in interpreting counseling records. If exceptions to confidentiality exist, you need to obtain written permission from your client to disclose or transfer records to legitimate third parties, and steps should be taken to ensure that receivers of counseling records are sensitive to their confidential nature.
You must store records following termination of services to ensure reasonable future access, to ensure that you are in line with federal and state laws and statutes, and dispose of client records and other sensitive materials in a manner that protects client confidentiality. You need to apply careful discretion and deliberation before destroying records that may be needed by a court of law, such as notes on child abuse, suicide, sexual harassment, or violence.
You must also take reasonable precautions to protect your client confidentiality in the event that you are terminated from practice, incapacity, or death. Always appoint a records custodian when identified as appropriate.
7. Case Consultation
When information is shared in a consulting relationship it needs to be discussed for professional purposes only. Written and oral reports present only data relevant to the purpose of the consultation, and every effort needs to be made to protect client identity and to avoid undue invasion of privacy.
If and when you are consulting with colleagues, you must not disclose confidential information that reasonably could lead to the identification of a client or other person or organization with whom they have a confidential relationship with; unless they have obtained the prior consent of the person or organization, or the disclosure cannot be avoided. In such a case, disclose the information only to the extent necessary to achieve the purposes of the consultation.
While upholding confidentiality is not the only avenue to build trust with your client, it is an important one, and one that should never be breached. You should familiarize yourself with the ACA Code of Ethics confidentiality section.
I hope this video was helpful. See you next time!