PSY 650 Module 4 Confidentiality and Privacy Example

When a Client Says "He'd Better Watch Out": Confidentiality, Its Limits and the Duty to Protect

Student Name

Psychology and Addiction Studies Program, Aspen University

PSY 650: Ethics

Instructor Name

Month Day, Year

When a Client Says "He'd Better Watch Out": Confidentiality, Its Limits and the Duty to Protect

Dale, forty-two, has seen Hannah for two months for depression and anger after his divorce. Both are invented, as is the Montana practice where Hannah works. Midway through a session in which Dale described seeing his former wife with a new partner at a grocery store, he said, "That guy had better watch out." He then moved on to talk about his children. Hannah had to decide what, if anything, the statement required of her.

Why Confidentiality Matters

Clients disclose painful, embarrassing and sometimes dangerous material in treatment because they trust it will remain private. That trust is a condition of effective help, not merely a courtesy. Pope and Vetter (1992) found that confidentiality was the most frequently reported category of ethical dilemma in their survey of psychologists, with incidents involving risks to third parties, child abuse reporting, information requested by others and the boundaries of privacy among the most common. The frequency reflects how often clinicians must balance clients' trust against other obligations.

An Ethical Practice Model

Fisher (2008) argued that clinicians often confuse ethical and legal obligations, treating permissions as requirements or warning clients about limits after they have already disclosed. She proposed an ethical practice model with several elements. Clinicians should understand the difference between what law requires, what it permits and what it forbids. They should inform clients about the specific limits of confidentiality before clients disclose, so that clients can decide what to share. They should seek clients' consent for disclosure wherever possible. And when disclosure without consent is legally required, they should disclose only the minimum necessary. Fisher emphasized that the ethical commitment to confidentiality is broader than the law, and that clinicians should not disclose simply because the law would permit it.

The APA Ethics Code reflects similar commitments, requiring psychologists to discuss the relevant limits of confidentiality at the outset of the relationship and to disclose confidential information without consent only as mandated or permitted by law for a valid purpose (American Psychological Association [APA], 2017).

Steps for Assessing the Statement

Applying the Steps

Hannah returned to the remark before the session ended: "Earlier you said that guy had better watch out. What did you mean?" Dale looked embarrassed and said he had been angry and meant only that he didn't want the man around his children. Hannah asked whether he had thought about hurting him. Dale said no, that he had never been violent and that "it would only hurt my kids." He had no weapons, no history of violence and no contact with the man beyond seeing him in the store. He agreed that his anger was strong and said he wanted to work on it.

Hannah then reviewed Montana's duty-to-protect statute, as she had done when she began practicing in the state. Like many state laws, it limits the duty to situations in which a client has communicated an actual threat of physical violence against a reasonably identifiable person and specifies how the duty may be discharged, for example by notifying the potential victim and law enforcement. Dale's remark, clarified, did not meet that threshold. Hannah consulted a colleague, who agreed.

Why Not Simply Warn?

Some clinicians, fearing liability, would warn a potential victim whenever a client said anything that sounded threatening. Fisher's model explains why this is a mistake. A warning without a legal requirement breaches the client's trust, may damage the client's relationships and reputation, and can make future clients less willing to disclose angry feelings, which are exactly what therapy needs to address. It may also provoke the conflict it was meant to prevent. Disclosure is a serious step reserved for the situations the law defines, after careful assessment.

The Decision

Hannah made no disclosure. Following Fisher's model, she did not treat the legal permission to disclose in some circumstances as a reason to disclose here, since no requirement was triggered and disclosure would have harmed Dale's treatment without protecting anyone. She did take other steps: she added the incident to her notes with her assessment and consultation, increased attention to Dale's anger in their sessions, agreed with him on what he would do if he felt his anger escalating and planned to ask about it at each session for the next month.

Other Limits on Confidentiality

Threats to others are only one limit. Others include a client's risk of serious self-harm, suspected abuse or neglect of a child or vulnerable adult, which clinicians are typically required to report, and court orders. Third-party payers and the client's own requests for release of records raise further questions. Each has its own legal rules, and each benefits from the same discipline Fisher recommends: know what is required, explain it in advance and disclose only what is necessary.

Limits Explained in Advance

At intake, Hannah had explained to Dale, in plain words and in writing, the specific limits on confidentiality: danger to himself, serious threats to others, suspected abuse of a child or vulnerable adult and court orders. Because of that, when she raised his remark, he understood why she was asking and did not feel ambushed. Fisher's point that clients should hear the limits before they disclose made this conversation possible.

Conclusion

Confidentiality supports the trust that treatment requires, and dilemmas about it are the most common in practice. Fisher's ethical practice model helped Hannah separate what law required from what it permitted, assess before acting and limit any disclosure to what was necessary. Assessment showed Dale's remark expressed anger, not intent, and did not trigger the state's duty to protect. Hannah kept his confidence, documented her reasoning and strengthened his treatment.

References

American Psychological Association. (2017). Ethical principles of psychologists and code of conduct (2002, amended effective June 1, 2010, and January 1, 2017). https://www.apa.org/ethics/code

Fisher, M. A. (2008). Protecting confidentiality rights: The need for an ethical practice model. American Psychologist, 63(1), 1-13. https://doi.org/10.1037/0003-066X.63.1.1

Pope, K. S., & Vetter, V. A. (1992). Ethical dilemmas encountered by members of the American Psychological Association: A national survey. American Psychologist, 47(3), 397-411. https://doi.org/10.1037/0003-066X.47.3.397