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Confidentiality Limits in Psychotherapy:Ethics Checklists for Mental Health Professionals

Mary Alice Fisher, Ph.D.

American Psychological Association, 2016
ISBN: 9781433821899

Confidentiality Limits in Psychotherapy [1]

Can therapists keep their patients’ secrets? Should they? Psychotherapists are careful to safeguard information about their clients, but in some instances, they may be legally or otherwise compelled to disclose information, even without client consent. This little confidentiality manual walks readers through this complex topic, using the author’s easy-to-follow six-step Ethical Practice Model. The checklist format enables therapists to inform themselves systematically about ethical options and relevant state and federal laws, so they can decide if, when, and in what respects they will limit their protection of clients’ confidences—and then discuss these limits with prospective clients. The chapters and case studies are full of useful information, making this the most convenient guide available to therapists on the topic. Resource lists and appendices for further reading are included. An essential tool not only for practicing therapists but also for ethics professors in clinical training programs, supervisors of students on internships and practica, and peer consultants, this handy reference belongs on every practitioner’s desktop.

“Fisher provides a much-needed desk manual for practicing clinicians, whether they be seasoned clinicians or therapists in training. In checklist format, she uses her ethical practice model to offer mental health professionals a step-by-step process for threading their way through the maze of ethical and legal responsibilities that have made the area of therapeutic confidentiality so complex in theory and so confusing in practice. Therapists should find this a useful tool for learning how to take an ethics-first approach to protecting their patients’ confidentiality rights, even when their confidences are not always protectable.” —Richard E. Redding, JD, PhD, Vice Chancellor for Graduate Education and Wang-Fradkin Professor of Law and Psychology, Chapman University, Orange, CA


This book can be purchased through: the American Psychological Association [2] or it is also available through Amazon.com [3]

Table of Contents

Using This Manual


An Ethical-Legal Review:
The Ethical ABCs of “Conditional” Confidentiality:

Checklist Chapters:

STEP 1. Prepare
STEP 2. Tell Prospective Patients the Truth About Confidentiality’s Limits
STEP 3. Respect the Rule: Obtain Informed Consent Before Disclosing Voluntarily
STEP 4. Respond Ethically to Laws That Require You to Disclose “Involuntarily”
STEP 5. Avoid Preventable Disclosures
STEP 6. Talk About Confidentiality: Educate Each Other & the Public 

Case Examples:   “Taking the Patient’s Perspective”

Step 1: The Case of the Unprepared Therapist
Step 2: The Case of “Uninformed Consent” to Receive Services
Step 3: The Case of “Uninformed Consent” to Disclose Information
Step 4: The Case of the Unprotective Therapist
Step 5: The Case of the Avoidable Disclosures
Step 6: The Case of the “Disconnected” Therapist


Appendix A.  Online Sources for Professional Ethics Codes and Listing of Ethics Texts
Appendix B.  Definitions and Clarifications
Appendix C.  Laws and Regulations Affecting Confidentiality
Appendix D.  Client Handout Template:  “Limits of Confidentiality”
Appendix E.  Elements of One-Way or Two-Way “Release of Information” Forms
Appendix F.  Protecting Clients’ Confidentiality Rights:

An Annotated Version of the Ethical Practice Model