The Ethics of Conditional Confidentiality A Practice Model for Mental Health Professionals

Therapists once promised patients "Everything you tell me will remain in this room." Today, they can keep that promise only if they are willing to break the laws that now require them to disclose information without patient consent. Most avoid such civil disobedience by placing limits on confidentiality; but ethically speaking, this 'conditional' confidentiality can be difficult to practice. The Ethics of Conditional Confidentiality: A Practice Model for Mental Health Professionalsis a guidebook designed to help therapists and other mental health professionals navigate the ethical and legal maze surrounding confidentiality. At its core is a practical Confidentiality Practice Model-a step-by-step guide for clarifying the ethical and legal issues that make the ethics of conditional confidentiality so complicated. Ethics codes represent the 'ethical floor,' which is the minimum standard of behavior about confidentiality. The goal in this book is to encourage reaching for the 'ethical ceiling,' by protecting confidentiality to the extent legally possible and not disclosing patients' confidences just because certain laws wouldallowthem to be disclosed.The Ethics of Conditional Confidentialitydemystifies confidentiality for therapists, clinical supervisors, educators, ethics consultants, attorneys who represent mental health professionals, clinicians, and administrators, and is an ideal supplemental ethics text for graduate courses. It is also useful for establishing confidentiality policies in any clinical setting and training program.

Mary Alice Fisher, Ph. D., is Founding Director of The Center for Ethical Practice, Inc., Adjunct Assistant Professor in the University of Virginia Curry Programs in Clinical and School Psychology, and a clinical psychologist in private practice in Charlottesville, VA. For over 25 years Dr. Fisher has provided workshops, seminars, and consultation for mental health professionals on topics related to ethical issues in clinical practice.

Acknowledgments
Introduction
Abbreviations

PART I. The ABC's of "Conditional Confidentiality": An Ethical, Legal, and Ethical/Legal Review
Chapter 1. Ethical Responsibilities about Confidentiality
Chapter 2. Law Affecting Confidentiality
Chapter 3. Placing Laws into Ethical Context

PART II. Protecting Patients' Confidentiality Rights with an Ethics-Based Practice Model
Introduction to Part II: "The Ethics of Conditional Confidentiality"
Chapter 4. Step 1 - Preparing
Chapter 5. Step 2 - Telling Prospective Patients the Truth about Confidentiality's Limits
Chapter 6. Step 3 - Obtaining Truly Informed Consent before Disclosing Confidential Information Voluntarily
Chapter 7. Step 4 - Responding Ethically to Legal Demands for "Involuntary" Disclosure of Patient Information
Chapter 8. Step 5 - Avoiding Preventable Breaches of Confidentiality
Chapter 9. Step 6 - Talking about Confidentiality

Part III. Practical Considerations
Chapter 10. Clinical Record Keeping
Chapter 11. Confidentiality with Specific Patient Populations
Chapter 12. Confidentiality in Specific Roles and Settings
Chapter 13. Ethics-Based Staff Training about Confidentiality

Appendix
I. Selected Ethical Standards Relevant to Confidentiality Listed Numerically
II - Ethical Standards (using categories from Knapp and VandeCreek (2006))
III - Laws Affecting Confidentiality - Summary and Examples
IV - HIPAA Regulations - Summary
V - Ethical Practice Model (with legal annotations)
VI - Ethical Responsibilities in Forensic Contexts: Which Hat Are You Wearing?
VII - Ethical and Professional Resources
VIII - Ethics-Based Staff Training About Confidentiality - Sample Outline
NOTES
REFERENCES
INDEX