Textual IRC Client Knowledge Base - Privacy Policy 8/17/17, 704 AM Page 1 of 3 Privacy Policy Home To print. Obtaining the client’s consent is often the best way of resolving legal and ethical disclosures over confidentiality (Cohen, 1992);” (Bond P158 Para 3 Lines 4-7) Notwithstanding all of the above there are then my own limits of ability, understanding and knowledge to consider within a counsellor/client.
Clients have a right to expect that what they disclose to a professional will not be revealed to a third party. This is significantly different to a situation where a friend requests a secret be kept. With a friend, your loyalty to them and desire to maintain the friendship will determine whether in fact you keep their secret. All information from, or communication with, a client, within a therapeutic relationship, irrespective of the content, must be kept confidential (Welfel, 2013). Consequently, confidentiality is essential to maintain trust and a working alliance within a therapeutic relationship (Parsons, 2001).
According to Bond (2010) confidentiality protects clients by giving them control over how the information they reveal is used. Bond (2010) explains the meaning of confidentiality in terms of trust:
One meaning of confidentiality is ‘strong trust’ (from the Latin con-fidere). High levels of trust are necessary to create the conditions in which clients can strive for the levels of personal truthfulness necessary to address the issues that are causing them concern. It requires corresponding levels of trustworthiness on the part of the counsellor. For these reasons, protecting confidentiality is a high ethical priority in counselling and requires sound ethical reasons for confidentiality to be curtailed in any way. (p. 155)
Bond (2010) reported that the historical commitment to confidentiality became apparent when in 1965 a psychoanalyst, Anne Haymen, refused to disclose her client’s material even though the client consented to the disclosure. Anne insisted that a client’s dependency on her analyst prevented a fully informed consent whereby the client may feel obligated to provide the consent and may be unconscious to their own motivation in providing that consent. Anne appeared in court in response to the subpoena and was prepared for the consequences. She hired a barrister to defend her in the event that she was held in contempt of the court and thus charged. In this case the judge used the discretion that the law allowed and decided that Anne’s conscience required her to protect her client’s information at any cost.
Agreements on confidentiality with clients provide them with a level of security in understanding how their disclosure will be safeguarded and whether discussed or not clients will expect confidentiality from their counsellor (Kampf, McSherry, Ogloff & Rothschild, 2009).
It may seem obvious that clients require confidentiality for counselling to be beneficial, but confidentiality is not absolute and pressures to breach confidentiality indicate that it may not be easy to guarantee. Therefore the role of the counsellor includes that as “custodian of sensitive client personal information, i.e. in deciding to maintain confidentiality or to disclose client information” (Tribe & Morrissey, 2005).
Students sometimes think that confidentiality is held in both directions, meaning that the client is also bound to confidentiality. This is not the case. Clients are free to discuss any aspect of their counselling (including everything their counsellor says) with any other person they wish
Why is confidentiality necessary?
Understanding the need for confidentiality, as well as the contexts for breaching confidentiality and the associated consequences, provides a basis for professionals to:
inform clients/individuals of the limits to confidentiality (Tribe & Morrissey, 2005)
analyse and interpret when it is ‘reasonable’, ‘necessary’ or ‘appropriate’ to disclose (Kampf et al., 2009)
apply the ethical thinking necessary in order to make decisions that create the least harm for the client/individual and for themselves as professionals.
The right of the client to confidentiality acknowledges the power imbalance intrinsic to the counsellor/coach-client relationship, the trust that has been placed in them and, importantly, the client’s vulnerability (Kampf et al., 2009).
Kampf et al. (2009) outline the key imperatives (in addition to the legal above) for the application of confidentiality:
Facilitating treatment: The promise of maintaining confidentiality is an important factor in encouraging persons who have mental health problems to seek treatment. Trust and safety is crucial to create the environment necessary for disclosure and therapeutic intervention.
Keeping sensitive information private: Maintaining confidentiality in counselling is also important for the control of personal information. Clients’ disclosures often include highly sensitive material such as fears, abuse, violence, drug abuse and sexuality. If this kind of information were raised in a context outside of the therapeutic setting, it can be misunderstood and misused. Therefore it needs to be restricted to the therapeutic relationship.
Avoiding stigmatisation and discrimination: The simple fact that an individual receives mental health care can lead to stigmatisation and discrimination. Confidentiality in mental health settings avoids information leaking into the community and therefore decreases the risk that a person receiving mental health support will be subject to stigmatisation and discrimination.
Safeguarding certain positions in life: Individuals who are subject to stigmatisation and discrimination may lose, or not be able to access, certain positions or services in life. These may include, for example, employment and leadership positions and access to accommodation, health and life insurance. Maintaining confidentiality decreases the likelihood of such negative outcomes.
Increasing positive ethical outcomes: Maintaining confidentiality is linked to important moral principles, such as respect for autonomy, non-maleficence, beneficence and justice. Apart from this principle-based approach, other philosophical viewpoints value confidentiality as a virtue in itself. Also, professional codes of ethics include the general principle that confidentiality should be protected.
Increasing positive health outcomes for other individuals: Clients who frankly discuss sensitive issues related to their mental health problems without fear of disclosure of information to third parties assist the mental health professional to diagnose the underlying issue, thereby advancing their proper treatment. Successful mental health care also improves the wellbeing of others such as family members, friends and colleagues who can be affected by an individual’s mental illness or mental disorder. (pp. 7–8)
What are the professional and public interests regarding the need for confidentiality?
Professionals themselves as well as the public are also stakeholders and benefit from the maintenance of confidentiality in therapeutic relationships.
Professional interests
Professionals at times discuss client details with colleagues. Sometimes this might be in formal supervision. Other times it may simply be a need to debrief a particularly difficult case, to get advice on an ethical issue, to report a difficult experience, to contribute to a collegial atmosphere or to provide some humour to a particularly stressful day. How ought professionals manage these normal impulses to share?
Welfel (2013) provides the following advice:
The first consideration must be for the dignity and welfare of the client. The best standard for determining whether informal information sharing with colleagues is ethical is to ask whether the client would understand the comment to be a professional consultation if he or she heard it… Second, even if the identity of the particular client is not revealed, the client may feel humiliated by a non-professional disclosure and be less willing to disclose personal information in future sessions. Thus, client information should be shared only within a formal consultation environment, and all sharing should respect the dignity of the individual. (p. 115)
Furthermore, Welfel (2013) recommends that professionals place themselves in the client’s position to determine if a disclosure is necessary, respectful and appropriate.
Mental health professionals are genuinely interested and care about the wellbeing of their clients and therefore wish to maintain confidentiality as this prioritises their clients’ best interests (Kampf et al., 2009).
Mental health professionals also pride themselves on their integrity and ability to make ethically sound decisions. Maintaining confidentiality provides professionals with a platform to foster their ethical decision-making and uphold their integrity (Kampf et al., 2009).
The reputation of the counselling industry is also affected by the maintenance of confidentiality. Professionals who take confidentiality seriously advance the reputation of counselling and provide important role modelling to students and those new to counselling.
Bond (2010) provides guidelines for maintaining confidentiality within settings where multiple professionals have access to a client or their records. Within a team approach Bond recommends:
minimizing the repetition of what may be a painful history or event being told repeatedly to each member of the team
better coordination between the people delivering the services
greater opportunities for service providers to pool knowledge and expertise and enhance the quality of service offered
the opportunity to be involved in decisions about what information is shared and with whom. Clients may be deprived of this opportunity where exchanges of information are informal or ad hoc, and thus outside their awareness. (p. 165)
Bond (2010) also recommends that organisations follow the Caldicott principles for information sharing. The six Caldicott principles are:
Justify the purpose(s) for using confidential information.
Only use when absolutely necessary.
Use the minimum that is required.
Access should be on a strict need-to-know basis.
Everyone must understand his/her responsibilities.
Understand and comply with the law. (p. 166)
As mentioned in Section 2, clients need to be given the opportunity to provide informed consent regarding what information is shared, for what purpose and with whom it is being shared.
The public interest
Not only does the reputation of industries benefit from the maintenance of confidentiality, trust of professional services is paramount to people being willing to approach those services for support. If a service cannot provide a guarantee of confidentiality (even if not absolute) then people may be deterred from seeking help and consequently the general mental health of the public is affected.
As mentioned earlier, the maintenance of confidentiality also supports clients’ autonomy, promotes beneficence and reduces the risk of harm to clients. It is essential that as confidentiality is increasingly seen as a human right, mental health services managers provide a level of confidentiality that meets the expected standard in general health settings. This ensures that the right to equal treatment and non-discrimination of confidentiality is upheld (Kampf et al., 2009).
There is also the court’s concept of “public interest” which refers to what is in the best interest of the greater public good and “holds decisive authority” (Tribe & Morrissey, 2005, p. 65). Though confidentiality is key to the public interest, it is also this authority that may justify or require the disclosure of confidential documents in order to protect the client, their family, the professional or any other party deemed to be at risk (Tribe & Morrissey, 2005).
Confidentiality and practice contexts
Certain settings and situations create unique challenges for the maintenance of confidentiality. Below we consider some of the circumstances that may challenge confidential practices.
These circumstances are influenced by a significant variation in settings or practices. The setting might be one of the below:
small-town private practice
school setting
email/online/phone counselling
non-government organisations
Employee Assistant Program
community centre
health service
part of a rehabilitation program
prison
private practice at home
private practice externally
private combined practice
The setting in which you work may provide services to a specific client group. This may include cancer survivors, people with anorexia, people with a disability, carers, survivors of child sexual assault, people with issues regarding drugs, alcohol or gambling, people in grief or many others.
Circumstances where there may be a pressure to breach the confidentiality of a client are also many and varied and may include:
a client with a diagnosed mental health condition who has stopped medication and appears to be emotionally, mentally or physically unstable
a teenager requesting you keep their drug behaviour a secret from their parents
a client with suicidal tendencies
being served a subpoena
a client seriously threatening harm to another person
a disclosure of child abuse
a dangerous client
an employer wanting a report on an employee’s ability to carry out their job
Technology or telecommunications may also present opportunities where professionals may not be aware of the potential for a breach of confidentiality.
The confidentiality of an individual could easily be compromised in any situation even where there is no live video evidence of an individual. Someone with access to another’s login details could enter a group online network. It is therefore recommended that counsellors not engage in online group counselling (Bond, 2010).
Apple iphone 5 applications free download. Remley and Herlily (2010) offer guidelines and suggestions for protecting the privacy of clients when using a telephone or mobile phone:
Telephone:
Do not divulge or confirm that a person is a client.
Do not give out information about a client without their consent.
If discussing confidential information ensure that you are speaking to the intended person who is authorised (i.e. the client themselves or someone to whom they have given consent) to discuss that information.
Ensure that the conversation will not be recorded or monitored.
Ensure external persons are unable to overhear the conversation.
Be careful to maintain a professional manner and to discuss only the information of which the client has given consent.
Do not make comments that the client would not be comfortable with or that you would be unwilling to be accountable for.
Be mindful that when ringing a client on a mobile phone that they may not be able to acknowledge you if they are in company.
Messages:
Do not allow others to hear or access messages that are left on your answering service.
Do not leave messages on a client’s answering machine unless you have permission by the client to do so. Even then be mindful that an unauthorised person may have access to their messages.
If leaving a text message, the same attention to confidentiality is warranted as when leaving a voice message. (pp. 152–153)
Using faxes and emails also provides challenges to maintaining confidentiality for clients. It is necessary to ensure that these communications arrive in an environment that protects the client’s confidentiality (Corey, Corey & Callanan, 2011).
Frankel (2000, as cited in Corey et al., 2011) insists that email counselling services must satisfy the following conditions:
the existence of an established professional relationship
there is informed consent about the risks to confidentiality using email
limiting email use to basic information exchange (p. 227)
Additionally Corey et al. (2011) provide the following cautions for using email:
be aware that email sent to a client’s work automatically becomes the property of the organisation and that privacy and confidentiality are not guaranteed
do not use email for counselling communication unless the client has given consent
The use of technology for communication is ubiquitous and most often used in an automatic manner. Professionals must be mindful of the ways in which confidentiality and privacy may be compromised when using technology. It is necessary and wise to establish acceptable frameworks for communication and use preventative ways to guarantee that clients understand the risks of various forms of communication and provide consent (Corey, et al., 2011).
Corey, G., Corey, M., & Callanan, P. (2011). Issues and ethics in the helping professions (8th ed.). Belmont, CA: Brooks/Cole.
Featherstone, T. (2012, April). A matter of public trust. Company Director, 15–19.
Ghadar, F. (2007, January/February). Governance: The rising role of NGOs. Industrial Management, 8–12.
Jenkins, P. (2010). Having confidence in therapeutic work with young people: Constraints and challenges to confidentiality. British Journal of Guidance & Counselling, 38(3), 263–274. http://dx.doi.org/10.1080/03069885.2010.483128
Kampf, A., McSherry, B., Ogloff, J., & Rothschild, A. (2009). Confidentiality for mental health professionals: A guide to ethical and legal principles. Brisbane, Australia: Australian Academic Press.
McSherry, B. (2006). Access to confidential medical records by courts and tribunals: The inapplicability of the doctrine of public interest immunity. Journal of Law and Medicine, 14,15–19.
Parsons, R. (2001). Informed consent. In R. Parsons (Ed.), The ethics of professional practice, (pp. 101–118). Needham Heights, MA: Allyn & Bacon.
Tribe, R. & Morrissey, J. (2005). Handbook of professional and ethical practice – for psychologists, counsellors & psychotherapists. New York, NY: Brunner-Routledge.
Welfel, E. R. (2013). Ethics in counseling and psychotherapy: Standards, research and emerging issues (4th ed.). Pacific Grove, CA: Brooks/Cole.
Younggren, J., & Harris, E. (2008). Can you keep a secret? Confidentiality in psychotherapy. Journal of Clinical Psychology: In Session, 64(5), 589–600.
Related Posts:
Is your private practice private? Can your clients feel safe in your office? As a mental health practitioner, you’re tasked with protecting your clients’ confidentiality, and that can be daunting. The following tips will help you improve privacy for your clients in your office setting.
Be Upfront With Your Privacy Policy
Start things off by being completely transparent with your privacy policy.
As a mental health professional, you abide by a code of ethics, but you’re also legally obligated to uphold certain mandates. It’s important that your clients know your privacy policy—including what information will be kept private when information can be shared, and with whom.
In your office, display your privacy policy for all to see. Some therapists even choose to frame their privacy policy and hang it on the wall or place it on their desk. When placed in a prominent location, your privacy policy will be unavoidable, and that’s a good thing.
In addition to displaying your privacy policy, also take the time to go over it personally with your clients during their initial visit. This can establish a baseline of trust between you and your client. It will also give your client an opportunity to get clarity on any areas of your privacy policy that may be unclear to them.
Be sure to explain that there may be times when you are required (by law) to share information without the client’s consent and give clear examples of when this would occur (if you believe the client will harm himself or others, if there is ongoing abuse to the client or others, or if you are ordered by the court to turn over information).
Your clients need to understand that as a mandated reporter, it’s not up to your discretion on when to disclose this information. By opening dialogue in the beginning, your clients will be aware of what you can and cannot do.
Also, consider including other practical, good-to-know information in your privacy policy, such as:
Do you need to share information with other care providers?
When do you share and under what circumstances?
Do you ask clients for their permission each time?
While you may not want to overwhelm your clients during their first meeting with all of this information, just go over the big ideas during your initial introduction and then ensure that your privacy policy is always (and easily) accessible. During the intake process, you’ll likely include your privacy policy along with authorization and release forms, but don’t forget to make these same documents available on your website and in your office reception area.
Practice Privacy
Now, let’s talk about how customer service affects client confidentiality.
From the moment the client steps into your office until the moment the client leaves, you must protect the client’s privacy. Here’s how you can ensure client privacy throughout your office space:
Reception & Waiting Area
When you meet a client in the reception area, don’t greet the client by name.
Don’t ask the client to verbally confirm why they’re meeting with you.
Don’t ask your clients to settle an unpaid or past-due bill in the reception area. This should be handled in a non-public space.
In Your Office
Don’t display another client’s private records on your desk for others—such as clients and staff—to see. If your client can easily see private information for another client, their trust in you will plummet. Ensuring confidentiality for all clients will make everyone feel more protected.
General Guidelines
Don’t speak to staff members about your clients’ private care.
Avoid speaking to other therapists about a client with non-essential staff members present.
Don’t discuss the client’s follow-up meeting or any “homework” you ask for in public spaces, including waiting rooms and hallways.
Protect Your Records
Where do you keep your records? And, perhaps more importantly, who has access to your clients’ identifying information and records?
Record keeping is not optional. As a mental health therapist, you need to keep records primarily as a form of reference and also to protect yourself. You must find a way to keep your information from getting into the wrong hands.
At the very least, invest in a lockable filing cabinet. Be sure to control access to this filing cabinet also.
As an added layer of protection, your filing cabinet should be kept in a locked room, such as your office. Keep your office locked when you’re not using it, and keep the keys to your office securely on your person.
But a better alternative to a filing cabinet is TheraNest, a robust, web-based practice management solution. With TheraNest, your client records are always kept safe and confidential.
Instead of using paper and then worrying about securing those papers behind lock and key, go digital. Digital record-keeping makes it so convenient to access your client information from wherever you need to, including the office, your home, or even on the go. Plus, TheraNest is both HIPAA-compliant and encrypted. Learn more about TheraNest here.
Soundproof Your Office
One of the best ways to improve client confidentiality in your office is to soundproof it. No one else—not by accident and definitely not intentionally—should be able to hear the private counseling conversations between you and your client.
But what if you’re renting an office space and you can’t remedy the thin walls?
Invest in a sound machine. Any sound machine will do—whether you go with a white noise machine, a background music player, or even a water fountain. If you’re not sure which to choose, consider a white noise machine. It almost magically masks the voices of people in other rooms.
Place your sound machine in the waiting or reception area. That way, it should drown out or make it difficult to understand the conversation in your office. Of course, you should definitely test it with different voices (male, female, young, old) to make sure that the machine masks your conversation satisfactorily.
Train Your Staff
It’s not enough for you alone to uphold the confidentiality of your clients. Your staff should also respect the client’s privacy—and it’s your responsibility to make sure that they do.
Here’s how you can work with your staff to protect your clients’ privacy:
Don’t use client sign-in sheets. Standard client sign-in sheets show the names of other clients. This is a no-no when you’re protecting the identity of your clients. Instead, keep records of sign-ins right in your TheraNest software.
Allow clients to fill out and submit their own intake forms online (or via an Internet-connected tablet in office). Not only does this improve the standard of confidentiality in your office, but it also reduces staff error and has the added benefit of eliminating a paper trail. Design your intake form with our client portal, Client Portal. Our Client Portal makes it easy to schedule clients, accept credit card payments, and sync information automatically and in real-time. Plus, our Client Portal is completely secure—so your clients’ information remains private.
Operate on a need-to-know basis. While you may need to provide the client’s private information to a third-party payor, such as an insurance company, remember that you only need to provide the minimum information necessary. Your staff should know what information to share (and to whom) and what information to never give out.
Ensure the computers and fax machines are kept in private, restricted areas. Because fax machines and computers often display sensitive information, these tools shouldn’t be kept in a common, public space where other clients may have a chance to see them.
Limit access to client records. Ideally, you’ll have a paperless practice that’s all digital, but if you still have physical records, be careful to keep these records safe. Use storage with locks, and also limit who has a key to this storage.
Protect yourself after terminating employment. You should change locks and computer passwords if you have to fire a staff member. While it may seem excessive, it’s better that you’re safe than sorry. Plus, it’ll be a good reminder to hand out keys to staff members only on a must-know basis.
Stay up to date on your state laws. Not only should you be aware of any privacy laws concerning mental health and private practice, but your staff should also know. Make it a habit to stay informed.
Related Resources
Textual 7 0 8 – Lightweight Irc Client Confidentiality Example
Before you go, check out these additional resources: