irreparably harmed. Clinicians should be clear and
open about matters of confidentiality and the con-
ditions under which it could be breached. In
today’s climate, not all information is deemed
“privileged.”For example, third parties (e.g., insur-
ance companies) may be paying for a client’s ther-
apy. They may demand periodic access to records
for purposes of review. Sometimes school records
that involve assessment data may be accessible to
others outside the school system under certain con-
ditions (e.g., if they are subpoenaed by a court).
More and more, clinicians cannot promise absolute
confidentiality.
Another question is whether all information
should be confidential. Take, for example, the
famous 1976Tarasoff case. The events leading up
to this case began when a client at a university
counseling center told his therapist that he planned
to kill his girlfriend. The therapist informed the
campus police of the client’s intentions. The police
promptly took the client into custody, but because
the girlfriend was away on vacation, they decided
to release him. Subsequently, the client did indeed
kill his girlfriend. Later, the woman’s parents sued
the therapist, the police, and the university, arguing
that these three parties were negligent in not
informing them of the threat. The California
Supreme Court eventually ruled in favor of the
parents, holding that the therapist was legally remiss
in not informing all appropriate persons so that vio-
lence could have been avoided. Such a decision
surely raises issues that would tax the judgment of
nearly every clinician.
What makes all this even more ambiguous is
that the legal precedents differ in various states.
Not only must clinicians decide when and whom
to inform and under what circumstances but they
must also try to determine whether theTarasoffdeci-
sion applies in their state. Although theEthical Stan-
dardsclearly state that psychologists must disclose
confidential information to protect the client/
patient, psychologist, or others from harm, the clause
“as mandated or permitted by law”still serves as a
source of confusion for some. Clearly, this reinforces
the idea that psychologists need to update them-
selves on current laws in their jurisdiction.
Confidentiality involves numerous other com-
plications. For example, what about working with
children? Issues of confidentiality can also arise
when clinicians are treating patients with HIV, per-
sons with disabilities, or the elderly, for example.
Apparently, the lay public believes in the principle
and importance of confidentiality. But they also
understand that confidences may be broken in
cases of suspected child abuse, potential suicide or
murder, and other potentially life-threatening situa-
tions. Most clinicians agree. However, only in
situations where they have felt the need to consult
with a colleague or have had a potentially danger-
ous client are most clinicians willing to consider
disclosure without client consent.
Finally, it is worth noting that a 1996 Supreme
Court ruling,Jaffe v. Redmond, provides for privi-
leged communication between licensed mental
health professionals and individual adult patients in
psychotherapy. Therefore, at least in federal courts,
a psychotherapy patient’s consent is necessary
before her or his psychotherapy records, commu-
nications, and documents can be disclosed. Essen-
tially, the Supreme Court’s decision reinforces the
view that privacy in psychotherapy is important.
However, because this decision does not necessarily
supersede state laws or state court decisions, clinical
psychologists should become well acquainted with
their state laws regarding confidentiality and privi-
leged communication in psychotherapy.Human Relations
Dual relationships pose many ethical questions
regardingclient welfare. Sexual activities with clients,
employing a client, selling a product to a client, or
even becoming friends with a client after the termi-
nation of therapy are all behaviors that can easily
lead to exploitation of and harm to the client.
Although perhaps not very common, such events
are clearly troublesome to the profession. Sexual
liaisons can be equally damaging in supervisory
relationships.
The worst of these dual relationships are sexual
harassment and sexual intimacies between psychol-
ogists and current clients. Make no mistake, ethical88 CHAPTER 3