720 CHAPTER 16
violent impulses that he couldn’t control when in subway stations or when around
blond-haired women, such a statement would probably not be viewed as posing
a specifi c enough danger to violate confi dentiality. The clinician would have been
legally compelled to violate Goldstein’s confi dentiality, however, if he had specifi -
cally named Kendra Webdale as someone he planned to harm.Privileged Communication
Confi dentiality is an ethical term. A related legal term is privileged communication,
which refers to confi dential information that is protected from being disclosed dur-
ing legal proceedings. Just as a priest cannot legally be compelled to reveal what
was said by a parishioner in the confessional, the Supreme Court has ruled that
communication between a patient and a therapist is privileged (Jaffee v. Redmond,
1996; Mosher & Swire, 2002). However, not all confi dential information is privi-
leged, and vice versa.
The person who shared information with the clinician is usually the one who
decides whether it can be revealed, but others can make this decision in certain cir-
cumstances. For example, if a judge orders that a defendant must undergo a mental
health evaluation, as happened to Goldstein after he was taken into custody, the
communication between the mental health clinician(s) doing the evaluation and
the defendant may not be considered privileged in some courts, depending on the
jurisdiction (Meyer & Weaver, 2006; Myers, 1998). In such a circumstance, in or-
der to comply with the law and behave ethically, the mental health clinician should
explain to the defendant at the very beginning of the evaluation that anything said
to the clinician may be disclosed to the judge. That is, the defendant should be
made aware at the outset about the limits of confi dentiality. Whenever the law
regarding privileged communication confl icts with the ethics of confi dentiality, pa-
tients should be told of the limits of confi dentiality as soon as possible (Meyer &
Weaver, 2006).
Another type of exception to the laws governing privileged communication oc-
curs when a patient (or former patient) initiates a civil lawsuit against another party
and raises the issue of personal injury (with mental health consequences) in the suit.
An example of this type of case would be one in which a woman sues her employer
for anguish that resulted from harassment at work. In these sorts of lawsuits for
personal injury, the mental health clinician is legally bound to testify if his or her
testimony is relevant to the case (Bartol & Bartol, 2004).
It is not always clear who owns a privileged communication that arises in the
context of group therapy. In this situation, the therapist may not be compelled
to testify about what transpired, but group members may be. At present, judges
decide on a case-by-case basis whether a therapist must testify, depending on the
specifi c circumstances (Meyer & Weaver, 2006).Informed Consent to Participate in Research on
Mental Illness: Can Patients Truly Be Informed?
In Chapter 5, we touched on ethical issues related to research, including the issue of
informed consent. But can someone who is mentally ill give truly informed consent
to participate in psychological research pertaining to his or her disorder? People
who have anxiety disorders may be able to understand fully the research procedure
and possible adverse effects, but what about people with schizophrenia? Are such
patients’ mental processes impaired to the extent that their consent isn’t really in-
formed? What about people who are having a fi rst episode of psychosis and agree
to participate in a study before the psychotic episode has abated?
The general rule of thumb for researchers is that potential participants must be
capable of understanding and reasoning about what they are consenting to (Meyer &
Weaver, 2006). Thus, the ability to understand and reason about the research pro-
cedure may be more important to informed consent than whether the person is
psychotic at the time of consent (Kovnick et al., 2003; Misra & Ganzini, 2004).Privileged communication
Confi dential information that is protected
from being disclosed during legal
proceedings.