Law and Ethics Continuing Education

 

for (Licensed and Pre-licensed) Psychologists, Marriage and Family Therapists, Social Workers and Professional Counselors. BBS, APA, NASW and NBCC approved provider.

 

Course Objectives

1. Describe the problematic issues associated with boundary violations.

2. Describe how the supervisory role can be used to prevent the violation of boundaries.

3. Identify how enactment may lead to sexual misconduct.

4. Identify the ethical and legal principals of confidentiality.

5. Describe confidentiality laws and the impact of those laws on the therapeutic relationship.     

 

Disclaimer: This course is not intended to offer legal advice or to provide a substitute for legal advice. While laws are frequently cited within the text of this paper, you should be aware that laws can be interpreted differently depending on the specific situation. This is a course which will provide you with an understanding of basic ethical issues which therapist often face but if you find yourself in a difficult situation in which you do not clearly understand what you should do, it is of vital importance that you take the matter seriously and consult with colleagues, an attorney, or an ethics review committee. It is much wiser to do this prior to trying a method you think is appropriate only to find that you have violated ethical rules and put yourself and your practice in legal danger. (Law and Ethics Ceus)

Confidential Communication

Confidential communication between patient and psychotherapist means information obtained by an examination of the patient, transmitted between a patient and his psychotherapist in the course of that relationship and in confidence by a means which, so far as the patient is aware, discloses the information to no third persons other than those who are present to further the interest of the patient in the consultation, or those to whom disclosure is reasonably necessary for the transmission of the information or the accomplishment of the purpose for which the psychotherapist is consulted, and includes a diagnosis made and the advice given by the psychotherapist in the course of that relationship.

Confidentiality is designed to reduce the stigma associated with seeking mental health care, foster trust in the treatment relationship and ensure individuals privacy in their health care decisions. Informed consent and confidentiality are important anchors to the principle of autonomy. If a patient believes that the information they share will be disseminated they will be less likely to seek treatment and be less likely to be completely honest.

When a patient enters our office and psychotherapy begins, everything which is said or done by that patient, with few exceptions, are confidential. The patient holds the privilege to release the confidential information in legal proceedings. While you may object to the patient using these records, you must have solid grounds for your objection. While these are quite variable, generally patients can request and use their records in any way they please. In some instances, a legal guardian or conservator may hold the privilege if the patient is unable to do so. If the patient dies, their privilege passes to the patient's personal representative who handles legal affairs.

The holder of the privilege also has the right to read all information in his or her file with the exception of your personal notes which belong solely to you. Some therapists find this requires them to keep separate files so their personal notes do not become part of the patient's legal record. Your patient can read all notes which have their identifying information, diagnosis, treatment plan, prognosis, and other information including billing and information from other sources which you have included in the file such as notes from other physicians and hospitals. Any spare notes in the patient's file also have information which must be passed to the patient. All information in HIPAA notes are the patient's property and must be released. The file is the property of the clinician so copies must be made if the patient requests a copy of their file. 

It is your responsibility to maintain the confidentiality of the records. Patient records should be kept in locked containers except when in use. They should be shredded when they are discarded to avoid the potential of having the notes fall into the hands of others. Office staff and others who handle the files should be made aware of the importance of confidentiality. Handle these records as if they were notes made by your own therapist about you. Your patient feels the same need to have the notes be private. Office staff, filing clerks, billing agencies, and others do not have the same burden of confidentiality as does the clinician. However, it is the responsibility of the therapist to inform the staff about the importance of confidentiality and to take reasonable action to be certain that staff does not violate the patient's confidentiality. While this is a solid part of HIPAA, it seems to be regularly violated by clerks and other office staff. Often my patients who work for or with counselors in the community or in government report cases which are confidential which they have read with avid interest. Try to keep this sort of clerk off your staff.

 

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