Protecting Your Confidentiality
Respect for the privacy of clients in treatment is a primary concern of psychologists. Patients must be confident that the information they reveal to their psychologists will be treated with discretion. Professional ethics established by the American Psychological Assocation (www.apa.org/ethic/code202.thml), along with federal and state laws and regulations bind psychologists to a very high standard of confidentiality. To quote from one of the general principles of the APA code: "Psychologists respect the dignity and worth of all people, and the rights of individuals to privacy, confidentiality, and self determination."
In most cases, disclosure of information obtained by psychologists only is made with written authorization of the client. However, sometimes it is necessary to balance this basic standard of confidentiality with other principles, such as when the safety of the patient or the public comes into question. Hence, disclosure may be ethically or legally appropriate in some situations without the usual client authorization. For example, if a patient is liable to harm him/herself or another person, psychologists must take action to prevent such a grave act, by notifying those in authority.
It is likewise important to consider privacy and confidentiality in emotional care for children. Parents are naturally concerned about their children and are ultimately responsible for their welfare. They may want to known how they can help by knowing what issues are being discussed in treatment. On the other hand, psychologists strive to develop rapport with children, without being seen as a "reporter". Effective treatment balances parental concerns and obligations with the need for children to trust their therapists. Hence confidentiality considerations for children depend on a number of factors including children's age, cognitive ability and maturity, context or purpose of treatment and assessment, and potential consequences of disclosing or withholding information.
Psychologists discuss the limits of confidentiality with all relevant parties at the outset of consultation or treatment. They understand the concerns of parents and children, as well as the factors that promote effective treatment of children. Psychologists make attempts to clarify how they intend to balance these considerations for the ultimate welfare of children and their families.
To protect especially vulnerable individuals, Pennsylvania legislature has enacted laws that mandate disclosure to governmental agencies of relevant information obtained by psychologists and other professionals. In most cases, it is not difficult to discern when such disclosures might be required. When psychologists suspect that a child's physical or enotional health is endangered as a result of abuse or neglect, they must report that concern to the appropriate state agency for investigation. Psychologists must also report concerns about the abuse or exploitation of the elderly or disabled.
Good practice often requires psychologists to consult with other psychologists to consider the best course of action; a process known as peer-review. Such collaboration is not only ethically appropriate, but is desirable in many situations, especially in determining when and when not to disclose information.
The federal government has recently issued wide-ranging regulations governing psychologists operations and records. (See http://www.hhs.gov/ocr/privacy/hipaa/administrative/index.html). Known as HIPPA regulations, the provisions define protected health information (PHI) and set up rules and procedures for its use. Among other provisions, HIPPA rules affirm patient access to their protected health information, regulate the routine use of such information, standardize electronic data transfer and insurance billing procedures, and set standards for disclosure and safeguarding of protected health information.
Psychologists must prepare written statements of policies and procedures consistent with HIPPA rules that they follow in their practices. These are generally presented to patients from the outset. In general, HIPPA regulations are intended to set minimum standards and do not supersede state laws that provide stronger privacy protection to patients.
This brief account is intended to provide an overview of privacy considerations and confidentiality by pschologists. It does not cover all situations or address the potential range of all the concerns that arise in the course of treatment. Those with particular issues should talk with their psychologists and if appropriate, seek legal advice from an attorney.