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Posted: October 23rd, 2023

Ethical Considerations in Psychotherapy: Privileged Information and Client Welfare

Book: Koocher, G.P., and Keith-Spiegel, P. (2016). Ethics in Psychology and the Mental Health Professions: Standards and Cases. (4th Edition). New York: Oxford

Case A: Joey & EAP You are seeing Joey, a 25-year-old man, who was referred through his employer’s Employee Assistant Program (EAP). The man claims symptoms of depression and anxiety. He states that if his boss finds out he has depression they will move him to a less favorable position and he is afraid it will make him further depressed. You have ruled out current suicidal ideation though Joey has had a history of suicidal thoughts. You are limited to 6 sessions to help him as part of the EAP. The next day after his session, his boss-Frank calls and leaves you a message stating that Joey mentioned he was seeing you for therapy and that Joey had given Frank permission to contact you.
Case B: Janet Godkin
On several occasions between 1962 and 1970, Janet Godkin had undergone treatment as a voluntary mental patient at three different New York hospitals. She and her husband decided to write a book on her experiences and sought access to her records, wishing to verify some of the material. The requests were refused, which led to a lawsuit against the New York State Commissioner of Mental Hygiene and the directors of the hospitals involved (Koocher & Keith-Spiegel, 2008).
Pick one of the above cases and answer the following questions:
1. Based on your reading of textbook chapter(s), presentations & online discussion what are the ethical issue(s) in this case? 2. Explain the ethical challenge by drawing on the necessary elements of ethical code(s) & principles. Use & identify either AAMFT or APA as per your discipline. In your words, tell us which ethical principle(s) (Koocher & Keith-Spiegel, 2016) are you drawing upon? 3. Based on the case you picked if you were the therapist a. for Case A: How would you respond to Frank? OR for Case B: How would you have responded to Godkin’s request for her record to publically tell her story by drawing on hospital records. b. Tell us how you decided YOUR best course of action? Which factors did you consider? What is/are the relational ethics issue(s)? How are you attending to it? (Clue: think about the therapeutic relationship and the client, law, organizational policies, & your personal values & context etc).

Ethical Considerations in Psychotherapy: Privileged Information and Client Welfare

Maintaining client confidentiality and prioritizing client welfare are fundamental ethical principles that guide psychotherapists in their work. However, at times these principles can come into conflict, presenting complex challenges for practitioners. This paper will examine two case examples that illustrate such ethical dilemmas and analyze the issues from the perspective of relevant codes of ethics. Potential courses of action will be considered with the goal of upholding duty to the client while respecting other responsibilities and relationships.
Case Analysis
The first case involves Joey, a 25-year-old man receiving counseling through his employer’s Employee Assistance Program (EAP). Joey disclosed symptoms of depression and anxiety to his therapist, who must now determine how to respond to an inquiry from Joey’s boss regarding his treatment (Koocher & Keith-Spiegel, 2008). Several ethical principles are implicated here. The APA Code of Ethics (2017) establishes that psychotherapists have a primary obligation to prioritize the welfare and best interests of the client. Revealing confidential client information without consent could undermine the therapeutic relationship and potentially cause harm. However, the therapist also has a duty to act with integrity and avoid misrepresentation when third parties inquire about services provided (APA, 2017).
The second case study describes Janet Godkin’s experience as a voluntary mental health patient in New York hospitals between 1962-1970 (Koocher & Keith-Spiegel, 2016). After deciding to write a book about her treatment, Godkin requested access to her medical records to verify details but was denied by hospital directors. This refusal prompted a lawsuit against state officials. Analyzing this scenario through the lens of the AAMFT Code of Ethics (2015), therapists have a responsibility to facilitate client access to their own records upon request barring certain exceptions, such as if release could cause harm. However, health care organizations also have policies governing privacy, consent and proprietary control over documentation (AAMFT, 2015).
Potential Courses of Action
For the first case, the most ethical response by Joey’s therapist would be to inform the boss that due to confidentiality policies, no details can be disclosed without Joey’s written consent (APA, 2017). The therapist could offer to discuss with Joey the possibility and parameters of granting permission, emphasizing his right to decline. Factors to consider include potential impact on employment and any legal duty to warn in cases of foreseeable harm. Overall, prioritizing the counseling relationship and client self-determination is paramount (Congress, 1996; APA, 2017).
Regarding the second scenario, providing Godkin access to her full records upon request would have been the most ethical path, in line with principles of informed consent and transparency (AAMFT, 2015). While hospitals have legitimate interests, privileging organizational policies over a client’s autonomy, recovery and ability to process their experience through creative expression risks causing harm. Therapists today can advocate for reform ensuring record access policies reasonably balance privacy, proprietary concerns and former clients’ wellbeing (Koocher & Keith-Spiegel, 2008; Congress, 1996).
Navigating competing ethical responsibilities presents an ongoing challenge for mental health professionals. By grounding decisions in core principles like protecting confidentiality and facilitating self-determination, therapists can uphold duties to clients, legal bodies and the public. Ongoing reflection on potential biases and an open, compassionate stance also supports resolving dilemmas in a way that causes no unwarranted harm. Overall, prioritizing the long-term interests and autonomy of individuals seeking help must guide the application of any code of ethics in practice.
American Association for Marriage and Family Therapy. (2015). AAMFT code of ethics.
American Psychological Association. (2017). Ethical principles of psychologists and code of conduct.
Congress, E. P. (1996). Dual relationships in counseling. Science & Behavior Books.
Koocher, G. P., & Keith-Spiegel, P. (2008). Ethics in psychology and the mental health professions: Standards and cases (3rd ed.). Oxford University Press.
Koocher, G. P., & Keith-Spiegel, P. (2016). Peers, ethics, and science: Psychological knowledge in the service of primary prevention. Oxford University Press.

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