5 Exceptions to the Confidentiality Rule

Confidentiality and minor therapists who treat minors often walk a fine line between respecting the minor`s need for confidentiality and the parents` desire to be informed about the minor`s treatment. In general, the younger the child, the more willing the therapist should be to share with the parents, the older the child, the less willing the therapist should be to share with the parents. However, therapists are wise to make it clear to parents of minors of all ages that effective therapy cannot be performed if the child does not trust the therapist. Parents should not expect therapists to act as an “information channel” for their minor child. Therapists should tell parents that the information will be shared as the therapist deems appropriate. If there is an age at which a limit can be set in terms of exchanging information with parents, it is twelve. Some minors 12 years of age or older are entitled to the same level of confidentiality as an adult. Minors who have consented or could have consented to their own treatment are granted this right. While this rule does not apply to all minors aged 12 and over, it does provide a useful guideline for therapists who deal with parents looking for information about their child`s treatment.

Therapists who treat minors who are 12 years of age or older may want to have a policy that requires the minor`s written permission before disclosing confidential information. CAMFT has worked to restore the therapists` ability to communicate with other health care providers without the patient`s written permission. However, until such a change in the law is made (which could happen this year), therapists are advised to obtain written authorization before disclosing patient information to another health care provider or person in accordance with the permissive exceptions described in paragraph 56.10(c). [11] A lawyer who is entitled to a fee is entitled, in accordance with point (b)(5), to prove the services provided in a recovery action. This aspect of the rule expresses the principle that the beneficiary of a fiduciary relationship cannot exploit it to the detriment of the fiduciary. Confidentiality is a cornerstone that distinguishes the relationship between therapist and patient from many other professional relationships, it also has a variety of exceptions, both mandatory and permissive, for which therapists must be able to navigate. 2.7 When working with a group, marriage and family therapists educate the group about the importance of maintaining confidentiality and are requested to obtain the written consent of group participants to respect the confidentiality of other group members. It cannot be stressed enough that the five Cs are a general guideline for exceptions to ethical secrecy, which may vary depending on jurisdiction and clinical environment. Keeping in mind the generalities of the five Cs, how do you handle the analysis of a clinical problem that involves confidentiality issues? Here is one way to address a potential confidentiality issue: [19] When submitting a notice containing information about a client`s representation, a lawyer must take reasonable precautions to prevent the information from falling into the hands of unintended recipients. However, this obligation does not require counsel to apply special security measures if the nature of the disclosure permits a reasonable expectation of privacy.

However, special circumstances may warrant special precautions. Factors to consider in determining the appropriateness of the lawyer`s expectations of confidentiality include the sensitivity of the information and the extent to which the confidentiality of the communication is protected by law or by a confidentiality agreement. A client may require the lawyer to take special security measures that are not required under this rule, or the client may give consent to the use of a means of communication that would otherwise be prohibited under this rule. Whether an attorney may need to take additional steps to comply with other laws, such as state and federal laws that govern privacy, would be beyond the scope of those rules. Privacy and third parties participating in therapy Many patients will have a third party participate in a session or sessions at some point during their therapy. For example, an adult male who focuses on his relationship with his sister at some point during individual therapy will have her participate in one or two sessions. And while it may be obvious to the therapist that the third “visitor” only participates in the sessions for the purpose of treating the actual patient, the visitor may see things differently. This problem may not occur until some time later, when the patient asks the therapist to send a copy of their records to their lawyer. At this point, the therapist can recognize that there is information about this visitor in the registration. Does the visitor have the right to confidentiality? Maybe.

Would the visitor have an expectation of confidentiality? Probably. The therapist can address these and other issues when the visitor attends the therapy session with the patient for the first time. The therapist must inform the visitor that he is not a patient and therefore does not have the right to confidentiality or psychotherapist-patient privilege under the law. Of course, the therapist respects the confidentiality of the session, but the visitor should not have any expectation as to the legal protection granted to the patient. While confidentiality is a cornerstone that distinguishes the therapist-patient relationship from many other professional relationships, there are also a variety of exceptions, both mandatory and permissive, for which therapists must be able to navigate. This article contains many legal exceptions to privacy that apply to therapists who work in most environments. However, this is not a complete catalog of exceptions. Therapists working in certain specialized environments, including those funded by federal funds, may be required to comply with laws and regulations different from those listed here. Moreover, this article does not address the complicated interaction between HIPAA and California law that has been covered in previous articles in The Therapist. Confidentiality and group therapy Therapists who treat patients in groups should develop a group confidentiality agreement.

Such an agreement should regulate not only the therapist`s duty of confidentiality to the group, but also the confidentiality rules for group participants established by the therapist. For example, the therapist may want each participant in the group to agree to keep confidential all information disclosed during the session as a condition of participation in group therapy. Continuation of treatment – A physician may disclose confidential information necessary for a patient`s further treatment. (This exception is also recognized by HIPAA, subject to the “minimum necessary” limited disclosure rule.5 ) Our colleague Tom Gutheil, MD, teaches mnemonics useful for distinguishing confidentiality from privilege. To paraphrase Dr. Gutheil, confidentiality (“co”) is the physician`s obligation not to disclose confidential patient information, while privilege (“pr”) deals with the patient`s right to exclude communications with an attending physician from legal proceedings.3 Éducaloi provides general information on Quebec law.