Posted: October 23rd, 2023

Confidentiality in Psychotherapy: Ethical and Legal Considerations

Psy665 Based on readings attached, and Chapter 6 of 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

Please respond to the questions below based on the following material:
• Readings: Chp 6 of the textbook • Confidentiality & NYS Law Presentation: Discussion 5-Bava-Confidentiality & Recordkeeping.pdf Download for discussion of NY state guidelines as it relates to confidentiality and record-keeping.
DISCUSS: Post your responses to the following questions 1. What was challenging in this week’s reading? 2. What is confidentiality? Is it an ethical or legal directive? 3. Based on which NY state law, do therapists have a duty to warn? If the client doesn’t plan to use a gun to commit an act, do we still have to warn or protect? Why & when? 4. Look over (eyeball or search the doc) the NY state’s guidance document (based on the SAFE act) with an eye for what it says about Licensed Marriage & Family Therapist (LM FT) & Mental Health counselors (LMHC)? Does it identify them? If not, are they required to act according to the act? Why or why not?

Confidentiality in Psychotherapy: Ethical and Legal Considerations
This week’s reading from Koocher and Keith-Spiegel (2016) discusses several important aspects of confidentiality as it relates to the practice of psychotherapy. Maintaining client confidentiality is both an ethical duty and a legal requirement for mental health professionals (American Counseling Association, 2014; American Psychological Association, 2017). However, there are also situations in which confidentiality may be broken, either ethically or legally.
Confidentiality is considered a core ethical principle in psychology and counseling (American Counseling Association, 2014; American Psychological Association, 2017). It helps foster trust in the therapeutic relationship and allows clients to openly discuss private matters without fear of disclosure (Koocher & Keith-Spiegel, 2016). Legally, confidentiality is also mandated through various laws and regulations governing mental health records and services (New York State Office of Mental Health, 2022).
While confidentiality is the standard, there are exceptions. Therapists have a duty to warn and breach confidentiality if a client presents an imminent danger to themselves or others (Tarasoff v. Regents of the University of California, 529 P.2d 553 – Cal: Supreme Court 1976). Under New York state law, this duty to warn applies regardless of whether the client intends to use a firearm or other weapon in committing a violent act (New York State SAFE Act, 2013, sec. 9). Therapists must make reasonable efforts to communicate the threat to the intended victim and/or law enforcement.
New York state provides guidance for licensed mental health professionals like licensed marriage and family therapists (LMFTs) and licensed mental health counselors (LMHCs) on applying the SAFE Act duty to warn requirements (New York State Office of Mental Health, 2022). While not explicitly named, the document indicates these licensees must comply with the law’s provisions due to their status as mandated reporters. Failure to do so could result in legal and regulatory penalties.
In summary, maintaining confidentiality is both an ethical duty and a legal requirement for psychotherapists. However, exceptions exist when clients present imminent threats of harm. New York state law clearly establishes a duty to warn and protect in such situations for licensed professionals like LMFTs and LMHCs. Upholding both client trust and public safety can present challenges, requiring balanced clinical judgment.
American Counseling Association. (2014). 2014 ACA code of ethics.
https://www.counseling.org/Resources/aca-code-of-ethics.pdf
American Psychological Association. (2017). Ethical principles of psychologists and code of conduct. https://www.apa.org/ethics/code
Koocher, G.P., & Keith-Spiegel, P. (2016). Ethics in psychology and the mental health professions: Standards and cases (4th ed.). Oxford University Press.
New York State Office of Mental Health. (2022). Laws and regulations. https://omh.ny.gov/omhweb/guidance/laws_regulations.html
New York State SAFE Act. (2013). Section 9: Duty to warn of violent patients. https://www.nysenate.gov/legislation/bills/2013/s2230
Tarasoff v. Regents of the University of California, 529 P.2d 553 – Cal: Supreme Court 1976. https://caselaw.findlaw.com/ca-supreme-court/1765197.html

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