Article

The privilege study: an empirical examination of the psychotherapist-patient privilege.

North Carolina law review 07/1982; 60(5):893-942.
Source: PubMed
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    ABSTRACT: Confidentiality is widely considered to be of great importance in psychotherapy. With few exceptions, the breaching of confidentiality is an ethical violation and grounds for litigation. One such exception is the mandated reporting of known or suspected child abuse, representing a legally sanctioned limitation of confidentiality. Because clients generally expect unlimited confidentiality in therapeutic relationships, many therapists have begun to "forewarn" clients as a matter of informed consent. This research report: (a) briefly reviews issues surrounding mandatory reporting and confidentiality as they relate to forewarning, (b) defines and discusses forewarning as contrasted with "informing," (c) examines state statutes, case law and ethical guidelines relevant to forewarning, and (d) presents a survey of 428 mental health providers (MHPs) on their forewarning practices in which 36.9% forewarned all clients, 36.4% informed clients only upon suspicion of abuse, and 20.6% informed only after receiving a disclosure of abuse. The implications of these findings are discussed.
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    ABSTRACT: This study explored relations between willingness to disclose in 5 psychotherapy scenarios and 2 independent variables (privilege condition and previous therapy experience). Scenarios involved suicidal, gravely disabled, physically abusive, and sexually abusive patients, and a police officer patient who shot a suspect. For each of the 5 scenarios, participants in the privilege condition had significantly higher willingness-to-disclose scores than participants in the non-privilege condition. There were no significant differences between willingness-to-disclose scores of participants with and without therapy experience; neither was there a significant interaction between privilege condition and therapy experience. Privilege condition was more predictive of willingness to disclose than personal characteristics or therapy experience. Results provide empirical support for the U.S. Supreme Court's recognition of the psychotherapist-patient privilege in Jaffee v. Redmond (1996).
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    ABSTRACT: This article explores the current ethical and legal standards concerning confidentiality in therapeutic relationships. It examines the existing literature concerning mental health professionals' experiences and attitudes towards confidentiality as well as patients' expectations. It argues that the existing standards are complex and confusing. It is suggested that there is a real need for comprehensive guidelines as to the circumstances in which confidentiality may be breached in order to help mental health professionals provide the best possible health care to their patients. The article outlines the methodology of a project funded by the Australian Research Council which aims to provide comprehensive guidelines for mental health professionals in this area.
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