Confidentiality Chronicles
Under what circumstances can you break client confidentiality?
When there is imminent risk of harm to self or others, or in cases of mandated reporting like abuse or neglect.
You bump into a client at a grocery store. What’s your best course of action?
Let the client take the lead in acknowledging you to protect their confidentiality.
What’s your obligation if a minor client confesses to being abused but asks you not to tell anyone?
Mandated reporting laws require you to report suspected abuse.
A therapist works with clients from various cultural backgrounds. What is the first step in developing cultural competence?
Self-awareness of one’s own cultural biases and assumptions.
How should you handle a client’s request to access their records?
Provide access unless it could harm the client or violate third-party confidentiality.
A parent requests access to their teenager’s therapy notes. What’s your ethical obligation?
Follow state laws and assess the best interest of the client, especially for minors over 12, who may have rights to confidentiality.
True or False: It’s acceptable for a therapist to discuss a client’s case anonymously with a friend if no identifying details are shared.
False. Even without identifying details, discussing a client’s case with non-professionals breaches confidentiality.
A client discloses they are experiencing domestic violence. Are you mandated to report this?
Not necessarily, unless children or vulnerable adults are involved, but providing resources and a safety plan is crucial.
A client practices a religion that the therapist is unfamiliar with and which informs their worldview. What is the therapist’s responsibility?
Learn about the religion through the client’s lens, avoid assumptions, and integrate their beliefs into the therapeutic process if appropriate.
A client asks their therapist to be a character witness in their custody case. Should the therapist agree?
No. Providing testimony risks compromising neutrality and the therapeutic relationship.
A client shares they committed a crime years ago. Do you disclose this information?
No, unless the crime involves ongoing harm or falls under mandatory reporting laws.
Can you accept a small holiday gift from a client? Why or why not?
It depends on the value and cultural context, but gifts that might influence the therapeutic relationship should generally be declined.
A client becomes physically aggressive during a session. What's your first step?
Ensure your safety and de-escalate the situation; contact law enforcement if necessary.
What is an ethical consideration when working with clients or meeting with the parents of a minor whose first language is not English?
Use professional interpreters rather than relying on family members, and ensure informed consent is properly translated.
A therapist receives a subpoena for a client’s records but the client has not signed a release. What steps should the therapist take?
Notify the client, consult with legal counsel, and request the court to limit disclosure if possible.
You’re in a crowded coffee shop, and a colleague starts discussing a mutual client. What should you do?
Stop the conversation immediately to protect client confidentiality.
A client asks for a hug after a difficult session. What’s your ethical obligation?
Consider the client’s needs and cultural context but maintain professional boundaries.
A client discloses childhood abuse by a teacher who is now retired. Should the therapist report?
Only if there is reasonable suspicion that the perpetrator currently has access to minors or if legally mandated.
A therapist avoids addressing race or ethnicity in sessions, fearing they might offend the client. Why is this a misstep?
Avoidance can hinder trust and rapport, as it may ignore critical aspects of the client’s identity and lived experiences.
Can a therapist legally terminate treatment if a client refuses to pay their bill?
Yes, but only after providing appropriate notice, offering referrals, and ensuring termination does not harm the client.
If a client reveals they are using illegal drugs, are you required to report this?
No, unless the drug use is placing others (e.g., children) at risk.
A client asks to follow you on social media. What’s the ethical response?
Decline to avoid crossing professional boundaries.
A client discloses plans to harm someone specific. What’s your ethical and legal obligation?
Notify the potential victim and law enforcement in accordance with duty-to-warn laws.
A therapist encounters a cultural practice they find morally or ethically challenging. How should they proceed?
Seek supervision or consultation to navigate the situation while respecting the client’s cultural values and adhering to ethical standards.
A therapist suspects self-neglect in a client who is over the age of 60 and lives alone. Is this considered reportable?
Yes. Self-neglect is a reportable condition under Illinois elder abuse laws if it places the client at significant risk. Contact the Illinois Department on Aging's Adult Protective Services Hotline to make a report.