Msft6008 Reading4

p';t1 1 Lun1,; l{lJ;s,l, )r1( 1a"u.r'u,1) Tt,VtuI R i chard S . Lesl rc, nrgconfidentiality.Sincctheseare "gcneral" rules, ir musr bc remembeledrhar thoe are exceptions. Virh .espectb not releasinginfof matidr wilhc,ut rhe client's signed iuthorization, there are times when therapists musr release information withoul a signcd aurhoriz.rbn and times when they mry do rhis. Chil abuseand eldc!ibuse reponinglaws arc well-.ecognizedmrndarory excetrions to the general rule. Pernissive discli! sures woukl typically include cascs where a thrr.pisr, among other peoplc, hasrc.son!bl eci use ro hel i evcrh . r r he pirienr is a dnnger to self or n) the peF son or property ofothers. Addirionally, ccrtri n forms of chi l d abuseand elder abusemay not rcquire repots, bur n.ry allowreportsto bc n:tde. tjndcr I III,AA (for covered providers) and srme st:rte laws, therapists are permirted rc nrikc disclosureswithout dre parienfs wrirr(n rudrorization for purposes of thc providcr\ tr€rrmcnr, prynent, :rnd heal thcareoperati ons. R cl €rsi D gthe mi ni mum i monnr of informarion necessarytoaccomplishrhc purtoseofrhc rcl ease i sn cotnmont r r crice dur has been aciopred in IIIPAA regularions.lt is oftcn confronteri wlren i nsuraD cecomfi .ni cs w anr i o scc a paticnCs entire filc, Therapisis should attempt to narrow the insurerl rcqucs! and to provide onIy the relevant porrion of thc records. In situations whcrc a he corncrstoneprinciplc of o n rh e c l i e n tt nertal he:rl thand how wrrnins has n, be (or may be) made to t hc v ar iousm e n ra lh e rl th the clienr vicws the profession. the intendccl vicrim of rhe pirientt protessionsis confidential thrcatcned violencc, as in the Tatasoff ity. This lcsal ard erhical a o m € G 6 n erat R ul eg casc, the warning should senerally be p. inc iplcis c ri ri c a lro s u c - The first general rule to rernember is concise,direci, aDdl;mited in scope.Th e cesrfully s'ork w'rh clicrrs, sinceclients thatyou should notreleaseinforDation mxrimum necessaryrule is inapplicable mu si b c r s s ur ed of c on fi d e n ri a l i ryi r rbout acl jentwithourrhe clienCssiSned in certajn circumsra.ces.[,or insrance, order lor them ro sharewith rheir tlrcr- authorization. Anorher general rule is it doesrt apply to relersesofconfiden, a p rsi srh e m os r pr iv ar e ,i n ri ' n .te , a n d rhrt when you release confidenrirl tial information by a Leafth care so mcri m es em bar r as s indge ta i l so f rh e i r infornatnD, only releaserhe mininum provider for purposes of treatment of live s. I h e lik elihoodof c l i n i c a ls n c c e s t a mo u n t o f;nformari on necess.ryto the prtient, where full and compl(tc is n rc.e rs ed\ ! h. n r he c l i e n rfe e l sc o m Nccomplishrlre puDose of the relerse. nrformatioD is helpful ro proper lreatf o .rrb l e s h. r ins s uc h de ra i l srv i rh rh e A third gereraI rule to rememberis thar ment. lt doesnl apply to a parienCs rh e rtrp ,lr .Cl, enr i pDr a l o r o f rru s r i n when in doDbt, resist fcleasing infor- requestf.'r a copl of his or hcr records, t h e i . rh er . r pis r ses . pec ia l l w v i rh re s p e c t madon and opt in fivor ofmaintaining and ir generirlly .1oesn'rapply in cases ro co n a ,J c nnr lin. , \$, . o n g h rlb rc a c ho f confidctrtialiry. Ordinarily, rhere is where ther. is a wriften .urho.izrrion. c o n n J.nr ir hc nor onlv s u b i e fts rh c sreater risk in wolgfully releasing With resfect to the general princi t h e rrp r* r o c r r il r nd adm !ri s rrtrri vlei a infornurio. without rhe patieDfs pl e of " w hen i n doubt, resi si disclob i l i $ . b u t : ls o c . r r hav c a l a s i i n Se ffe c t authorizatjon rhan there is in prcscrv- sure," therap;sts will typically not ser

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i n rro u bleif t hey r es is tw h e ni . d o u b t, .s l o n g as t hey na k e re a s o n a b l e dttemprs to ascertainrhe appropriarcn e ss o r nec es s ir yof d i s c l o s u re .T h i s p ri n ci p lec om c nr s r opl a y w i th g re rtfrc rl u e n c y( ant lwit h f r eq L re nm t i s ra k c sb y th e ra p is t s ) when ar a$ o rn e yn s k srh e m to ma k e and s ign a de c | rri ti o n , u s u a l ' ly in a divor.e/cu5t.,dy proccednr8, a b o u !o neof t he pir t ie s .Wh i l c d refx c rs a n d ci rc ur ns r r nc esv ir l i n rh e s ek i n d o f tro c eedingsit, ls ot rc n n c c c s s a ry fo r th cra p is t sio nuk c 5urcrh a t d re y h rv e wri rre n |er nis s ion f r o m a l l o f rh o s e w h o m ight r r guc r h. rr rh e y w e re e n ti tl c(l to c onf idc nr ir lir yl n i l to c o n s i d c r i ski n F f or r dc r oiiii. , r i u b p o c n ao r a n b p o e nr t o r pper r r tb a t c l a i ms o f tri vi l e se c . r r l, e r s \ c r c (l .rn d .c y )l v e d .

Anothcr dring to consider about the fa c r o f th c r el ari onshi p(as opposedro thc conrent of the therapy) is whether or not you hivethe paticnCspern ission ro wrire ro then, call them, or other wise communicate wirh drem ar rheir home or at some other place. Perhaps the spouse or partner docs not know rhar rhe p.rienr is in therapy, and pcrhaps thc p.tient is .or ready to rcveal th i s fx c t.A l eti cror bi l l senrbythetherrpist nay bc sceDby the spouseor partner .rnd Inay cause problems for the p.tienr, even if it is nrarked "conf rnti i l ." Ye t another consi derati on i s w h e rh e ro r not thc pati cntw oul d w anr y o u to a c know l edgcthem shoul d you un€xpectedlybump into thern in a pub. l i c p l a c e .T h esei ssrres shoul d he cons i d e re d ,d i rcussed,antl cl :rri fi edw i th c l i e n tse a rl y i n the rel ati onshi p, The fact of thc relationship comcs into play with rcspect to pursuing a paticnt or cx-pitienr for monies owed. Somestate Inwscontqin prcvisions th:rt c l a ri fy th a t i t i s nor a vi ol ati onofconfidcntiality or of the psycbotherapistprricnt privilegeto suea paticnt lusunll y i n s N a l l cl ai ms courr) for moni es o w e d . S n n i l arl y,therrpi stsand orher bcalrh prtrctirioners somctimes send unprid bills to a colleciion agency.(Use o f r c o l l e c t i on.gency shoul d,i f possi b l e , b e .v o i dcd and onl y be done w i th c N rea n d p r i or noti ce ro the pati cnr.) Generilln thcse rcrions do nor consiitute a breach of confidenrirliry so lorlg as tlre disclosuresmade only reveal the f.rct of the fel.tionship aDd rhe amount owed! not the corltenr or subsr:rnceof the therapy. If the law were orherwisc (eachstaic'sLawvaries to sornedcgree, so therapisrsmust derermine whar the law albws in their state), iherapisrs would be unable to collect monies that rvereliwfully due then.

Th e Fac t of t he Re l a tl o n s h i p Yor shonld nerr th. i.r!r 1)frhc rcl:rii{rrsh i f xs. or f idenr ir l.ln ( )rl r$rv o rd sy, o u sh o u l dror i. ll r n\ ( m c \ h o \ { \rr td ti e n rs a reo r.r c k no$l( \ lqrr hrr \,{ r.rr. rre rri D u . p rri i . ulr r t . r t |. nr .k i , n { )r!n u m tl l fo r i th (rrti\ t ( , be r \ l. J h \ .r h s e n fo rc e mcn i o iii. c ( s r nc r , r h c rq rx e rn rn e n ri l o fti ci .l , or t er hr r ' h\ . r i rfti l r n re mb e r w h e th cror n( ' r t h. ! hc r rn i ,s rre .ri n g . p .n i cu lir t i! . . r . T l: . 1 ' r\$ .r. g i v e ni n vo u r (^ \ . $ir J \ ir i d \1 .- r, n o n c o f - l: \ , , . , r.( n i ,i i re .ri n g ),o L 'rb u\ , . . s , . q! . . . $ e Frn' n rh ,tr,i , d o .\ a ckn o s leJ qc. hr : : . : J:. i .u r J e c l i n ero .e sp o n dr t , ! hi: . ! r : ^. s rmp l yp u r, th e i d e n n r \, , i r h. i: , j: . , .o n rrJ .n ri rl . So m . m r ' : - : . . : - ! . w ,rh l h i s p ri n ' ci p l c, !t nr . . : . : , , : un u s u .rlfo r i h c r.n i sts,rnd . . , . , r L, : { r g (n .i d s !o h rv e wi i rn g R\ . . r ii. r . p .n r.n tss e eo rh e r p 3 f'e nr ! r n: \ i. r ( nr nr .s crl l e .l , , ut P : : r t nr s nr v rl s o & s e e n e n rc!rng: _. : : : . . i ot r h e ra ti s rca, n d i n smrl l t: - - - : n, : , es . !h e i d e n n ry o f su .h f:: : . : ! l' . .p p l rc n r. T o -. ,r.1, : s cq h c rw i s ew o u l d rr..:. . i. : : . , plc rh rn k th a r rh e re : : s .h s o i n g ro a th e r Therapistsare generallyaware of their dDty of confidentiality to each part;ci pant in group therapy. Evcn psy . . r , r . p :fl c n rs p re fe r chotherapist-patient privilege srarotes :::: i: : , : recognizethat the privilcseis notwaived becauseof the presenceof otbe.s during the therapy sessnD,as long as the

others are prescnrro furrher the iDrcF estsof thc parient in the consukarionor tfeatmenr. Disclosufesshould nor gen erall)- be rnade withour rhe signed authorization of eachgroup menrber. A more troubling issueis rhe question of corfidentiality amons Iroup mem bcrs. In olher words, doesgroup mem ber "A" have a dury to keep confiden tial d1e comn .ications of group member "l'"? Rcfcrence to state law must be mi1deto .nswer rhe qucstion, bu1 it apperrs thit nla.y sirre laws do not addressthis issue.Ir is n y suggesrkD th.t thcrapists,prior ro thc commencemcnt ol treatment,hrve prtients sign an agreementthat wouid require eachparticipint ro promise ro hold confidenrial al l communi cari onsmi de hy paf r ici pantsind :lll info|mation obtaincil fronr ofaboutrny parri ci pA rrw hi lien o gr oLr p The agreementshould :rdditnnr:illy specify that eich narticipanr makes his or hcr promhe in considcrarionol rhe mutual pronrisesof confi(lcnrialirynr,rde by all particinantsand in recognirionof the bcnefirsavail:lblefrom group rher.py, It is also helpful rnd ailvisable to inform participantswhy confrdcntiality isi portant.The miin poirr t() highlighr is the fact drat mutual promjsesof confideltialhy help to ensurerhrr prtienrs will reverl personnl,soDerimesembnr fassing, detiils abour rheir lives, ihus enabli g the therapistrc obrain .s much inform.don !s possible.This, ofcoursc, is neccssary for effedive trearnent. By obhining a signeclsroup theripy confidentiality asreemenr,rhe therlpisr ,ccomp|shes scveral rhings. Firsr, rhe therapist has informed the pafticipanK of the seriousness of the group thenpy processandisactulllyfacilitatnrgthefree flow of information. Seconclly, the ther apist;sarguablycreatinga causeof action (breachof contract/breachof confidentialiry) by getting the groDf p,rrricip.nts to sig! this agreemenr.It is reasonableto think thar . court might nrlc ihar Nch an agreemert,becrureof rhe quid pro quo hhc nutual promiseg, constirntes an dnbrcexble contract. Finally, rhe drera pisr hrs iaken stepsto prorecrhi'nselfor hersclffron allegftionsof neslisencefor

I

LOUISIANA Association for Marriage andFamily Therapy ANNUALSTATE CONFERENCT frrlurc to inforn group membersabout conficlcntialityanclus limits md for laif ure k) protectgrouf memberslrom each orhc! ar le.sr to lhe e\tent tos;ble.

versall)',this mf ornrar;onisconf identirl, e v rn w b c rc the prti eD treverl sthrt he or she is conrinuin8 to have seru.rl relations with one or tnore trtners. This dury of corf cntiality arisesborh is a C ri me s of t he P at ie n t re s u l to fl e g i sl atn)n Iharsfeci fi cal l ypro su te h r v s L, s uallyr ildr e s sth e i s s u eo f tectssuch affectedp.rtientsfrom disclr co n i i rl ent iallt rar d s pe c i fyth e e x c e p s o re sb y h e a l thc.l reprovi ders,as scl l ri o fs rc c onf ident iilit y .k i s i mp o rtrn t is from the geaerrl duty of confiilcnto b e ftr , nilir rwit ht he h w s rn th e s t.te tialily. Some hlrle argued thAt thcre is sh e re vr : r rpr r c ! c e s o t h rt ri o l .ti o n s o f or ought io be r "dLrty t.' w.rfn," likc in .o n i l (l cnt iir lit yd, ) not o c c u r.Ge n e rrl l y dre frmed lbrasol/decision, lrut others th rr ro r il$r ! ! ) r he p rs t c ri me so f a h i v e p o i n tedout rhi t " ft/dsol /si ruap rl rrn r. r ! \ c . r lc Llr )t bc r h c .,tp i sdt u ri n g ti o n s " i n v o lve sernms(i nd i nrmi nenl ) th crrp r l r r e eoniidc nti a l M.n . y c l i e n ts rh re rts o f v i ol ence.conununi crtedby re l ltl ,e rr pl*sr hout pr s r d i n re s ,s u c ha s p 0 ti e n tsro therrrpi sts,rgl l i nst rcrdi l y fi .\scsriln or s . r leo{ co n a .l l e d s L ,b strn ce r dr , Lringn hilein to x i c rte rls, te a l So meh rve al soarguedth.rtw hi l e ro i n g l n ,nr r n em t lo! e( o r c o m n i tti n g g d u ty to w a rn i y exi st,thcrapi stsi rre vi o l e rr.r inr r . I lr c r . f l\ rs i trrti n c l yk c e p pefmitted to warn becauscdie piticnt is, su ch i nn' dn. r o, n . ( ' n i i d (n ti n l . Of u n d c rc i rc n Nti ncesw hcre nodi sckxure co L rAcLh, . l, l. r l. r ' r , r nJ i c g l c c t rc p o rt- of thc condiri(m is ftaclc by the p.rienr i n s l .1 s\ . 1n( .l 1J . . 1, ' (l e p (n d c n rrd u l t to i s c x u rl p .mncrli " drngcr to others." i b u se rc nonLn' .l. r $' . )' . w c l l k n o w n This argumcDr.in nry view. fnlls shorr cY!fto od\ f t ) r h( , i, r ) . r.rlru l c . a n d rs u n p c r sursi vcbeci userhe drnger Irro \t . c l\ . i ! , 1. n. c. .i rh e r c o mn u ' to o th e rsmusrusLr.l l ybe rs rheresul tof n ,c,rred( o r hf ! l) er r t , n ,)r.r\s c s \c dl )y rh cm c n trl o r enxni orl .r I condi ti onofthc th c th c. . 1t s r .t . r ' Ldr ' i J ,i l .rfrt s i tu .r' piricnr. Thc cl lgc. hcfc is LrsLrally the ri ,'r. l rr ) d. r r |. \ ! ! 1. . ! . ,\r,rr.c !, d i rc l o ' resulrof a physic.rldiseaseor condirion su rc I'v r he r hc r . r ps rnr.ri l ,c .n rd trl e d that may or nray not be rr:rnsnitted, not o r I]cm r i( < J .J ( t ( f J Lnq u t,,f s i rtc l i w .s rh e re s u ltof r mentrl or emoi !)nnl In rh o rt. t hc r r p, . r . : r t u s u rl l v a r l e rs r c o n d i ri o n .Addi ti oni l l y,the drngcrconp e rh i rr c dn' l. . . r k i, , it id e r!l rrL i rv rv h e n remplaredis usu.rllythe dr ger of phys. Lt r h f r.n ri l o r c mo - i c .l v i o l e n ce,suchrs hon)i ci de. rh € p i n. nr i' ', n ,,n .l e , , nd, r L, ,ri,. ( , , hi r J .n g c r tu s c l f l-:nvisionr scen.ri,' wherc drc tcflIio f ro .'rh. r \ . r ! . 1 . 1r ! 1,)ru r.i s n c c e s s i ry nallv ill prticnt is in srch menr.l of cDx! ro frc!.n! r h. : r r et r t u' D ..1 rl i n s c r IrD D ri - trnal conditnn rs ro bc dangeroLrs prti enttel l srherheLapi sr n e .r rh . c . r c , , : . 1, ,e. . e .l g ri n s tre i d i l y l i k e ,w h e re such i d e n rL iir hi. ' r ir nr s . c o h h u n i c rte d th a i h i s o rh e r rentai ni nggoali s to i nfecr d i re ctl r t , ' t l. r \ c r r lis t b y e p a ti e n r, a s m .n y p e o pl eas possi bl ernd ro rake rri ss.r\ Lr . f , . i h c s o -c a l l e d otbers down wirh hinr of her Even in 'rrrcs) ''Ju r\ n, \ r . , \ t rh c N o v e mb e r/ tbis situation, it is argu:rblcthrt confr : ."ot ri F,ifllilyTbenDcr.rnl..: I dcnrialiry shoulclbc manrtained(unless j. \l .i rr : : : . r nr ore rh o ro u g h d l s there ls specificst.riutory i|siruction to tr .u 'i 1 ,,:,, f , : : , - . r . , nq. ro u s p l ri e n r.n d d rec o n tri ry).l fstatesw .nt to i nposc a dur-vto w.rrn under theseor similar circ u m s ta n c e s! the duty (and l i abi l ny for AID S;H lV O is eas e i N i l u .eto w i rn)ough! to be i mposedon Su fr !- : : . : : : : : ; r h e rh e .a fi s td ra t the prtier!, not drerherapistwhosedory rh i : :.: r : . . . : : r : r ! . . l e d $ ;rh A l 1 )S . it is to keep communicationsconiden , : rh i rh e p i s r, i f tirl. l'herapistscan.rct by, among other \\':::: . : i: : . : : : : : : i: . r . r! r\ i n d w rrn thngs, discussingthe option of full dis : : : , \ i r.r: Or i s rh c closc bv thc paticnt to sexual partncrs and br discussingother possiblechanses

"Bouncing forward: [amilg Iherapg and familg Resilience inanAge ofUncertaintg" FEATURINC

FromaWalsh,PhD Profersof andCo Directorofthe Cenler tor Fan y H€ath arthe Univ€Blty ol Chi.ago Authat .n "SttengtheningFonily Retilien.eand" SpntuolResourcet in Fonilylherupy''(ari)fa.d P@j) lcbrulry 26-24, 2oO4 SheratonConventionC€nter Hotel 102 Franc€Street Baton Rouge,Louhiana (225) 242-2600

MAKE PLANSNOWI FormoreinformaUon checkthe websitewwwlamft/org Tim Dwyer(504)398-2169 tdwyer@olhcc,edu

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demands of a relationship andcub those destructivebehavioBthat sabotagetheir capacityto enjoy a lasting,deep,and meanlngful relationship.

"clear.practical, insightful, and use|uI.,,-TERRY REAL