Chapter 5
Confidentiality and Privileged Communication
Focus Questions
1. What do you think are the distinctions among the terms “privacy,” “confidentiality,”
and “privileged communication?”
Points instructors may want to make:
• Privacy refers to the right of persons to decide what information about themselves
will be shared with or withheld from others.
2. Some studies have shown that clients are not very concerned about privacy or
confidentiality when they seek counseling services. What do you think about such
findings?
Points instructors may want to make:
• Counselors should not assume that all clients want information they tell to counselors
kept secret. Clients have the right to waive their privacy.
3. How would you respond if a client asked to see the notes you have taken related to his
counseling sessions?
Points instructors may want to make:
• Counselors might feel a bit nervous about letting a client see what the counselor has
4. What do you think should happen to clients’ records after they die?
Points instructors may want to make:
• The person who handles the client’s estate gets to decide what happens to the client’s
records.
In-Class Activity
Title: Awareness of Exceptions to Confidentiality
Learning
Goal: To clarify students’ understanding of exceptions to confidentiality.
Procedures: Break the class into small groups, with three or four students in each group.
Each group is to list as many exceptions to confidentiality as the members can think
Discussion
Questions: Can you think of any exceptions to confidentiality that have not already been
discussed in this class?
Describe any instance in which your group had difficulty reaching consensus on appropriate
response(s) to a particular situation.
Were there strong reactions to any of the situations your group discussed? If so, discuss the strong
reactions.
Point/Counterpoint (Debate) Topics
Title: Confidentiality in Couples Counseling
Learning
Goal: To consider the issues involved in keeping secrets when counseling couples.
Procedures: Assign (or allow students to volunteer) 2 groups of students (preferably 3-5
Point: If one partner in a relationship reveals a secret to the counselor, in the
absence of the other partner, the counselor should respect the confidentiality of that
revelation if asked.
Title: Confidentiality of Minor Clients
Learning
Goal: To consider the pro’s and con’s of confidentiality when counseling minor
clients.
vs.
Counterpoint: The limits on privacy and confidentiality with minors should not be changed, as parents
have the right to know what their children are discussing in counseling.
Outside Class Activity
Title: Written Confidentiality Agreement Relative to Counseling Minor Clients
Learning
Goal: To consider specific difficulties or misunderstandings that can arise when
parents demand information and minor clients refuse to authorize the counselor to
provide it, and to formulate an agreement to minimize such misunderstandings.
Procedures: Prepare a brief confidentiality agreement for use by counselors, their minor
Topic for Self-Reflection/Journaling
Topic: Project yourself into your future as a counselor – what types of clients (e.g., minors or
adults, individuals seeking counseling to deal with normal life transitions or clients
Case Study
Marcie is a new client, a 22-year-old female who works as a receptionist in a doctor’s
office. She has just revealed to you during the intake session that she has recently lost interest in
most activities, has been sleeping a great deal yet feels tired all the time, and sometimes wishes
she could cease to exist. She mentioned feeling as though she were “on an emotional roller
coaster” during the past year, throughout her on-again, off-again relationship with a 35-year-old
married man. The last breakup with him seemed really final, and Marcie has felt herself sinking
Case Study Discussion
You should inform Marcie at the very beginning of the intake session, when discussing the
issue of confidentiality, that counselors are mandated by ethics and law to protect clients from
harming themselves. At this time, you will need to express your concern for Marcie’s well-being
and explain to her the need for a psychiatric evaluation in order to keep her safe and to determine
to her mother or some other responsible adult, to be returned to its owner.
1. How did you feel as you thought about how you would handle this situation?
2. What were your primary ethical and legal concerns related to this case?
Short Paper or Oral Class Presentation Topics
1. Privileged Communication Statutes of this State Regarding Counseling Relationships