Psychologists often disagree on confidentiality breaches

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Psychologists often disagree on confidentiality breaches

Although current guidelines regarding confidentiality within psychological practice are internationally consistent, many Australian psychologists still disagree on when they would breach confidentiality when dealing with adolescents, a new study by Murdoch Childrens Research Institute and Swinburne University of Technology has found.

Researchers asked over 260 psychologists about whether they would breach confidentiality with an adolescent client to disclose information about risk behaviour to their parents across 68 different scenarios. The scenarios covered six domains of risk behaviour, including smoking, drinking, sexual behaviour, drug taking, suicide and stealing, and varied in intensity, frequency and duration.

The study showed that, while they reached consensus in the most high-risk and low-risk scenarios, in 43% of cases, the psychologists failed to agree about whether a breach of confidentiality was necessary. The tendency to breach confidentiality increased across all six behavioural domains as the frequency, intensity and duration increased.

The highest level of consensus reached was 96%, who agreed that a parent should be informed following an admission of a suicide attempt more than once in the last month. Psychologists also agreed about not breaching confidentiality on a range of low-risk behaviours such as smoking cigarettes and engaging in sex with a steady girlfriend, as well as a range of higher risk behaviours at low intensities, such as engaging in illicit drug use once several months ago or binge drinking once a month for several months.

“It seems Australian psychologists are interpreting guidelines about confidentiality in very different ways. The Code of Ethics, written by the Australian Psychological Society, is clear, but making decisions on a case-by-case basis is complex. ‘An immediate and specified risk of harm’ might mean different things to different psychologists,” lead researcher, Dr Rony Duncan said.

“Given that psychologists vary in their practice, the findings also highlight the importance of psychologists maintaining principles of transparency and informed consent through communication about their limits to confidentiality.”

Researchers said the findings indicated that an extensive number of considerations are taken into account when making decisions about confidentiality, including how parents will respond if told about the risk behaviour, the adolescent’s maturity and the protective factors present in the adolescent’s life.

Circumstances in which participants demonstrated more than 80% consensus that confidentiality should be breached to inform parents
Risk behaviour Level of frequency / duration % who would breach confidentiality
Engaging in unprotected sex while HIV+ Monthly for several months 87
Weekly for several months 88
Nearly daily for the last year 89
Using amphetamines Nearly daily for the last year 80
Using inhalants Nearly daily for the last year 83
Using hallucinogens Nearly daily for the last year 82
Suicidal ideation (“I wish I was dead”) Nearly daily for the last year 85
Suicide gesture (taking pills) Once during the last month 87
More than once during last month 94
Suicide attempt Once during the last month 93
More than once during last month 96

 

Circumstances in which participants demonstrated more than 80% consensus that confidentiality should not be breached to inform parents
Risk behaviour Level of frequency / duration % who would breach confidentiality
Smoking cigarette Once several months ago 97
Nearly daily for the last year 92
Engaging in sex with multiple partners Once several months ago 94
Monthly for several months 91
Binge drinking Once several months ago 98
Monthly for several months 82
Stealing clothing from a store Once several months ago 95
Once during the last month 87
Stealing a car for a joyride with friends Once over a year ago 83

 

Source: Murdoch Childrens Research Institute 

Date Created: February 4, 2013

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