7.1 Confidentiality

Client confidentiality and privacy are paramount ethical considerations for counselors. Protecting them requires pervasive thought and action by counselors. Additionally, virtue ethics are ingrained in practicing them, and all counseling ethics codes include specific language on client confidentiality, privacy, legal privilege, and how counselors protect them. Counselors strive to follow ethics, which the APA defines as “the rules and standards governing the conduct of members in a professional association, and are adopted by the agencies, institutions, and associates that choose to act by them” (APA, 2003, pg. 595). Often ethics guide legal policies, which are “a codified, body of rules governing affairs or persons within a community, state or country” (APA, 2003, pg. 595). Legal requirements come about by case law, which entails someone navigating a sticky situation, bringing it to court, and having the decision codified into state or federal statutes. When something is written into state law, other states often follow suit, and counselors are responsible for knowing the legal landscape of their jurisdiction. In navigating issues related to confidentiality and privacy, counselors are asked to balance ethics and law in ethical decision-making processes, as each explicitly addresses them. The best practice is to follow the more stringent code of conduct (APA, 2003).

Confidentiality

By participating in counseling, clients show significant vulnerability in sharing sensitive information as part of their care. This is the basic premise of counseling. To do so, clients must be guaranteed that counselors will not use the information they share against them or for any purpose other than their direct benefit (Younggren, 2008). Confidentiality refers to the counselor’s direct actions to reinforce to clients that “what happens here stays here.” It is based on the client’s right to privacy, which encompasses the underlying counseling values and will be discussed further in section 7.2. Generally speaking, the counseling field holds client confidentiality in high regard and acts to safeguard it to provide effective services. All counseling ethics codes have ethical guidelines regarding confidentiality (dual diagnosis counselors consider ACA and NAADAC codes, presented below; ACA, 2014; NAADAC, 2021). There are also legal considerations based on historical case law that guide confidentiality practices, some of which are presented in this chapter to highlight confidentiality needs and their significance.

The ACA (2014) highlights this in its ethical code:

The therapeutic relationship between client and counselor is the foundation for all counseling work. Various studies demonstrate that the therapeutic relationship between client and counselor accounts for a majority of positive clinical outcomes (DeAngelis, 2019). The link between the quality of therapeutic alliance and effective counseling reinforces the need for confidentiality, which builds the therapeutic bond, trust, and a safe environment based on mutual trust (Younggren, 2008). Clients must trust that their information is kept safe, and any threat or possibility of disclosure can hinder the counseling relationship and, thereby, the therapeutic process (Younggren, 2008). The counselor must facilitate and maintain their clients’ confidentiality and privacy, promoting their autonomy and reinforcing their human rights. If they decide information should be shared with relevant parties for safety reasons or care coordination, they obtain informed consent and complete the release of information paperwork. The list below details the necessary elements for adequate release of information between entities (SAMHSA, 2008). Additionally, confidentiality has limitations and can be broken without a signed release of information document, as discussed later in this chapter; counselors take effective steps to protect confidentiality as much as they can and involve clients in breaking it.

In addition to confidentiality guidelines in ethical codes (see above), state statutes guide a client’s rights to confidentiality, and counselors consider both during ethical decision-making processes. They avoid hasty decisions in breaking confidentiality and seek consultation with peers and ethics committees, supervision, and potentially a lawyer specializing in counseling ethics when potential limitations arise. The counseling field takes confidentiality very seriously, which directly benefits person-centered and empathetic care.