The changing nature of confidentiality in the psychotherapeutic relationship: An exploratory study

Robert John Lacey (1989)

Twenty licensed doctoral level psychologists from southeastern Massachusetts were interviewed about how they would handle four cases presenting conflicts around the issue of confidentiality. They also answered a questionnaire about their experiences with these issues and their knowledge of the regulations about confidentiality. Psychologists seem more willing to practice a version of informed consent (79% do so), yet it is a flawed version, as many do not themselves know the rules regarding confidentiality. Fifty-eight percent report having breached a client's confidentiality, and 35% indicate that they have warned someone about a client's potential danger to them. While fully half of the respondents feel that breaking confidentiality to report abuse or warn about danger changes their position from therapist to social control agent, all participants believe that it is possible to return to a therapeutic stance. Psychologists are much more likely to file a report of child abuse than they were ten years ago. They are about evenly divided on whether they should break confidentiality to warn the girlfriend of a client with AIDS, who is himself unwilling to inform her of his illness. This study showed that there is a great variability in how confidentiality is addressed, depending upon the type of problem the client brings to the therapist, and the age, sex, and type of practice of the therapist. A discussion of the meaning of this inconsistent practice of confidentiality is presented. Some of the implications for clients, practitioners, and society are explored. From the perspective of critical theory, it is argued that these findings support Habermas' (1975) concept of a legitimation crisis.