At the very foundation of counseling is the professional relationship and the rapport established between the client and the psychologist. Anyone seeking professional assistance from a psychologist must be able to trust that what is shared will not be shared with anyone else … will not be repeated … will not be used by others against the person. Confidentiality is paramount and all of us at BSS strictly adhere to the laws and regulations protecting client’s confidentiality.
Imagine you and your spouse are not getting along and you go see a Department psychologist for assistance. Maybe your 15 year old is using drugs and acting rebellious. Maybe you’ve been having trouble sleeping as intrusive thoughts of a DV radio call creep into your dreams. Or you’ve been feeling sad, withdrawing from family and friends and finding no pleasure in anything these days. If you’re seeking help from a psychologist for these matters, you can trust that only you and the psychologist will know.
The following information is written using lay terminology for ease of understanding. You may wish to review Behavioral Science Service’s Informed Consent and the Notice of Privacy Practices for the binding language regarding confidentiality.
Generally speaking, all communications between an individual obtaining professional clinical services (“client”) from a psychologist are confidential. This means that most anything shared can’t be repeated by the psychologist to others without the client’s authorization. This also includes misconduct. Psychologists’ confidentiality is not determined by City Charter or Department policy, but rather by professional ethics, State and Federal law and regulation. When confidentiality can or may be broken is dictated by law.
There are a few situations in which a psychologist either may, or must, break confidentiality without the client’s permission. These include when the psychologist believes there is: a suspicion of child, elder or dependant adult abuse; the client is actively suicidal and likely to harm themselves; or when a client threatens serious harm or is actively homicidal and has a plan and identifiable target. There are also some differences between when an individual seeks counseling on their own (“self-referred”) verses is mandated or directed to BSS.
Suspected child abuse. All psychologists are mandated reporters of suspected child abuse, just as are all law enforcement officers. If in the course of a clinical contact a psychologist develops a reasonable suspicion that child abuse may have or might occur, the psychologist is mandated to contact either the Department of Family Services (DFS) or local law enforcement.
Suicidality. Psychologists may break confidentiality if they reasonably believe that the client is planning on killing themselves or otherwise causing grave bodily injury to themselves. If a psychologist breaks confidentiality, they do so in a way that minimizes the exposure of the client and his or her issues to others, while ensuring that everything possible is done to prevent the suicide or grave bodily injury.
Homicidality. If a client makes a reasonable threat against another identifiable person, the psychologist must break confidentially and attempt to warn the indentified target, the local law enforcement agency as well as any other person(s) who may be in close approximation to the intended target.
Mandated and Directed referrals. If a person is mandated by Department policy to see a psychologist, or is directed in to BSS because of problematic behavior, confidentiality still applies as articulated above with one exception. The person’s commanding officer, as the Department representative, is entitled to know four additional bits of information. The psychologist will communicate to the commanding officer: (1) if the person had a clinical session with the psychologist; (2) if there are any safety (suicidality or homicidality) concerns; (3) if there are any short term work modification recommendations (but not any detail or rationale for them); and (4) if the person was directed to return for an additional clinical session. Psychologists do not share any detail of how they arrived at the recommendation(s) they make. In most cases, the psychologist will go over the feedback he or she intends to share with the commanding officer with the client at the end of each session. On occasion, it may be in the client’s best interest for the psychologist to provide a more detailed level of feedback. Should this arise, the psychologist will discuss this with the client and, if the client agrees and authorizes this in writing, will share additional information with the commanding officer.
Releases of Medical Information. The client may, at any time, execute in writing a release authorizing their treating psychologist / BSS to produce and transmit a copy of their medical record to a named individual. Clients are entitled to a complete and accurate copy of their medical record themselves; if a client wants a copy of their own record, a signed release is also required. There are occasions in which the use of such releases can be beneficial. For example, when coordinating medical and psychological care between two different doctors, it may be in the clients best interest to sign a release so that the two health professionals can discuss your care and ensure the best possible care is being provided.
Professional Consultation. Psychologists may seek consultation from other health professionals in order to provide the best quality care as possible. When seeking consultation, psychologists do not disclose identifying information.
Subpoena & Court Orders. Behavioral Science Services must respond to any legitimate subpoena or court order to produce records, for a deposition or for court testimony. While it is rare to be called to a deposition or to court, BSS does receive requests for records from various attorneys, including the Workers’ Compensation Appeal Board. What the client’s responsibilities are, how we respond, and what actions can be taken by which parties to quash or prevent the release of records is too involved to address herein. Your psychologist can address this during the first session or at any time. We recommend that if this applies to you and you have specific questions, consult with an attorney to ensure you understand your rights. Please know that if BSS receives a subpoena or court order, we make multiple attempts to contact the client prior to releasing any information.