Ethics of confidentiality

[Paddy Landau]

At first glance, it may seem obvious that our ethics as hypnotherapists include confidentiality and privacy for our clients.

On another (unrelated) forum, a professional was asking some advice about a client who had stated, clearly and unambiguously, the intent to kill his ex-wife.

What would you do in such a case? It would be interesting to know how the laws differ between countries.

(One example, in the USA some years ago, was of a man convicted of murder. The real murderer had confessed to his psychiatrist, but the psychiatrist's testimony was thrown out of court for technical reasons -- client confidentiality! The man was still "found guilty" on appeal, even though he was obviously innocent.)

Paddy

[hypno-therapist]

Hi Paddy,

Here is a great question. I wounder if many would know the answer?

Of course you would have to be fully aware that the persons statement meant that they were going to act. As you will know there are certainly mental health issues that will cause individuals to believe statements like this that are actually not true. For instance I have spoken to people with a condition called Obsessive Compulsive Disorder that actually believed that they were going to murder someone, however the person would never have acted on the urges or thoughts that they had.

If a mental health professional would have broken his confidentiality then this guy would have received more hassle than help as the condition is not widely understood in the various public services such as the police and our judicial system.

If you are however certain then you have legal obligations to fulfill. I saw this on the Mind website that might explain those obligations a little clearer than I can:

[Paddy Landau]

Just a couple of points of clarification before this thread continues:

[Barry Thain]

This is a difficult area. I think it's best to decide your own policy and stick to it.

For example, the psychotherapists in an institution with which I am associated are mandated to tell their patients, at the outset "If you tell me that you are a threat to yourself or anyone else I am obliged to report that to the relevant authorities."

I don't say that. I think saying that is most likely to impose a stricture on the patient which may act as an impediment to therapy.

The alternative is to adopt the sanctity of the confessional, wherein everything is confidential however unsavoury. This may be the more productive approach, but risks censure if the patient commits some heinous act they'd told the therapist about 'in confidence'.

There probably is no right answer. I see myself primarily as an agent of my patient's well-being, rather than as an agent of law-enforcement. Just as a war photographer is there to record the atrocities rather than prevent them, I deal with the currency of mind rather than the potential consequences; I think.

However, I twice saw a 16 year old boy whom I found to be the living embodiment of evil, and bereft of redeeming qualities. Although I declined to treat, his mother wanted me to talk to his GP in the hope that he might be sectioned. As he left he pointed at me and said "If anything happens to me, I know where you live." There are reasons I won't go into which made this a seriously ominous threat.

I agonised for a week before calling the GP. And the GP said "There's nothing I can do. We just have to wait for him to do something dreadful." Police had been called to the house several times previously. The boy had punched the mother in the head so often she'd lost count. She'd woken up with him standing over her with a raised claw hammer while he ejaculated on her face, and the 'authorities' wanted to wait for something bad to happen.

Our starting pint has to be acting in the best interests of our patient. Beyond that, it's a personal call. And certainly a case for reference to ones clinical supervisor.

Difficult.

Best wishes

barry

[katharina]

[Gandalf]

I believe that the notion of confidentiality in the treatment of children and their families as practised 'among and between' professionals is vastly overplayed, to the detriment of children and of the interests of minimal intervention aimed at maximum benefit. One element of such maximum benefit is that all therapeutic agents should know what the others are doing so as to regulate their own actions accordingly. In any case, public accountability for all actions, which we regard as the chief ethical safeguard for the children and their care-givers, demands the sharing of information. If we do not believe in the integrity of other people involved in the treatment of the child, we should not allow them to participate in treatment in the first place.



— MASUD HOGHUGHI

[R1986]

Well I think this issue would mainly come down to the professional judgement of the hypnotherapist in question. If there is a clear intent to kill or do harm then it is in the best interest of the patient to break confidentiality for the safety of everyone involved. Still, I'm not a practicing hypnotist so this may seem more black and white to the outside observer.