Having read this post regarding informed consent and confidentiality, the author has mentioned two grey areas regarding the topic. The first grey area mentioned is the issue of clients and therapists not thoroughly reviewing and ensuring a cooperative understanding of a consent form, especially when language barriers are involved. The second grey area discussed is a client’s lack of understanding of the limits of confidentiality, especially when it comes to issues involving abuse or harm to others.
These are both important issues to consider, but rather than mention them as two separate grey areas, consider how these issues are directly related. It would be interesting to combine the issues of understanding problems with consent forms and limits to confidentiality when it comes to abuse or harm in respect to language barriers between the therapist and client.
The post author mentions section 4.05 of the American Psychological Association Ethical Principles of Psychologists and Code of Conduct (Ethics Code), which discusses the ethics of disclosing a client’s confidential information (Pope & Vasquez, 2011, p. 341). While this section is critical for therapists dealing with situations involving abuse or harm, when combined with the issues of informed consent, understanding limits to confidentiality, and language barriers, section 2.01 of the Ethics Code dealing with boundaries of competence must be considered as well. Section 2.01 states that “Psychologists provide services . . . in areas only within the boundaries of their competence,” as well as “an understanding of factors associated with . . . language . . . is essential for effective implementation of their services . . . [and] psychologists have to obtain the training . . . or supervision necessary to ensure the competence of their services, or they make appropriate referrals” (Pope & Vasquez, 2011, p. 335).
When there are problems with forms or the understanding of consent and confidentiality, the “clinician bears the responsibility for ensuring that the client understands the information” (Ford, 2006, p. 185). The best way to ensure a client understands consent and confidentiality is to take a proactive approach during intake; the clinician can review some of the issues with the client to make sure the pertinent issues are clear to the client. If the language barrier between the clinician and the client is too great, it will be impossible for the client to give informed consent, and as Section 2.01 of the Ethics Code suggests, the clinician is ethically obligated to refer this client to another professional who will not have a language barrier with the client.
Grey areas in therapy situations often require more than one section of the Ethics Code. If the grey area is cleared up by considering only one section of the Ethics Code, it is probably not as grey as the clinician believes. However, when confronted with a grey area in therapy, a clinician should carefully review the Ethics Code, speak to a supervisor, or obtain further training and information through reading journal articles and discussion with colleagues who have encountered similar situations.
References
Ford, G. (2006). Ethical Issues in Psychotherapy and Counseling. Ethical Reasoning for Mental Health Professionals (pp. 99-129). Thousand Oaks, CA: Sage Publications.
Pope, K.S. & Vasquez, M. J. T. (2011). Ethics in Psychotherapy and Counseling: A Practical Guide (4th ed.). San Francisco, CA: Jossey-Bass.
