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The Ethics of Conditional Confidentiality


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Table of Contents

Acknowledgments Introduction Abbreviations PART I. The ABC's of "Conditional Confidentiality": An Ethical, Legal, and Ethical/Legal Review Chapter 1. Ethical Responsibilities about Confidentiality Chapter 2. Law Affecting Confidentiality Chapter 3. Placing Laws into Ethical Context PART II. Protecting Patients' Confidentiality Rights with an Ethics-Based Practice Model Introduction to Part II: "The Ethics of Conditional Confidentiality" Chapter 4. Step 1 - Preparing Chapter 5. Step 2 - Telling Prospective Patients the Truth about Confidentiality's Limits Chapter 6. Step 3 - Obtaining Truly Informed Consent before Disclosing Confidential Information Voluntarily Chapter 7. Step 4 - Responding Ethically to Legal Demands for "Involuntary" Disclosure of Patient Information Chapter 8. Step 5 - Avoiding Preventable Breaches of Confidentiality Chapter 9. Step 6 - Talking about Confidentiality Part III. Practical Considerations Chapter 10. Clinical Record Keeping Chapter 11. Confidentiality with Specific Patient Populations Chapter 12. Confidentiality in Specific Roles and Settings Chapter 13. Ethics-Based Staff Training about Confidentiality Appendix I. Selected Ethical Standards Relevant to Confidentiality Listed Numerically II - Ethical Standards (using categories from Knapp and VandeCreek (2006)) III - Laws Affecting Confidentiality - Summary and Examples IV - HIPAA Regulations - Summary V - Ethical Practice Model (with legal annotations) VI - Ethical Responsibilities in Forensic Contexts: Which Hat Are You Wearing? VII - Ethical and Professional Resources VIII - Ethics-Based Staff Training About Confidentiality - Sample Outline NOTES REFERENCES INDEX

About the Author

Mary Alice Fisher, Ph. D., is Founding Director of The Center for Ethical Practice, Inc., Adjunct Assistant Professor in the University of Virginia Curry Programs in Clinical and School Psychology, and a clinical psychologist in private practice in Charlottesville, VA. For over 25 years Dr. Fisher has provided workshops, seminars, and consultation for mental health professionals on topics related to ethical issues in clinical practice.


"No one has written more thoughtfully, knowledgeably, and realistically about confidentiality than Mary Alice Fisher. She has rescued the ethics of confidentiality after they have been all but hopelessly confused with legal mandates, risk management, and impractical guidelines. This book is unsurpassed in helping us think through the hard questions we encounter in practice, work through conflicting values, and find creative ways to meet our responsibilities. It deserves to land on the required reading lists in all graduate programs and find its way into the libraries of all clinicians, from those just starting out to the most experienced." -- Kenneth S. Pope, Ph.D., ABPP "Dr. Fisher has created a comprehensive guide to confidentiality for mental health professionals in a highly digestible and readily useable form. Practitioners and students alike will quite easily find answers to their questions on best practices and management of confidential material. I recommend this as interesting reading and an important practical reference work." -- Gerald P. Koocher, Associate Provost and Professor of Psychology, Simmons College "With the constant changes in ethical and legal circles regarding many areas of patient care, frequent updates are vital to give practitioners an understanding of the history of such issues, as well as the current climate and anticipated future directions. This work is ambitious in its attempt to pull this off, and it does a remarkably decent job of meeting the author's goals. Challenging concepts are discussed thoroughly, with a practical bent relevant for mental health providers across specialty or training. What may be the most useful is the last chapter, Ethics-Based Staff Training About Confidentiality. This work should find a place on the shelf of any provider practicing in healthcare." -- DOODY'S "This book is an outstanding resource for mental health professionals in all areas of professional practice. It is clearly written, easily understood, very practical in its focus, and, actually, a very interesting and engaging read. In keeping with a focus on prevention and on avoiding ethical missteps, I recommend that every mental health clinician read and regularly use this excellent book. Doing so is in keeping with the general principles of the American Psychological Association (2010) ethics code that guide us to aspire to the highest possible levels of competence and conduct in our professional roles. The Ethics of Conditional Confidentiality is an outstanding resource that can help us make great strides toward achieving these goals." -- PsycCRITIQUES "Mary Alice Fisher's book is comprehensive and thought provoking. . . the sort of book really worth dipping into, and bringing to the attention of colleagues."--Elizabeth Shaw, Psychotherapy in Australia

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