Ethical Dilemmas of Confidentiality with Adolescent Clients: Case Studies from Psychologists

Rony E. Duncan, Annette C. Hall, Ann Knowles
Ethics & Behavior 
DOI:10.1080/10508422.2014.923314

Abstract

Navigating limits to confidentiality with adolescent clients can be ethically and professionally challenging. This study follows on from a previous quantitative survey of psychologists about confidentiality dilemmas with adolescents. The current study used qualitative methods to explore such dilemmas in greater depth. Twenty Australian psychologists were interviewed and asked to describe an ethically challenging past case. Cases were then used to facilitate discussion about the decision-making process and outcomes. Interviews were transcribed and analysed using interpretive content and thematic analysis. Three key findings are discussed. First, it is of little use to perceive confidentiality dilemmas as binary choices (breach/don’t breach) because psychologists described five distinct options. These can be conceptualised on a spectrum of varying degrees of client autonomy, ranging from ‘no disclosure’ (highest client autonomy) to ‘disclosure without the client’s knowledge or consent’ (lowest client autonomy). Second, confidentiality dilemmas often involve balancing multiple and conflicting risks regarding both immediate and future harm. Third, a range of strategies are employed by psychologists to minimise potential harms when disclosing information. These are primarily aimed at maintaining the therapeutic relationship and empowering clients. These findings and the case studies described provide a valuable resource for teaching and professional development.

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1. It is of little use to conceptualise confidentiality as a binary choice.

2. Reaching a final decision about confidentiality dilemmas often entails balancing multiple and conflicting risks.

3. Participants demonstrated significant practice wisdom about how to negotiate confidentiality with adolescents in a manner that minimises harm.

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