Introduction This document is a part of an online course on confidentiality and focuses on the sections of the Codes of Ethics of the major professional organizations that deal with confidentiality. It is also designed to ensure that California psychologists, MFTs and LCSWs are provided with the relevant and most current and up-to-date information regarding the applicable professional codes of ethics and California Law. Ten major codes of ethics are discussed in this paper. The relevant sections of these codes to record keeping and informed consent will be presented and direct links to the codes online will be provided. Links to the Codes of Ethics of Mental Health Professionals American Association of Marriage and Family Therapists, AAMFT American Counseling Association, ACA American Mental Health Counselors Association, AMHCA American Psychiatric Association, ApA American Psychological Association, APA California Association of Marriage and Family Therapists, CAMFT Canadian Psychological Association, CPA Commission on Rehabilitation Counselor Certification: Code of Professional Ethics Feminist Therapy Institute, FTI National Association of Social Workers, NASW United States Association for Body Psychotherapy, USABP American Art Therapy Association (AATA) Ethics Document, 2003: 1.0 RESPONSIBILITY TO CLIENTS  1.3. Where the client is a minor, any and all disclosure or consent required is  obtained from the parent or legal guardian of the minor client, except where  otherwise mandated by law. Care is taken to preserve confidentiality with the minor  client and to refrain from disclosure of information to the parent or guardian that might  adversely affect the treatment of the client.  1.11. Art therapists strive to provide a safe, functional environment in which to offer art  therapy services.  This includes:   f. allowance for privacy and confidentiality;  2.0 CONFIDENTIALITY  Art therapists protect confidential information obtained from clients, through artwork and/or  conversation, in the context of the professional relationship while clients are in treatment  and post-treatment.      2.1. Art therapists treat clients in an environment that protects privacy and confidentiality.    2.2. Art therapists inform clients of the limitations of confidentiality.    2.3. Art therapists do not disclose confidential information for the purposes of consultation  and supervision without client’s explicit consent unless there is reason to believe that  the client or others are in immediate, severe danger to health or life. Any such  disclosure must be consistent with laws that pertain to the welfare of the client, family,  and the general public.    2.4. In the event that an art therapist believes it is in the interest of the client to disclose  confidential information, he/she seeks and obtains written consent from the client or  client’s guardian(s) when possible before making any disclosures, unless there is  reason to believe that the client or others are in immediate, severe danger to health or  life.    2.5. Art therapists disclose confidential information when mandated by law in a civil,  criminal, or disciplinary action arising from such art therapy services. In these cases  client confidences may be disclosed only as reasonably necessary in the course of  that action.    2.6. Art therapists maintain client treatment records for a reasonable amount of time  consistent with state regulations and sound clinical practice, but not less than seven  years from completion of treatment or termination of the therapeutic relationship.  Records are stored or disposed of in ways that maintain confidentiality.  3.0 ASSESSMENT METHODS  3.6. Art therapists take reasonable steps to ensure that all assessment artwork and related  data are kept confidential according to the policies and setting in which these assessments are administered.  8.0 RESPONSIBILITY TO RESEARCH PARTICIPANTS  8.5. Information obtained about a research participant during the course of an investigation  is confidential unless there is authorization previously obtained in writing. When there  is a risk that others, including family members, may obtain access to such information,  this risk, together with the plan for protecting confidentiality, is to be explained as part  of the procedure for obtaining informed consent.  13.0 REFERRAL AND ACCEPTANCE   13.1. Independent practitioners of art therapy, upon acceptance of a client, specify to  clients their fee structure, payment schedule, session scheduling arrangements, and information pertaining to the limits of confidentiality and the duty to report.  14.0 ART THERAPY BY ELECTRONIC MEANS  14.1. Art therapists who offer services or information via electronic transmission inform  clients of the risks to privacy and the limits of confidentiality.  American Association for Marriage and Family Therapy Ethics Code, July 1, 2001 http://www.aamft.org/resources/LRM_Plan/Ethics/ethicscode2001.asp Principle I Responsibility to Clients Marriage and family therapists advance the welfare of families and individuals. They respect the rights of those persons seeking their assistance, and make reasonable efforts to ensure that their services are used appropriately. 1.12 Marriage and family therapists obtain written informed consent from clients before videotaping, audio recording, or permitting third-party observation. 1.13 Marriage and family therapists, upon agreeing to provide services to a person or entity at the request of a third party, clarify, to the extent feasible and at the outset of the service, the nature of the relationship with each party and the limits of confidentiality. Principle II Confidentiality Marriage and family therapists have unique confidentiality concerns because the client in a therapeutic relationship may be more than one person. Therapists respect and guard the confidences of each individual client. 2.1 Marriage and family therapists disclose to clients and other interested parties, as early as feasible in their professional contacts, the nature of confidentiality and possible limitations of the clients' right to confidentiality. Therapists review with clients the circumstances where confidential information may be requested and where disclosure of confidential information may be legally required. Circumstances may necessitate repeated disclosures. 2.2 Marriage and family therapists do not disclose client confidences except by written authorization or waiver, or where mandated or permitted by law. Verbal authorization will not be sufficient except in emergency situations, unless prohibited by law. When providing couple, family or group treatment, the therapist does not disclose information outside the treatment context without a written authorization from each individual competent to execute a waiver. In the context of couple, family or group treatment, the therapist may not reveal any individual's confidences to others in the client unit without the prior written permission of that individual. 2.3 Marriage and family therapists use client and/or clinical materials in teaching, writing, consulting, research, and public presentations only if a written waiver has been obtained in accordance with Subprinciple 2.2, or when appropriate steps have been taken to protect client identity and confidentiality. 2.4 Marriage and family therapists store, safeguard, and dispose of client records in ways that maintain confidentiality and in accord with applicable laws and professional standards. 2.5 Subsequent to the therapist moving from the area, closing the practice, or upon the death of the therapist, a marriage and family therapist arranges for the storage, transfer, or disposal of client records in ways that maintain confidentiality and safeguard the welfare of clients. 2.6 Marriage and family therapists, when consulting with colleagues or referral sources, do not share confidential information that could reasonably lead to the identification of a client, research participant, supervisee, or other person with whom they have a confidential relationship unless they have obtained the prior written consent of the client, research participant, supervisee, or other person with whom they have a confidential relationship. Information may be shared only to the extent necessary to achieve the purposes of the consultation. Principle III Professional Competence and Integrity Marriage and family therapists maintain high standards of professional competence and integrity. 3.2 Marriage and family therapists maintain adequate knowledge of and adhere to applicable laws, ethics, and professional standards. 3.14 To avoid a conflict of interests, marriage and family therapists who treat minors or adults involved in custody or visitation actions may not also perform forensic evaluations for custody, residence, or visitation of the minor. The marriage and family therapist who treats the minor may provide the court or mental health professional performing the evaluation with information about the minor from the marriage and family therapist's perspective as a treating marriage and family therapist, so long as the marriage and family therapist does not violate confidentiality. Principle IV Responsibility to Students and Supervisees Marriage and family therapists do not exploit the trust and dependency of students and supervisees. 4.7 Marriage and family therapists do not disclose supervisee confidences except by written authorization or waiver, or when mandated or permitted by law. In educational or training settings where there are multiple supervisors, disclosures are permitted only to other professional colleagues, administrators, or employers who share responsibility for training of the supervisee. Verbal authorization will not be sufficient except in emergency situations, unless prohibited by law. Principle V Responsibility to Research Participants Investigators respect the dignity and protect the welfare of research participants, and are aware of applicable laws and regulations and professional standards governing the conduct of research. 5.4 Information obtained about a research participant during the course of an investigation is confidential unless there is a waiver previously obtained in writing. When the possibility exists that others, including family members, may obtain access to such information, this possibility, together with the plan for protecting confidentiality, is explained as part of the procedure for obtaining informed consent. Principle VII Financial Arrangements Marriage and family therapists make financial arrangements with clients, third-party payors, and supervisees that are reasonably understandable and conform to accepted professional practices. 7.3 Marriage and family therapists give reasonable notice to clients with unpaid balances of their intent to seek collection by agency or legal recourse. When such action is taken, therapists will not disclose clinical information. American Counseling Association Code of Ethics and Standards of Practice, Effective 2005 http://www.zurinstitute.com/aca_code_of_ethics_2005.pdf A.2. Informed Consent in the Counseling Relationship A.2.b. Types of Information Needed Counselors explicitly explain to clients the nature of all services provided. They inform clients about issues such as, but not limited to, the following: the purposes, goals, techniques, procedures, limitations, potential risks, and benefits of services; the counselor’s qualifications, credentials, and relevant experience; continuation of services upon the incapacitation or death of a counselor; and other pertinent information. Counselors take steps to ensure that clients understand the implications of diagnosis, the intended use of tests and reports, fees, and billing arrangements. Clients have the right to confidentiality and to be provided with an explanation of its limitations (including how supervisors and/or treatment team professionals are involved); to obtain clear information about their records; to participate in the ongoing counseling plans; and to refuse any services or modality change and to be advised of the consequences of such refusal. B.1. Respecting Client Rights B.1.a. Multicultural/Diversity Considerations Counselors maintain awareness and sensitivity regarding cultural meanings of confidentiality and privacy. Counselors respect differing views toward disclosure of information. Counselors hold ongoing discussions with clients as to how, when, and with whom information is to be shared. B.1.b. Respect for Privacy Counselors respect client rights to privacy. Counselors solicit private information from clients only when it is beneficial to the counseling process. B.1.c. Respect for Confidentiality Counselors do not share confidential information without client consent or without sound legal or ethical justification. B.1.d. Explanation of Limitations At initiation and throughout the counseling process, counselors inform clients of the limitations of confidentiality and seek to identify foreseeable situations in which confidentiality must be breached. (See A.2.b.) B.2. Exceptions B.2.a. Danger and Legal Requirements The general requirement that counselors keep information confidential does not apply when disclosure is required to protect clients or identified others from serious and foreseeable harm or when legal requirements demand that confidential information must be revealed. Counselors consult with other professionals when in doubt as to the validity of an exception. Additional considerations apply when addressing end-of-life issues. (See A.9.c.) B.2.b. Contagious, Life-Threatening Diseases When clients disclose that they have a disease commonly known to be both communicable and life threatening, counselors may be justified in disclosing information to identifiable third parties, if they are known to be at demonstrable and high risk of contracting the disease. Prior to making a disclosure, counselors confirm that there is such a diagnosis and assess the intent of clients to inform the third parties about their disease or to engage in any behaviors that may be harmful to an identifiable third party. B.2.c. Court-Ordered Disclosure When subpoenaed to release confidential or privileged information without a client’s permission, counselors obtain written, informed consent from the client or take steps to prohibit the disclosure or have it limited as narrowly as possible due to potential harm to the client or counseling relationship. B.2.d. Minimal Disclosure To the extent possible, clients are informed before confidential information is disclosed and are involved in the disclosure decision-making process. When circumstances require the disclosure of confidential information, only essential information is revealed. B.3. Information Shared With Others B.3.a. Subordinates Counselors make every effort to ensure that privacy and confidentiality of clients are maintained by subordinates, including employees, supervisees, students, clerical assistants, and volunteers. (See F.1.c.) B.3.b. Treatment Teams When client treatment involves a continued review or participation by a treatment team, the client will be informed of the team’s existence and composition, information being shared, and the purposes of sharing such information. B.3.c. Confidential Settings Counselors discuss confidential information only in settings in which they can reasonably ensure client privacy. B.3.d. Third-Party Payers Counselors disclose information to third-party payers only when clients have authorized such disclosure. B.3.e. Transmitting Confidential Information Counselors take precautions to ensure the confidentiality of information transmitted through the use of computers, electronic mail, facsimile machines, telephones, voicemail, answering machines, and other electronic or computer technology. (See A.12.g.) B.3.f. Deceased Clients Counselors protect the confidentiality of deceased clients, consistent with legal requirements and agency or setting policies. B.4. Groups and Families B.4.a. Group Work In group work, counselors clearly explain the importance and parameters of confidentiality for the specific group being entered. B.4.b. Couples and Family Counseling In couples and family counseling, counselors clearly define who is considered “the client” and discuss expectations and limitations of confidentiality. Counselors seek agreement and document in writing such agreement among all involved parties having capacity to give consent concerning each individual’s right to confidentiality and any obligation to preserve the confidentiality of information known. B.5. Clients Lacking Capacity to Give Informed Consent B.5.a. Responsibility to Clients When counseling minor clients or adult clients who lack the capacity to give voluntary, informed consent, counselors protect the confidentiality of information received in the counseling relationship as specified by federal and state laws, written policies, and applicable ethical standards. B.5.b. Responsibility to Parents and Legal Guardians Counselors inform parents and legal guardians about the role of counselors and the confidential nature of the counseling relationship. Counselors are sensitive to the cultural diversity of families and respect the inherent rights and responsibilities of parents/guardians over the welfare of their children/charges according to law. Counselors work to establish, as appropriate, collaborative relationships with parents/guardians to best serve clients. B.5.c. Release of Confidential Information When counseling minor clients or adult clients who lack the capacity to give voluntary consent to release confidential information, counselors seek permission from an appropriate third party to disclose information. In such instances, counselors inform clients consistent with their level of understanding and take culturally appropriate measures to safeguard client confidentiality. B.6. Records B.6.a. Confidentiality of Records Counselors ensure that records are kept in a secure location and that only authorized persons have access to records. B.6.b. Permission to Record Counselors obtain permission from clients prior to recording sessions through electronic or other means. B.6.c. Permission to Observe Counselors obtain permission from clients prior to observing counseling sessions, reviewing session transcripts, or viewing recordings of sessions with supervisors, faculty, peers, or others within the training environment. B.6.d. Client Access Counselors provide reasonable access to records and copies of records when requested by competent clients. Counselors limit the access of clients to their records, or portions of their records, only when there is compelling evidence that such access would cause harm to the client. Counselors document the request of clients and the rationale for withholding some or all of the record in the files of clients. In situations involving multiple clients, counselors provide individual clients with only those parts of records that related directly to them and do not include confidential information related to any other client. B.6.e. Assistance With Records When clients request access to their records, counselors provide assistance and consultation in interpreting counseling records. B.6.f. Disclosure or Transfer Unless exceptions to confidentiality exist, counselors obtain written permission from clients to disclose or transfer records to legitimate third parties. Steps are taken to ensure that receivers of counseling records are sensitive to their confidential nature. (See A.3., E.4.) B.6.g. Storage and Disposal After Termination Counselors store records following termination of services to ensure reasonable future access, maintain records in accordance with state and federal statutes governing records, and dispose of client records and other sensitive materials in a manner that protects client confidentiality. When records are of an artistic nature, counselors obtain client (or guardian) consent with regard to handling of such records or documents. (See A.1.b.) B.6.h. Reasonable Precautions Counselors take reasonable precautions to protect client confidentiality in the event of the counselor’s termination of practice, incapacity, or death. (See C.2.h.) B.7. Research and Training B.7.a. Institutional Approval When institutional approval is required, counselors provide accurate information about their research proposals and obtain approval prior to conducting their research. They conduct research in accordance with the approved research protocol. B.7.b. Adherence to Guidelines Counselors are responsible for understanding and adhering to state, federal, agency, or institutional policies or applicable guidelines regarding confidentiality in their research practices. B.7.c. Confidentiality of Information Obtained in Research Violations of participant privacy and confidentiality are risks of participation in research involving human participants. Investigators maintain all research records in a secure manner. They explain to participants the risks of violations of privacy and confidentiality and disclose to participants any limits of confidentiality that reasonably can be expected. Regardless of the degree to which confidentiality will be maintained, investigators must disclose to participants any limits of confidentiality that reasonably can be expected. (See G.2.e.) B.7.d. Disclosure of Research Information Counselors do not disclose confidential information that reasonably could lead to the identification of a research participant unless they have obtained the prior consent of the person. Use of data derived from counseling relationships for purposes of training, research, or publication is confined to content that is disguised to ensure the anonymity of the individuals involved. (See G.2.a., G.2.d.) B.7.e. Agreement for Identification Identification of clients, students, or supervisees in a presentation or publication is permissible only when they have reviewed the material and agreed to its presentation or publication. (See G.4.d.) B.8. Consultation B.8.a. Agreements When acting as consultants, counselors seek agreements among all parties involved concerning each individual’s rights to confidentiality, the obligation of each individual to preserve confidential information, and the limits of confidentiality of information shared by others. B.8.b. Respect for Privacy Information obtained in a consulting relationship is discussed for professional purposes only with persons directly involved with the case. Written and oral reports present only data germane to the purposes of the consultation, and every effort is made to protect client identity and to avoid undue invasion of privacy. B.8.c. Disclosure of Confidential Information When consulting with colleagues, counselors do not disclose confidential information that reasonably could lead to the identification of a client or other person or organization with whom they have a confidential relationship unless they have obtained the prior consent of the person or organization or the disclo- sure cannot be avoided. They disclose information only to the extent necessary to achieve the purposes of the consultation. (See D.2.d.) ACA Standards of Practice Standard of Practice Two (SP-2): Disclosure to Clients. Counselors must adequately inform clients, preferably in writing, regarding the counseling process and counseling relationship at or before the time it begins and throughout the relationship. (See A.3.a.) Section B: Confidentiality Standard of Practice Nine (SP-9): Confidentiality Requirement. Counselors must keep information related to counseling services confidential unless disclosure is in the best interest of clients, is required for the welfare of others, or is required by law. When disclosure is required, only information that is essential is revealed and the client is informed of such disclosure. (See B.1. a.+f.) Standard of Practice Ten (SP-10): Confidentiality Requirements for Subordinates. Counselors must take measures to ensure that privacy and confidentiality of clients are maintained by subordinates. (See B.1.h.) Standard of Practice Eleven (SP-11): Confidentiality in Group Work. Counselors must clearly communicate to group members that confidentiality cannot be guaranteed in group work. (See B.2.a.) Standard of Practice Twelve (SP-12): Confidentiality in Family Counseling. Counselors must not disclose information about one family member in counseling to another family member without prior consent. (See B.2.b.) Standard of Practice Thirteen (SP-13): Confidentiality of Records. Counselors must maintain appropriate confidentiality in creating, storing, accessing, transferring, and disposing of counseling records. (See B.4.b.) Standard of Practice Fourteen (SP-14): Permission to Record or Observe. Counselors must obtain prior consent from clients in order to record electronically or observe sessions. (See B.4.c.) Standard of Practice Fifteen (SP-15): Disclosure or Transfer of Records. Counselors must obtain client consent to disclose or transfer records to third parties, unless exceptions listed in SP-9 exist. (See B.4.e.) Standard of Practice Sixteen (SP-16): Data Disguise Required. Counselors must disguise the identity of the client when using data for training, research, or publication. (See B.5.a.) Section G: Research and Publication Standard of Practice Forty-Five (SP-45): Confidentiality of Research Information. Counselors must keep confidential information obtained about research participants. (See G.2.d.) American Mental Health Counselors Association Code of Ethics 2000 http://www.amhca.org/code Principle 3:   Confidentiality Mental health counselors have a primary obligation to safeguard information about individuals obtained in the course of practice, teaching, or research. Personal information is communicated to others only with the person's written consent or in those circumstances where there is clear and imminent danger to the client, to others or to society. Disclosure of counseling information is restricted to what is necessary, relevant and verifiable. A) At the outset of any counseling relationship, mental health counselors make their clients aware of their rights in regard to the confidential nature of the counseling relationship. They fully disclose the limits of, or exceptions to, confidentiality, and/or the existence of privileged communication, if any. B) All materials in the official record shall be shared with the client, who shall have the right to decide what information may be shared with anyone beyond the immediate provider of service and be informed of the implications of the materials to be shared. C) Confidentiality belongs to the clients. They may direct the mental health counselor, in writing, to release information to others. The release of information without the consent of the client may only take place under the most extreme circumstances. The protection of life, as in the case of suicidal or homicidal clients, exceeds the requirements of confidentiality. The protection of a child, an elderly person, or a person not competent to care for themselves from physical or sexual abuse or neglect requires that a report be made to a legally constituted authority. The mental health counselor complies with all state and federal statutes concerning mandated reporting of suicidality, homicidality, child abuse, incompetent person abuse and elder abuse. The protection of the public or another individual from a contagious condition known to be fatal also requires action that may include reporting the willful infection of another with the condition. The mental health counselor (or staff member) does not release information by request unless accompanied by a specific release of information or a valid court order. Mental health counselors will comply with the order of a court to release information but they will inform the client of the receipt of such an order. A subpoena is insufficient to release information. In such a case, the counselor must inform his client of the situation and, if the client refuses release, coordinate between the client's attorney and the requesting attorney so as to protect client confidentiality and one's own legal welfare. In the case of all of the above exceptions to confidentiality, the mental health counselor will release only such information as is necessary to accomplish the action required by the exception. D) The anonymity of clients served in public and other agencies is preserved, if at all possible, by withholding names and personal identifying data. If external conditions require reporting such information, the client shall be so informed. E) Information received in confidence by one agency or person shall not be forwarded to another person or agency without the client's written permission. F) Service providers have the responsibility to ensure the accuracy and to indicate the validity of data shared with their parties. G) Case reports presented in classes, professional meetings, or publications shall be so disguised that no identification is possible unless the client or responsible authority has read the report and agreed in writing to its presentation or publication. H) Counseling reports and records are maintained under conditions of security, and provisions are made for their destruction when they have outlived their usefulness. Mental health counselors ensure that all persons in his or her employ, volunteers, and community aides maintain privacy and confidentiality. I) Mental health counselors who ask that an individual reveal personal information in the course of interviewing, testing or evaluation, or who allow such information to be divulged, do so only after making certain that the person or authorized representative is fully aware of the purposes of the interview, testing or evaluation, and of the ways in which the information will be used. J) Sessions with clients may be taped or otherwise recorded only with their written permission or the written permission of a responsible guardian. Even with a guardian's written consent, one should not record a session against the expressed wishes of a client. Such tapes shall be destroyed when they have outlived their usefulness. K) Where a child or adolescent is the primary client, or the client is not competent to give consent, the interests of the minor or the incompetent client shall be paramount. Where appropriate, a parent(s) or guardian(s) may be included in the counseling process. The mental health counselor must still take measures to safeguard the client's confidentiality. L) In work with families, the rights of each family member should be safeguarded. The provider of service also has the responsibility to discuss the contents of the record with the parent and/or child, as appropriate, and to keep separate those parts, which should remain the property of each family member. M) In work with groups, the rights of each group member should be safeguarded. The provider of service also has the responsibility to discuss the need for each member to respect the confidentiality of each other member of the group. He must also remind the group of the limits on and risk to confidentiality inherent in the group process. N) When using a computer to store confidential information, mental health counselors take measures to control access to such information. When such information has outlived its usefulness, it should be deleted from the system. The Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry 2001 Edition http://www.psych.org/psych_pract/ethics/ppaethics.cfm Preamble Section 4 A physician shall respect the rights of patients, colleagues, and other health professionals, and shall safeguard patient confidences and privacy within the constraints of the law. Section 4 A physician shall respect the rights of patients, colleagues, and other health professionals, and shall safeguard patient confidences and privacy within the constraints of the law. 1. Psychiatric records, including even the identification of a person as a patient, must be protected with extreme care. Confidentiality is essential to psychiatric treatment. This is based in part on the special nature of psychiatric therapy as well as on the traditional ethical relationship between physician and patient. Growing concern regarding the civil rights of patients and the possible adverse effects of computerization, duplication equipment, and data banks makes the dissemination of confidential information an increasing hazard. Because of the sensitive and private nature of the information with which the psychiatrist deals, he or she must be circumspect in the information that he or she chooses to disclose to others about a patient. The welfare of the patient must be a continuing consideration. 2. A psychiatrist may release confidential information only with the authorization of the patient or under proper legal compulsion. The continuing duty of the psychiatrist to protect the patient includes fully apprising him/her of the connotations of waiving the privilege of privacy. This may become an issue when the patient is being investigated by a government agency, is applying for a position, or is involved in legal action. The same principles apply to the release of information concerning treatment to medical departments of government agencies, business organizations, labor unions, and insurance companies. Information gained in confidence about patients seen in student health services should not be released without the students' explicit permission. 3. Clinical and other materials used in teaching and writing must be adequately disguised in order to preserve the anonymity of the individuals involved. 4. The ethical responsibility of maintaining confidentiality holds equally for the consultations in which the patient may not have been present and in which the consultee was not a physician. In such instances, the physician consultant should alert the consultee to his or her duty of confidentiality. 5. Ethically, the psychiatrist may disclose only that information which is relevant to a given situation. He or she should avoid offering speculation as fact. Sensitive information such as an individual's sexual orientation or fantasy material is usually unnecessary. 6. Psychiatrists are often asked to examine individuals for security purposes, to determine suitability for various jobs, and to determine legal competence. The psychiatrist must fully describe the nature and purpose and lack of confidentiality of the examination to the examinee at the beginning of the examination. 7. Careful judgment must be exercised by the psychiatrist in order to include, when appropriate, the parents or guardian in the treatment of a minor. At the same time, the psychiatrist must assure the minor proper confidentiality. 8. When, in the clinical judgment of the treating psychiatrist, the risk of danger is deemed to be significant, the psychiatrist may reveal confidential information disclosed by the patient." 9. When the psychiatrist is ordered by the court to reveal the confidences entrusted to him/her by patients, he or she may comply or he/ she may ethically hold the right to dissent within the framework of the law. When the psychiatrist is in doubt, the right of the patient to confidentiality and, by extension, to unimpaired treatment should be given priority. The psychiatrist should reserve the right to raise the question of adequate need for disclosure. In the event that the necessity for legal disclosure is demonstrated by the court, the psychiatrist may request the right to disclosure of only that information which is relevant to the legal question at hand. 10. With regard for the person's dignity and privacy and with truly informed consent, it is ethical to present a patient to a scientific gathering if the confidentiality of the presentation is understood and accepted by the audience. 11. It is ethical to present a patient or former patient to a public gathering or to the news media only if the patient is fully informed of enduring loss of confidentiality, is competent, and consents in writing without coercion. 12. When involved in funded research, the ethical psychiatrist will advise human subjects of the funding source, retain his or her freedom to reveal data and results, and follow all appropriate and current guidelines relative to human subject protection. American Psychological Association's Ethical Principles of Psychologists and Code of Conduct 2002 http://www.apa.org/ethics/code2002.html INTRODUCTION AND APPLICABILITY This Ethics Code applies to these activities across a variety of contexts, such as in person, postal, telephone, internet, and other electronic transmissions. Principle A: Beneficence and Nonmaleficence Psychologists strive to benefit those with whom they work and take care to do no harm. In their professional actions, psychologists seek to safeguard the welfare and rights of those with whom they interact professionally and other affected persons Principle E: Respect for People's Rights and Dignity Psychologists respect the dignity and worth of all people, and the rights of individuals to privacy, confidentiality, and self-determination. Psychologists are aware that special safeguards may be necessary to protect the rights and welfare of persons or communities whose vulnerabilities impair autonomous decision making. 3.07 Third-Party Requests for Services When psychologists agree to provide services to a person or entity at the request of a third party, psychologists attempt to clarify at the outset of the service the nature of the relationship with all individuals or organizations involved. This clarification includes the role of the psychologist (e.g., therapist, consultant, diagnostician, or expert witness), an identification of who is the client, the probable uses of the services provided or the information obtained, and the fact that there may be limits to confidentiality. (See also Standards 3.05, Multiple Relationships, and 4.02, Discussing the Limits of Confidentiality.) 3.10 Informed Consent (a) When psychologists conduct research or provide assessment, therapy, counseling, or consulting services in person or via electronic transmission or other forms of communication, they obtain the informed consent of the individual or individuals using language that is reasonably understandable to that person or persons except when conducting such activities without consent is mandated by law or governmental regulation or as otherwise provided in this Ethics Code. (See also Standards 8.02, Informed Consent to Research; 9.03, Informed Consent in Assessments; and 10.01, Informed Consent to Therapy.) (b) For persons who are legally incapable of giving informed consent, psychologists nevertheless (1) provide an appropriate explanation, (2) seek the individual's assent, (3) consider such persons' preferences and best interests, and (4) obtain appropriate permission from a legally authorized person, if such substitute consent is permitted or required by law. When consent by a legally authorized person is not permitted or required by law, psychologists take reasonable steps to protect the individual's rights and welfare. (c) When psychological services are court ordered or otherwise mandated, psychologists inform the individual of the nature of the anticipated services, including whether the services are court ordered or mandated and any limits of confidentiality, before proceeding. (d) Psychologists appropriately document written or oral consent, permission, and assent. (See also Standards 8.02, Informed Consent to Research; 9.03, Informed Consent in Assessments; and 10.01, Informed Consent to Therapy.) 3.11 Psychological Services Delivered To or Through Organizations (a) Psychologists delivering services to or through organizations provide information beforehand to clients and when appropriate those directly affected by the services about (1) the nature and objectives of the services, (2) the intended recipients, (3) which of the individuals are clients, (4) the relationship the psychologist will have with each person and the organization, (5) the probable uses of services provided and information obtained, (6) who will have access to the information, and (7) limits of confidentiality. As soon as feasible, they provide information about the results and conclusions of such services to appropriate persons. (b) If psychologists will be precluded by law or by organizational roles from providing such information to particular individuals or groups, they so inform those individuals or groups at the outset of the service. 4. Privacy And Confidentiality 4.01 Maintaining Confidentiality Psychologists have a primary obligation and take reasonable precautions to protect confidential information obtained through or stored in any medium, recognizing that the extent and limits of confidentiality may be regulated by law or established by institutional rules or professional or scientific relationship. (See also Standard 2.05, Delegation of Work to Others.) 4.02 Discussing the Limits of Confidentiality (a) Psychologists discuss with persons (including, to the extent feasible, persons who are legally incapable of giving informed consent and their legal representatives) and organizations with whom they establish a scientific or professional relationship (1) the relevant limits of confidentiality and (2) the foreseeable uses of the information generated through their psychological activities. (See also Standard 3.10, Informed Consent.>) (b) Unless it is not feasible or is contraindicated, the discussion of confidentiality occurs at the outset of the relationship and thereafter as new circumstances may warrant. (c) Psychologists who offer services, products, or information via electronic transmission inform clients/patients of the risks to privacy and limits of confidentiality. 4.03 Recording Before recording the voices or images of individuals to whom they provide services, psychologists obtain permission from all such persons or their legal representatives. (See also Standards 8.03, Informed Consent for Recording Voices and Images in Research; 8.05, Dispensing With Informed Consent for Research; and 8.07, Deception in Research.) 4.04 Minimizing Intrusions on Privacy (a) Psychologists include in written and oral reports and consultations, only information germane to the purpose for which the communication is made. (b) Psychologists discuss confidential information obtained in their work only for appropriate scientific or professional purposes and only with persons clearly concerned with such matters. 4.05 Disclosures (a) Psychologists may disclose confidential information with the appropriate consent of the organizational client, the individual client/patient, or another legally authorized person on behalf of the client/patient unless prohibited by law. (b) Psychologists disclose confidential information without the consent of the individual only as mandated by law, or where permitted by law for a valid purpose such as to (1) provide needed professional services; (2) obtain appropriate professional consultations; (3) protect the client/patient, psychologist, or others from harm; or (4) obtain payment for services from a client/patient, in which instance disclosure is limited to the minimum that is necessary to achieve the purpose. (See also Standard 6.04e, Fees and Financial Arrangements.) 4.06 Consultations When consulting with colleagues, (1) psychologists do not disclose confidential information that reasonably could lead to the identification of a client/patient, research participant, or other person or organization with whom they have a confidential relationship unless they have obtained the prior consent of the person or organization or the disclosure cannot be avoided, and (2) they disclose information only to the extent necessary to achieve the purposes of the consultation. (See also Standard 4.01, Maintaining Confidentiality.) 4.07 Use of Confidential Information for Didactic or Other Purposes Psychologists do not disclose in their writings, lectures, or other public media, confidential, personally identifiable information concerning their clients/patients, students, research participants, organizational clients, or other recipients of their services that they obtained during the course of their work, unless (1) they take reasonable steps to disguise the person or organization, (2) the person or organization has consented in writing, or (3) there is legal authorization for doing so. 6. Record Keeping and Fees (b) If confidential information concerning recipients of psychological services is entered into databases or systems of records available to persons whose access has not been consented to by the recipient, psychologists use coding or other techniques to avoid the inclusion of personal identifiers. (c) Psychologists make plans in advance to facilitate the appropriate transfer and to protect the confidentiality of records and data in the event of psychologists' withdrawal from positions or practice. (See also Standards 3.12, Interruption of Psychological Services, and 10.09, Interruption of Therapy.) 7. Education and Training 7.04 Student Disclosure of Personal Information Psychologists do not require students or supervisees to disclose personal information in course- or program-related activities, either orally or in writing, regarding sexual history, history of abuse and neglect, psychological treatment, and relationships with parents, peers, and spouses or significant others except if (1) the program or training facility has clearly identified this requirement in its admissions and program materials or (2) the information is necessary to evaluate or obtain assistance for students whose personal problems could reasonably be judged to be preventing them from performing their training- or professionally related activities in a competent manner or posing a threat to the students or others. 8. Research and Publication 8.02 Informed Consent to Research (a) When obtaining informed consent as required in Standard 3.10, Informed Consent, psychologists inform participants about (1) the purpose of the research, expected duration, and procedures; (2) their right to decline to participate and to withdraw from the research once participation has begun; (3) the foreseeable consequences of declining or withdrawing; (4) reasonably foreseeable factors that may be expected to influence their willingness to participate such as potential risks, discomfort, or adverse effects; (5) any prospective research benefits; (6) limits of confidentiality; (7) incentives for participation; and (8) whom to contact for questions about the research and research participants' rights. They provide opportunity for the prospective participants to ask questions and receive answers. (See also Standards 8.03, Informed Consent for Recording Voices and Images in Research; 8.05, Dispensing With Informed Consent for Research; and 8.07, Deception in Research.) 8.03 Informed Consent for Recording Voices and Images in Research Psychologists obtain informed consent from research participants prior to recording their voices or images for data collection unless (1) the research consists solely of naturalistic observations in public places, and it is not anticipated that the recording will be used in a manner that could cause personal identification or harm, or (2) the research design includes deception, and consent for the use of the recording is obtained during debriefing. (See also Standard 8.07, Deception in Research.) 9. Assessment 9.03 Informed Consent in Assessments (a) Psychologists obtain informed consent for assessments, evaluations, or diagnostic services, as described in Standard 3.10, Informed Consent, except when (1) testing is mandated by law or governmental regulations; (2) informed consent is implied because testing is conducted as a routine educational, institutional, or organizational activity (e.g., when participants voluntarily agree to assessment when applying for a job); or (3) one purpose of the testing is to evaluate decisional capacity. Informed consent includes an explanation of the nature and purpose of the assessment, fees, involvement of third parties, and limits of confidentiality and sufficient opportunity for the client/patient to ask questions and receive answers. (b) Psychologists inform persons with questionable capacity to consent or for whom testing is mandated by law or governmental regulations about the nature and purpose of the proposed assessment services, using language that is reasonably understandable to the person being assessed. (c) Psychologists using the services of an interpreter obtain informed consent from the client/patient to use that interpreter, ensure that confidentiality of test results and test security are maintained, and include in their recommendations, reports, and diagnostic or evaluative statements, including forensic testimony, discussion of any limitations on the data obtained. (See also Standards 2.05, Delegation of Work to Others; 4.01, Maintaining Confidentiality; 9.01, Bases for Assessments; 9.06, Interpreting Assessment Results; and 9.07, Assessment by Unqualified Persons.) 9.04 Release of Test Data (a) The term test data refers to raw and scaled scores, client/patient responses to test questions or stimuli, and psychologists' notes and recordings concerning client/patient statements and behavior during an examination. Those portions of test materials that include client/patient responses are included in the definition of test data. Pursuant to a client/patient release, psychologists provide test data to the client/patient or other persons identified in the release. Psychologists may refrain from releasing test data to protect a client/patient or others from substantial harm or misuse or misrepresentation of the data or the test, recognizing that in many instances release of confidential information under these circumstances is regulated by law. (See also Standard 9.11, Maintaining Test Security.) (b) In the absence of a client/patient release, psychologists provide test data only as required by law or court order. 10. Therapy 10.01 Informed Consent to Therapy (a) When obtaining informed consent to therapy as required in Standard 3.10, Informed Consent, psychologists inform clients/patients as early as is feasible in the therapeutic relationship about the nature and anticipated course of therapy, fees, involvement of third parties, and limits of confidentiality and provide sufficient opportunity for the client/patient to ask questions and receive answers. (See also Standards 4.02, Discussing the Limits of Confidentiality, and 6.04, Fees and Financial Arrangements.) 10.02 Therapy Involving Couples or Families (a) When psychologists agree to provide services to several persons who have a relationship (such as spouses, significant others, or parents and children), they take reasonable steps to clarify at the outset (1) which of the individuals are clients/patients and (2) the relationship the psychologist will have with each person. This clarification includes the psychologist's role and the probable uses of the services provided or the information obtained. (See also Standard 4.02, Discussing the Limits of Confidentiality.) 10.03 Group Therapy When psychologists provide services to several persons in a group setting, they describe at the outset the roles and responsibilities of all parties and the limits of confidentiality. California Association of Marriage and Family Therapists http://www.camft.org/scriptcontent/index.cfm?displaypage=../CamftBenefits/EthicalStandards1.html 1.4 ELECTRONIC THERAPY: When patients are not physically present (e.g., therapy by telephone or Internet) during the provision of therapy, marriage and family therapists take extra precautions to meet their responsibilities to patients. Prior to utilizing electronic therapy, marriage and family therapists consider the appropriateness and suitability of this therapeutic modality to the patient’s needs. When therapy occurs by electronic means, marriage and family therapists inform patients of the potential risks, consequences, and benefits, including but not limited to, issues of confidentiality, clinical limitations, transmission difficulties, and ability to respond to emergencies. Marriage and family therapists ensure that such therapy complies with the informed consent requirements of the California Telemedicine Act. 1.5.4 LIMITS OF CONFIDENTIALITY: Marriage and family therapists are encouraged to inform patients as to certain exceptions to confidentiality such as child abuse reporting, elder and dependent adult abuse reporting, and patients dangerous to themselves or others. 2. CONFIDENTIALITY Marriage and family therapists have unique confidentiality responsibilities because the "patient" in a therapeutic relationship may be more than one person. The overriding principle is that marriage and family therapists respect the confidences of their patient(s). 2.1 DISCLOSURES OF CONFIDENTIAL INFORMATION: Marriage and family therapists do not disclose patient confidences, including the names or identities of their patients, to anyone except a) as mandated by law b) as permitted by law c) when the marriage and family therapist is a defendant in a civil, criminal, or disciplinary action arising from the therapy (in which case patient confidences may only be disclosed in the course of that action), or d) if there is an authorization previously obtained in writing, and then such information may only be revealed in accordance with the terms of the authorization. 2.2 SIGNED AUTHORIZATIONS— RELEASE OF INFORMATION: When there is a request for information related to any aspect of psychotherapy or treatment, each member of the unit receiving such therapeutic treatment must sign an authorization before a marriage and family therapist will disclose information received from any member of the treatment unit. 2.3 ELECTRONIC MEDIA: Marriage and family therapists are aware of the possible adverse effects of technological changes with respect to the dissemination of patient information, and take care when disclosing such information. Marriage and family therapists are also aware of the limitations regarding confidential transmission by Internet or electronic media and take care when transmitting or receiving such information via these mediums. 2.4 MAINTENANCE OF PATIENT RECORDS—CONFIDENTIALITY: Marriage and family therapists store, transfer, transmit, and/or dispose of patient records in ways that protect confidentiality. 2.5 EMPLOYEES—CONFIDENTIALITY: Marriage and family therapists take appropriate steps to ensure, insofar as possible, that the confidentiality of patients is maintained by their employees, supervisees, assistants, and volunteers. 2.6 USE OF CLINICAL MATERIALS—CONFIDENTIALITY: Marriage and family therapists use clinical materials in teaching, writing, and public presentations only if a written authorization has been previously obtained in accordance with 2.1 d), or when appropriate steps have been taken to protect patient identity. 2.7 GROUPS—CONFIDENTIALITY: Marriage and family therapists, when working with a group, educate the group regarding the importance of maintaining confidentiality, and are encouraged to obtain written agreement from group participants to respect the confidentiality of other members of the group. 6.4 CONFIDENTIALITY: Information obtained about a research participant during the course of a research project is confidential unless there is an authorization previously obtained in writing. When the possibility exists that others, including family members, may obtain access to such information, this possibility, together with the plan for protecting confidentiality, is explained. 8.3 CONFLICTING ROLES: Whenever possible, marriage and family therapists avoid performing conflicting roles in legal proceedings and disclose any potential conflicts. At the outset of the service to be provided and as changes occur, marriage and family therapists clarify role expectations and the extent of confidentiality to prospective clients, to the courts, or to others as appropriate. Canadian Psychological Association: Canadian Code of Ethics For Psychologists (3rd Edition) http://www.cpa.ca/cpasite/userfiles/Documents/Canadian%20Code%20of%20Ethics%20for%20Psycho.pdf Principle I: Respect for the Dignity of Persons Values Statement Adherence to the concept of moral rights is an essential component of respect for the dignity of persons. Rights to privacy, self-determination, personal liberty, and natural justice are of particular importance to psychologists, and they have a responsibility to protect and promote these rights in all of their activities. As such, psychologists have a responsibility to develop and follow procedures for informed consent, confidentiality, fair treatment, and due process that are consistent with those rights. Informed consent I.20 Obtain informed consent for all research activities that involve obtrusive measures, invasion of privacy, more than minimal risk of harm, or any attempt to change the behaviour of research participants. I.24 Ensure, in the process of obtaining informed consent, that at least the following points are understood: purpose and nature of the activity; mutual responsibilities; confidentiality protections and limitations; likely benefits and risks; alternatives; the likely consequences of non-action; the option to refuse or withdraw at any time, without prejudice; over what period of time the consent applies; and, how to rescind consent if desired. (Also see Standards III.23-30.) I.26 Clarify the nature of multiple relationships to all concerned parties before obtaining consent, if providing services to or conducting research at the request or for the use of third parties. This would include, but not be limited to: the purpose of the service or research; the reasonably anticipated use that will be made of information collected; and, the limits on confidentiality. Third parties may include schools, courts, government agencies, insurance companies, police, and special funding bodies. Privacy I.37 Seek and collect only information that is germane to the purpose(s) for which consent has been obtained. I.38 Take care not to infringe, in research, teaching, or service activities, on the personally, developmentally, or culturally defined private space of individuals or groups, unless clear permission is granted to do so. I.39 Record only that private information necessary for the provision of continuous, coordinated service, or for the goals of the particular research study being conducted, or that is required or justified by law. (Also see Standards IV.17 and IV.18.) I.40 Respect the right of research participants, employees, supervisees, students, and trainees to reasonable personal privacy. I.41 Collect, store, handle, and transfer all private information, whether written or unwritten (e.g., communication during service provision, written records, e-mail or fax communication, computer files, video-tapes), in a way that attends to the needs for privacy and security. This would include having adequate plans for records in circumstances of one's own serious illness, termination of employment, or death. I.42 Take all reasonable steps to ensure that records over which they have control remain personally identifiable only as long as necessary in the interests of those to whom they refer and/or to the research project for which they were collected, or as required or justified by law (e.g., the possible need to defend oneself against future allegations), and render anonymous or destroy any records under their control that no longer need to be personally identifiable. (Also see Standards IV.17 and IV.18.) Confidentiality I.43 Be careful not to relay information about colleagues, colleagues' clients, research participants, employees, supervisees, students, trainees, and members of organizations, gained in the process of their activities as psychologists, that the psychologist has reason to believe is considered confidential by those persons, except as required or justified by law. (Also see Standards IV.17 and IV.18.) I.44 Clarify what measures will be taken to protect confidentiality, and what responsibilities family, group, and community members have for the protection of each other's confidentiality, when engaged in services to or research with individuals, families, groups, or communities. I.45 Share confidential information with others only with the informed consent of those involved, or in a manner that the persons involved cannot be identified, except as required or justified by law, or in circumstances of actual or possible serious physical harm or death. (Also see Standards II.39, IV.17, and IV.18.) Ethical Standards Minimize harm II.30 Be acutely aware of the need for discretion in the recording and communication of information, in order that the information not be misinterpreted or misused to the detriment of others. This includes, but is not limited to: not recording information that could lead to misinterpretation and misuse; avoiding conjecture; clearly labelling opinion; and, communicating information in language that can be understood clearly by the recipient of the information. Straightforwardness/openness III.14 Be clear and straightforward about all information needed to establish informed consent or any other valid written or unwritten agreement (for example: fees, including any limitations imposed by third-party payers; relevant business policies and practices; mutual concerns; mutual responsibilities; ethical responsibilities of psychologists; purpose and nature of the relationship, including research participation; alternatives; likely experiences; possible conflicts; possible outcomes; and, expectations for processing, using, and sharing any information generated). Commission on Rehabilitation Counselor Certification: Code of Professional Ethics (Effective Jan. 1, 2002) http://www.crccertification.com/code.html A.3. CLIENT RIGHTS a. DISCLOSURE TO CLIENTS. When counseling is initiated, and throughout the counseling process as necessary, rehabilitation counselors will inform clients, preferably through both written and oral means, of their credentials, the purposes, goals, techniques, procedures, limitations, potential risks, and benefits of services to be performed, and other pertinent information. Rehabilitation counselors will take steps to ensure that clients understand the implications of diagnosis, the intended use of tests and reports, fees, and billing arrangements. Clients have the right to (1) expect confidentiality and will be provided with an explanation of its limitations, including disclosure to supervisors and/or treatment team professionals; (2) obtain clear information about their case records; (3) actively participate in the development and implementation of rehabilitation counseling plans; and (4) refuse any recommended services and be advised of the consequences of such refusal. b. THIRD PARTY REFERRAL. Rehabilitation counselors who have direct contact with a client at the request of a third party will define the nature of their relationships and role to all rightful, legal parties with whom they have direct contact. Direct contact is defined as any written, oral, or electronic communication. Legal parties may include clients, legal guardians, referring third parties, and attorneys actively involved in a matter directly related to rehabilitation services. f. INVOLVEMENT OF SIGNIFICANT OTHERS. Rehabilitation counselors will attempt to enlist family understanding and involvement of family and/or significant others as a positive resource if (or when) appropriate. The client or legal guardian's permission will be secured prior to any involvement of family and/or significant others. B.1. RIGHT TO PRIVACY a. RESPECT FOR PRIVACY. Rehabilitation counselors will respect clients' rights to privacy and will avoid illegal and unwarranted disclosures of confidential information. b. CLIENT WAIVER. Rehabilitation counselors will respect the right of the client or his/her legally recognized representative to waive the right to privacy. c. EXCEPTIONS. When disclosure is required to prevent clear and imminent danger to the client or others, or when legal requirements demand that confidential information be revealed, the general requirement that rehabilitation counselors keep information confidential will not apply. Rehabilitation counselors will consult with other professionals when in doubt as to the validity of an exception. d. CONTAGIOUS, FATAL DISEASES. Rehabilitation counselors will become aware of the legal requirements for disclosure of contagious and fatal diseases in their jurisdiction. In jurisdictions where allowable, a rehabilitation counselor who receives information will confirm that a client has a disease known to be communicable and/or fatal. If allowable by law, the rehabilitation counselor will disclose this information to a third party, who by his or her relationship with the client is at high risk of contracting the disease. Prior to disclosure, the rehabilitation counselor will ascertain that the client has not already informed the third party about his or her disease and that the client is not intending to inform the third party in the immediate future. e. COURT-ORDERED DISCLOSURE. When court ordered to release confidential information without a client's permission, rehabilitation counselors will request to the court that the disclosure not be required due to potential harm to the client or counseling relationship. f. MINIMAL DISCLOSURE. When circumstances require the disclosure of confidential information, rehabilitation counselors will endeavor to reveal only essential information. To the extent possible, clients will be informed before confidential information is disclosed. g. EXPLANATION OF LIMITATIONS. When counseling is initiated and throughout the counseling process as necessary, rehabilitation counselors will inform clients of the limitations of confidentiality and will identify foreseeable situations in which confidentiality must be breached. h. WORK ENVIRONMENT. Rehabilitation counselors will make every effort to ensure that a confidential work environment exists and that subordinates including employees, supervisees, clerical assistants, and volunteers maintain the privacy and confidentiality of clients. i. TREATMENT TEAMS. If client treatment will involve the sharing of client information among treatment team members, the client will be advised of this fact and will be informed of the team's existence and composition. j. CLIENT ASSISTANTS. When a client is accompanied by an individual providing assistance to the client (e.g., interpreter, personal care assistant, etc.), rehabilitation counselors will ensure that the assistant is apprised of the need to maintain confidentiality. B.2. GROUPS AND FAMILIES a. GROUP WORK. In group work, rehabilitation counselors will clearly define confidentiality and the parameters for the specific group being entered, explain its importance, and discuss the difficulties related to confidentiality involved in group work. The fact that confidentiality cannot be guaranteed will be clearly communicated to group members. b. FAMILY COUNSELING. In family counseling, unless otherwise directed by law, information about one family member will not be disclosed to another member without permission. Rehabilitation counselors will protect the privacy rights of each family member. B.3. RECORDS a. REQUIREMENT OF RECORDS. Rehabilitation counselors will maintain records necessary for rendering professional services to their clients and as required by laws, regulations, or agency or institution procedures. b. CONFIDENTIALITY OF RECORDS. Rehabilitation counselors will be responsible for securing the safety and confidentiality of any counseling records they create, maintain, transfer, or destroy whether the records are written, taped, computerized, or stored in any other medium. c. PERMISSION TO RECORD OR OBSERVE. Rehabilitation counselors will obtain and document written or recorded permission from clients prior to electronically recording or observing sessions. When counseling clients who are minors or individuals who are unable to give voluntary, informed consent, written or recorded permission of guardians must be obtained. d. CLIENT ACCESS. Rehabilitation counselors will recognize that counseling records are kept for the benefit of clients, and therefore provide access to records and copies of records when requested by clients, unless prohibited by law. In instances where the records contain information that may be sensitive or detrimental to the client, the rehabilitation counselor has a responsibility to adequately interpret such information to the client. In situations involving multiple clients, access to records will be limited to those parts of records that do not include confidential information related to another client. e. DISCLOSURE OR TRANSFER. Rehabilitation counselors will obtain written permission from clients to disclose or transfer records to legitimate third parties unless exceptions to confidentiality exist as listed in Section B.1. B.4. CONSULTATION a. RESPECT FOR PRIVACY. Information obtained in a consulting relationship will be discussed for professional purposes only with persons clearly concerned with the case. Written and oral reports will present data germane to the purposes of the consultation, and every effort will be made to protect client identity and to avoid undue invasion of privacy. b. COOPERATING AGENCIES. Before sharing information, rehabilitation counselors will make efforts to ensure that there are defined policies in other agencies serving the counselor's clients that effectively protect the confidentiality of information. B.5. ALTERNATIVE COMMUNICATION Rehabilitation counselors will make every effort to ensure that methods of exchanging information that utilize alternative means of communication (i.e., facsimile, cellular telephone, computer, or videoconferencing) will be conducted in such a manner that ensures protection of client confidentiality. If confidentiality cannot be ensured, client or guardian permission must be obtained. SECTION F: EVALUATION, ASSESSMENT, AND INTERPRETATION F.1. INFORMED CONSENT a. EXPLANATION TO CLIENTS. Prior to assessment, rehabilitation counselors will explain the nature and purposes of assessment and the specific use of results in language the client (or other legally authorized person on behalf of the client) can understand. Regardless of whether scoring and interpretation are completed by rehabilitation counselors, by assistants, or by computer or other outside services, rehabilitation counselors will take reasonable steps to ensure that appropriate explanations are given to the client. b. RECIPIENTS OF RESULTS. The client's welfare, explicit understanding, and prior agreement will determine the recipients of test results. Rehabilitation counselors will include accurate and appropriate interpretations with any release of test results. F.2. RELEASE OF INFORMATION TO COMPETENT PROFESSIONALS b. RELEASE OF RAW DATA. Rehabilitation counselors will ordinarily release data (e.g., protocols, counseling or interview notes, or questionnaires) in which the client is identified only with the consent of the client or the client's legal representative. Such data will be released only to persons recognized by rehabilitation counselors as competent to interpret the data. F.3. RESEARCH AND TRAINING a. DATA DISGUISE REQUIRED. Use of data derived from counseling relationships for purposes of training, research, or publication will be confined to content that is disguised to ensure the anonymity of the individuals involved. b. AGREEMENT FOR IDENTIFICATION. Identification of a client in a presentation or publication will be permissible only when the client has agreed in writing to its presentation or publication. G.2. REHABILITATION COUNSELOR EDUCATION AND TRAINING PROGRAMS a. ORIENTATION. Prior to admission, rehabilitation counselor educators will orient prospective students to the counselor education or training program's expectations, including but not limited to the following: (1) the type and level of skill acquisition required for successful completion of the training, (2) subject matter to be covered, (3) basis for evaluation, (4) training components that encourage self-growth or self-disclosure as part of the training process, (5) the type of supervision settings and requirements of the sites for required clinical field experiences, (6) student evaluation and dismissal policies and procedures, and (7) up-to-date employment prospects for graduates. G.3. STUDENTS AND SUPERVISEES b. SELF-GROWTH EXPERIENCES. Rehabilitation counselor educators, when designing training groups or other experiences conducted by the rehabilitation counselor educators themselves, will inform students of the potential risks of self-disclosure. Rehabilitation counselor educators will respect the privacy of students by not requiring self-disclosure that could reasonably be expected to be harmful and student evaluation criteria will not include the level of the student's self-disclosure. d. CLIENTS OF STUDENTS AND SUPERVISEES. Rehabilitation counselors will make every effort to ensure that clients are aware of the services rendered and the qualifications of the students and supervisees rendering those services. Clients will receive professional disclosure information and will be informed of the limits of confidentiality. Client permission will be obtained in order for the students and supervisees to use any information concerning the counseling relationship in the training process. SECTION H: RESEARCH AND PUBLICATION H.2. INFORMED CONSENT a. TOPICS DISCLOSED. In obtaining informed consent for research, rehabilitation counselors will use language that is understandable to research participants and that (1) accurately explains the purpose and procedures to be followed; (2) identifies any procedures that are experimental or relatively untried; (3) describes the attendant discomforts and risks; (4) describes the benefits or changes in individuals or organizations that might reasonably be expected; (5) discloses appropriate alternative procedures that would be advantageous for participants; (6) offers to answer any inquiries concerning the procedures; (7) describes any limitations of confidentiality; and (8) instructs that participants are free to withdraw their consent and to discontinue participation in the project at any time. d. CONFIDENTIALITY OF INFORMATION. Information obtained about research participants during the course of an investigation will be confidential. When the possibility exists that others may obtain access to such information, ethical research practice requires that the possibility, together with the plans for protecting confidentiality, will be explained to participants as a part of the procedure for obtaining informed consent. H.3. REPORTING RESULTS d. IDENTITY OF PARTICIPANTS. Rehabilitation counselors who supply data, aid in the research of another person, report research results, or make original data available will take due care to disguise the identity of respective participants in the absence of specific authorization from the participants to do otherwise. Section I: Electronic Communication and Emerging Applications I.1. COMMUNICATION c. CONFIDENTIALITY. Rehabilitation counselors will ensure that clients are provided sufficient information to adequately address and explain the limits of: (1) computer technology in the counseling process in general; and (2) the difficulties of ensuring complete client confidentiality of information transmitted through electronic communication over the Internet through on-line counseling. I.2. COUNSELING RELATIONSHIP b. SECURITY. Rehabilitation counselors will use encryption methods whenever possible. If encryption is not made available to clients, clients must be informed of the potential hazards of unsecured communication on the Internet. Hazards may include authorized or unauthorized monitoring of transmissions and/or records of sessions. SECTION J: BUSINESS PRACTICES J.3. CLIENT RECORDS c. PRIVACY. Documentation generated by rehabilitation counselors will protect the privacy of clients to the extent that it is possible and appropriate, and will include only relevant information. d. MAINTENANCE. Rehabilitation counselors will maintain records necessary for rendering professional services to their clients and as required by applicable laws, regulations, or agency/institution procedures. Subsequent to file closure, records will be maintained for the number of years consistent with jurisdictional requirements or for a longer period during which maintenance of such records is necessary or helpful to provide reasonably anticipated future services to the client. After that time, records will be destroyed in a manner assuring preservation of confidentiality. Feminist Therapy Institute: Code of Ethics (revised 1999) http://www.feministtherapyinstitute.org/ethics.htm Preamble Feminist therapists live with and practice in competing forces and complex controlling interests. When mental health care involves third-party payers, it is feminist therapists' responsibility to advocate for the best possible therapeutic process for the client, including short or long term therapy. Care and compassion for clients include protection of confidentiality and awareness of the impacts of economic and political considerations, including the increasing disparity between the quality of therapeutic care available for those with or without third-party payers. Ethical Guidelines for Feminist Therapists D. A feminist therapist, teacher, or researcher is alert to the control of information dissemination and questions pressures to conform to and use dominant mainstream standards. As technological methods of communication change and increase, the feminist therapist recognizes the socioeconomic aspects of these developments and communicates according to clients' access to technology. National Association Of Alcoholism And Drug Abuse Counselors (NAADAC) Ethical Standards, 2004: http://naadac.org/documents/index.php?CategoryID=23 Principle 2: Client Welfare I shall do everything possible to safeguard the privacy and confidentiality of client information except where the client has given specific, written, informed, and limited consent or when the client poses a risk to himself or others. I shall provide the client his/her rights regarding confidentiality, in writing, as part of informing the client of any areas likely to affect the client’s confidentiality. Principle 6: Rights and Duties I understand that the right of confidentiality cannot always be maintained if it serves to protect abuse, neglect, or exploitation of any person or leaves another at risk of bodily harm. National Association of Social Workers Code of Ethics (revised 1999) http://www.socialworkers.org/pubs/code/default.asp 1.01 Commitment to Clients Social workers' primary responsibility is to promote the well-being of clients. In general, clients' interests are primary. However, social workers' responsibility to the larger society or specific legal obligations may on limited occasions supersede the loyalty owed clients, and clients should be so advised. (Examples include when a social worker is required by law to report that a client has abused a child or has threatened to harm self or others.) 1.02 Self-Determination Social workers respect and promote the right of clients to self-determination and assist clients in their efforts to identify and clarify their goals. Social workers may limit clients' right to self-determination when, in the social workers' professional judgment, clients' actions or potential actions pose a serious, foreseeable, and imminent risk to themselves or others. 1.03 Informed Consent (a) Social workers should provide services to clients only in the context of a professional relationship based, when appropriate, on valid informed consent. Social workers should use clear and understandable language to inform clients of the purpose of the services, risks related to the services, limits to services because of the requirements of a third-party payer, relevant costs, reasonable alternatives, clients' right to refuse or withdraw consent, and the time frame covered by the consent. Social workers should provide clients with an opportunity to ask questions. (e) Social workers who provide services via electronic media (such as computer, telephone, radio, and television) should inform recipients of the limitations and risks associated with such services. (f) Social workers should obtain clients' informed consent before audiotaping or videotaping clients or permitting observation of services to clients by a third party. 1.07 Privacy and Confidentiality (a) Social workers should respect clients' right to privacy. Social workers should not solicit private information from clients unless it is essential to providing services or conducting social work evaluation or research. Once private information is shared, standards of confidentiality apply. (b) Social workers may disclose confidential information when appropriate with valid consent from a client or a person legally authorized to consent on behalf of a client. (c) Social workers should protect the confidentiality of all information obtained in the course of professional service, except for compelling professional reasons. The general expectation that social workers will keep information confidential does not apply when disclosure is necessary to prevent serious, foreseeable, and imminent harm to a client or other identifiable person. In all instances, social workers should disclose the least amount of confidential information necessary to achieve the desired purpose; only information that is directly relevant to the purpose for which the disclosure is made should be revealed. (d) Social workers should inform clients, to the extent possible, about the disclosure of confidential information and the potential consequences, when feasible before the disclosure is made. This applies whether social workers disclose confidential information on the basis of a legal requirement or client consent. (e) Social workers should discuss with clients and other interested parties the nature of confidentiality and limitations of clients' right to confidentiality. Social workers should review with clients circumstances where confidential information may be requested and where disclosure of confidential information may be legally required. This discussion should occur as soon as possible in the social worker-client relationship and as needed throughout the course of the relationship. (f) When social workers provide counseling services to families, couples, or groups, social workers should seek agreement among the parties involved concerning each individual's right to confidentiality and obligation to preserve the confidentiality of information shared by others. Social workers should inform participants in family, couples, or group counseling that social workers cannot guarantee that all participants will honor such agreements. (g) Social workers should inform clients involved in family, couples, marital, or group counseling of the social worker's, employer's, and agency's policy concerning the social worker's disclosure of confidential information among the parties involved in the counseling. (h) Social workers should not disclose confidential information to third-party payers unless clients have authorized such disclosure. (i) Social workers should not discuss confidential information in any setting unless privacy can be ensured. Social workers should not discuss confidential information in public or semipublic areas such as hallways, waiting rooms, elevators, and restaurants. (j) Social workers should protect the confidentiality of clients during legal proceedings to the extent permitted by law. When a court of law or other legally authorized body orders social workers to disclose confidential or privileged information without a client's consent and such disclosure could cause harm to the client, social workers should request that the court withdraw the order or limit the order as narrowly as possible or maintain the records under seal, unavailable for public inspection. (k) Social workers should protect the confidentiality of clients when responding to requests from members of the media. (l) Social workers should protect the confidentiality of clients' written and electronic records and other sensitive information. Social workers should take reasonable steps to ensure that clients' records are stored in a secure location and that clients' records are not available to others who are not authorized to have access. (m) Social workers should take precautions to ensure and maintain the confidentiality of information transmitted to other parties through the use of computers, electronic mail, facsimile machines, telephones and telephone answering machines, and other electronic or computer technology. Disclosure of identifying information should be avoided whenever possible. (n) Social workers should transfer or dispose of clients' records in a manner that protects clients' confidentiality and is consistent with state statutes governing records and social work licensure. (o) Social workers should take reasonable precautions to protect client confidentiality in the event of the social worker's termination of practice, incapacitation, or death. (p) Social workers should not disclose identifying information when discussing clients for teaching or training purposes unless the client has consented to disclosure of confidential information. (q) Social workers should not disclose identifying information when discussing clients with consultants unless the client has consented to disclosure of confidential information or there is a compelling need for such disclosure. (r) Social workers should protect the confidentiality of deceased clients consistent with the preceding standards. 1.08 Access to Records (a) Social workers should provide clients with reasonable access to records concerning the clients. Social workers who are concerned that clients' access to their records could cause serious misunderstanding or harm to the client should provide assistance in interpreting the records and consultation with the client regarding the records. Social workers should limit clients' access to their records, or portions of their records, only in exceptional circumstances when there is compelling evidence that such access would cause serious harm to the client. Both clients' requests and the rationale for withholding some or all of the record should be documented in clients' files. (b) When providing clients with access to their records, social workers should take steps to protect the confidentiality of other individuals identified or discussed in such records. 2. Social Workers' Ethical Responsibilities to Colleagues 2.02 Confidentiality Social workers should respect confidential information shared by colleagues in the course of their professional relationships and transactions. Social workers should ensure that such colleagues understand social workers' obligation to respect confidentiality and any exceptions related to it. 2.05 Consultation (c) When consulting with colleagues about clients, social workers should disclose the least amount of information necessary to achieve the purposes of the consultation. 3. Social Workers' Ethical Responsibilities in Practice Settings 3.04 Client Records (a) Social workers should take reasonable steps to ensure that documentation in records is accurate and reflects the services provided. (b) Social workers should include sufficient and timely documentation in records to facilitate the delivery of services and to ensure continuity of services provided to clients in the future. (c) Social workers' documentation should protect clients' privacy to the extent that is possible and appropriate and should include only information that is directly relevant to the delivery of services. (d) Social workers should store records following the termination of services to ensure reasonable future access. Records should be maintained for the number of years required by state statutes or relevant contracts. 5.02 Evaluation and Research (k) Social workers engaged in the evaluation of services should discuss collected information only for professional purposes and only with people professionally concerned with this information. (l) Social workers engaged in evaluation or research should ensure the anonymity or confidentiality of participants and of the data obtained from them. Social workers should inform participants of any limits of confidentiality, the measures that will be taken to ensure confidentiality, and when any records containing research data will be destroyed. (m) Social workers who report evaluation and research results should protect participants' confidentiality by omitting identifying information unless proper consent has been obtained authorizing disclosure. National Board For Certified Counselors (NBCC) Code Of Ethics, 2005: http://www.nbcc.org/extras/pdfs/ethics/nbcc-codeofethics.pdf Section A: General  13. Certified counselors are accountable at all times for their behavior. They must be aware that all actions and  behaviors of the counselor reflect on professional integrity and, when inappropriate, can damage the public trust in the  counseling profession. To protect public confidence in the counseling profession, certified counselors avoid behavior that  is clearly in violation of accepted moral and legal standards.   Section B: Counseling Relationship  5. Records of the counseling relationship, including interview notes, test data, correspondence, audio or visual tape  recordings, electronic data storage, and other documents are to be considered professional information for use in  counseling. Records should contain accurate factual data. The physical records are property of the certified counselors or  their employers. The information contained in the records belongs to the client and therefore may not be released to  others without the consent of the client or when the counselor has exhausted challenges to a court order. The certified  counselors are responsible to insure that their employees handle confidential information appropriately. Confidentiality  must be maintained during the storage and disposition of records. Records should be maintained for a period of at least  five (5) years after the last counselor/client contact, including cases in which the client is deceased. All records must be  released to the client upon request.  16. The counseling relationship and information resulting from it remains confidential, consistent with the legal and  ethical obligations of certified counselors. In group counseling, counselors clearly define confidentiality and the  parameters for the specific group being entered, explain the importance of confidentiality, and discuss the difficulties  related to confidentiality involved in group work. The fact that confidentiality cannot be guaranteed is clearly  communicated to group members. However, counselors should give assurance about their professional responsibility to   keep all group communications confidential.   Ethics Guidelines Of United States Association For Body Psychotherapy (USABP), 2001: http://www.usabp.org/associations/1808/files/USABPethics.pdf III. INFORMED CONSENT Body psychotherapists provide services to clients only in the context of a professional relationship based on valid, on-going informed consent. Initial informed consent to use body psychotherapy is expected and should be updated and documented as appropriate during the relationship. Informed consent requires that the person haves the capacity to consent, has been informed of and understands necessary information concerning the course of their treatment, and that this consent has been given without undue influence. 1. Body psychotherapists use clear, understandable language to inform clients of the purpose of treatment, the risks related to treatment, reasonable alternatives to the proposed treatment, limits to the provision of treatment, and the right to seek a second opinion. Recommended additional topics for consent and/or discussion include but are not limited to: confidentiality and its limits, client's right to refuse or withdraw consent, nature of the business contract, health care benefits, fees, record keeping, termination, supervision, use of touch, complaint or disagreement process and contact information. Ample opportunity for the client to ask questions is provided. VII. PRIVACY AND CONFIDENTIALITY Body psychotherapists have a primary obligation and responsibility to take precautions to respect the confidentiality of those with whom they work or consult. 1. Confidential information includes all information obtained in the context of the professional relationship. They maintain the confidentiality of clients and former clients. Body psychotherapists take appropriate steps to protect their confidential information and to limit access by others to confidential information. 2. Body psychotherapists disclose confidential information without the consent of the client only as mandated by law, or where permitted by law. Such situations include, but may not be limited to: providing essential professional services to the client, obtaining appropriate professional consultation, or protecting the client or others from harm. 3. Unless unfeasible or contraindicated, the discussion of confidentiality and its limits occurs at the beginning of the professional relationship and thereafter as circumstances may warrant. When appropriate, body psychotherapists clarify at the beginning of treatment issues related to the involvement of third parties 4. Body psychotherapists may disclose confidential information with the appropriate consent of the patient or the individual or organizational client (or of another legally authorized person on behalf of the patient or client), unless prohibited by law. 5. When agreeing to provide services to several persons who have a relationship (such as partners or parents and children), body psychotherapists attempt to clarify at the outset 1) which of the individuals are clients and 2) the relationship body psychotherapy will have with each person. This clarification includes the role of the body psychotherapist and the probable uses of the services provided or the information obtained. 6. If and when it becomes apparent that the body psychotherapist may be called on to perform potentially conflicting roles (such as marital counselor to husband and wife, and then witness for one party in a divorce proceeding), body psychotherapists attempt to clarify and adjust, or withdraw from, roles appropriately. 7. In cases where there is more than one person involved in treatment by the same therapist (such as with groups, families and couples), the therapist obtains an initial agreement with those involved concerning how confidential information will be handled both within treatment and with regard to third parties. 8. Body psychotherapists maintain and retain appropriate records as necessary to render competent care and as required by law or regulation. 9. Body psychotherapists are aware of the possible adverse effects of technological changes with respect to the confidential dissemination of patient information and take reasonable care to ensure secure and confidential transmission of such information. 10. Body psychotherapists take steps to protect the confidentiality of client records in their storage, transfer, and disposal. They conform to applicable state laws governing the length of storage and procedures for disposal. 11. Body psychotherapists take appropriate steps to ensure, as far as possible, that employees, supervisees, assistants, and volunteers maintain the confidentiality of clients. They take appropriate steps to protect the client's identity or to obtain prior, written authorization for the use of any identifying clinical materials in teaching, writing and public presentations. 12. When working with groups, body psychotherapists explain to participants the importance of maintaining confidentiality and obtain agreement from group participants to respect the confidentiality and privacy of other group members but they also inform group members that privacy and confidentiality cannot be guaranteed. 13. Body psychotherapists obtain written consent from clients/students before taping or filming any session, such consent to include the intended use of the material and the limits of confidentiality. X. RESEARCH Body psychotherapists design, conduct and report research in accordance with recognized standards of scientific competence and ethics, minimizing the possibility that the results might be misleading. If an ethical issue is unclear, body psychotherapists resolve the issue through consultation with institutional review boards, peer consultations, or other proper mechanisms. They take reasonable steps to implement appropriate protections for the rights and welfare of human participants, other persons affected by the research, and animal subjects. 11. Body psychotherapists inform research participants of the anticipated sharing or further use of personally identifiable research data and of the possibility of unanticipated future uses. Summary of Codes of Ethics on Confidentiality There exists uniform agreement in the ethics codes of the mental health professions that confidentiality is a fundamental right of all those to whom we provide services. These ethics codes make it very clear that confidentiality and its limits are important issues to include in each client's, student's, supervisee's, and research subject's informed consent agreement at the outset of the professional relationship and on an ongoing basis if any changes to it arise. The ethics codes are also clear that all reasonably expected limits to confidentiality should be discussed in detail so the individual can make an informed decision about participation in light of these anticipated limitations. It is also seen that each ethics code addresses confidentiality in all settings, with all treatment modalities, and with all populations. Services provided in person, via the telephone, online, and through other media; to children and adolescents, the elderly, those with diminished capacity to consent, those referred by third-parties, those being involuntarily treated; individuals, couples, families, and groups; all need to have confidentiality and its limits explained to participants at the outset and efforts must be made not to violate their confidentiality rights. The ethics codes also make it clear that each individual's confidentiality rights must be preserved even when mental health professionals seek consultation from colleagues, when using clinical information for teaching purposes, and when sharing research and assessment results. Further, similar efforts must be made to ensure that confidentiality is protected and preserved in the storage, retention, disposal, and sharing of clinical records. It is each mental health professional's ethical obligation to anticipate risks to confidentiality, take preventative steps to ensure confidentiality is not inappropriately violated, and accept responsibility for our subordinates in the protection of confidentiality as well. We all also must comply with relevant laws and breech confidentiality as required (having already included these limits in the informed consent agreement and ensuring that the client understands this). We also must transmit, share, and communicate confidential information (with appropriate consent) in a manner that protects confidentiality and minimizes the risk of inadvertent disclosures.

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