Confidentiality is the cornerstone of the therapeutic relationship, fostering trust and creating a safe space for clients to share their innermost vulnerable thoughts and feelings. However, as societal norms, technology, and legal frameworks evolve, so do the ethical challenges surrounding confidentiality in therapy. Staying informed and adaptable is essential for mental health professionals to navigate these changes effectively. Continuing education (CE) emerges as a vital tool for therapists to stay ahead, ensuring their practices align with updated ethical standards and confidentiality laws. 

Kathryn S. Krase is a mental health ethics expert with PhD, JD, MSW, and LMSW who offers her expertise to teach new practitioners and experienced mental health professionals about the ethics of confidentiality. Her significant experience as a family lawyer guarantees meaningful development and understanding of new ethical challenges. Let’s understand the importance of confidentiality in therapy, how continuing education will help therapists stay updated, and learn from professional legal advocate and presenter at Core Wellness, Kathryn Krase.  

Why Confidentiality is Necessary in Therapy?

Therapy provides a safe and supportive space for individuals to explore their thoughts, feelings, and experiences. A cornerstone of this safe space is confidentiality. Without it, clients would be far less likely to open up honestly, hindering the therapeutic process. Confidentiality ensures that clients feel secure in sharing sensitive information without fear of judgment or exposure. It is not only an ethical obligation but also a legal requirement guided by frameworks like HIPAA (Health Insurance Portability and Accountability Act) in the United States. Let’s discuss it in detail. 

Foundation of Trust and Safety

Confidentiality ensures that what happens in therapy stays in therapy. This fosters trust and safety, encouraging clients to communicate openly and create therapeutic alliances which is a key predictor of positive therapeutic outcomes.

Ethical and Legal Obligations

Confidentiality is not just a professional courtesy; it's a fundamental ethical and legal obligation for therapists. Professional organizations like the American Psychological Association (APA), the American Counseling Association (ACA), and the National Association of Social Workers (NASW) have strict ethical codes that mandate confidentiality. These codes outline the therapist's responsibility to protect client information.

In the United States, the Health Insurance Portability and Accountability Act (HIPAA) provides federal protection for the privacy of individuals' health information, including mental health records. Similar legislation exists in other countries. These laws establish standards for the use and disclosure of protected health information (PHI).

Limitations of Confidentiality

While confidentiality has a significant spot in therapy, there are some specific situations where therapists are legally or ethically obligated to break it.

• Harm to Self or Others – If a client poses a serious threat to themselves or others, the therapist has a duty to warn and take steps to prevent harm. This might involve contacting law enforcement, emergency services, or even the intended victim.   
• Child Abuse or Neglect – Therapists are mandated reporters, meaning they are legally required to report any suspected child abuse or neglect to the appropriate authorities.   
• Court Orders – A court of law can issue a subpoena requiring a therapist to disclose client information for several reasons, including if the client turns out to be a suspect in a criminal case.

Ethical Challenges of Confidentiality in the Modern World

Advancements in technology, cultural shifts, and evolving legal landscapes present unique challenges to maintaining confidentiality. Let’s have a look at how these challenges arise in therapy.

• Technology – Teletherapy platforms, email communication, and cloud-based recordkeeping bring unique risks to maintaining privacy. Therapists must use secure, HIPAA-compliant platforms for communication, taking digital information, and online therapy sessions and ensure clients understand the potential risks.
• Cultural Shifts – Different cultures have varying expectations regarding privacy and disclosure of personal information. Therapists must be culturally sensitive and adapt their practices to respect clients' cultural backgrounds.
• Legal Changes – Laws surrounding confidentiality, duty to warn, and cross-jurisdictional practice are constantly evolving. Therapists must stay up-to-date on these changes to ensure they are practicing ethically and legally. 

How Continuing Education Helps Therapists Maintain Confidentiality 

The landscape of therapy is constantly evolving, presenting new challenges to maintaining confidentiality. This is where continuing education (CE) becomes absolutely vital for therapists. CE empowers therapists to remain current with technological advancements, legal complexities, cultural shifts, and emerging ethical dilemmas, ensuring they can effectively protect client information and uphold the highest standards of professional boundaries.  Here's how continuing education helps therapists navigate these challenges:

• Adapting to Technological Advances – Learning to use technology securely and ethically in therapy, including telehealth platforms and electronic records.
• Navigating Legal Complexities – Understanding and adhering to the various laws and regulations that govern confidentiality in therapy.
• Addressing Cultural Sensitivity – Recognizing and respecting diverse cultural perspectives on privacy and tailoring therapeutic practices accordingly.
• Handling Emerging Ethical Dilemmas – Developing strategies to address novel and ambiguous ethical challenges related to confidentiality in therapy.

Continuing Education with Experienced Legal Advocates

Kathryn S. Krase is a prolific speaker and expert on professional ethics in therapy with an extensive educational background in PhD, JD, MSW, and LMSW. She shares her extensive experience and valuable insights from working as a social worker, researcher, and educator. She has significant experience as a family law practitioner and social work supervisor, along with more than 20 years of experience in faculty and administrative roles in undergraduate, Masters, and doctoral-level social work programs in and around New York City. 

Currently, she is the Principal Consultant for Krase Consulting in Brooklyn, New York, where she focuses on educating mental and physical health professionals on their general legal and ethical obligations.  Her extensive experience has led her to develop many engaging live and on-demand courses that are helpful for therapists to learn new advancements and tackle modern-day confidentiality dilemmas. Some of her most prominent courses are described below:

• Children or Family First

In this course, Kathryn investigates the past development and ethical implications of navigating the conflict of child protection vs. parental rights in order to provide professional reporters of suspected child maltreatment with the skills they need to report when necessary while also respecting family autonomy.

• Exploring the Rights of Students, Parents, Teachers

In this workshop, Kathryn explores the rights of students, their parents, and teachers/school administrators through an examination of international, federal, state, and local law. She offers different tools for proactive and responsive advocacy. 

• Preparing Mental Health Professionals for Legal System Involvement

The legal system often puts mental health professionals in legal involvements. Kathryn, with her dual role as a mental health professional and lawyer, appropriately prepares mental health professionals for legal system involvements with the necessary information and skills to confidently face the legal system. 

Final Thoughts!

The ethics of confidentiality in therapy are continually evolving, shaped by advancements in technology, shifting societal norms, and legal updates. For therapists, staying informed is not just an ethical duty—it’s a professional necessity. Continuing education provides the knowledge and tools to navigate these changes, ensuring therapists uphold client trust and maintain the integrity of their practice.

By investing in ongoing learning, mental health professionals can confidently address the challenges of a changing landscape, fostering a safer and more effective therapeutic environment for all. If you want to stay updated about changes in confidentiality ethics, Core Wellness's on-demand and upcoming live sessions offer an excellent opportunity to continue learning and stay updated on new ethical standards and confidentiality laws.