Growing 3, November 1994
Can We Talk?

Featured Writer: James H. Shackelford, Ph.D., Licensed Clinical Psychologist

“For everything there is a season, and a time for every matter under heaven... a time to keep silence, and a time to speak.”
Ecclesiastes 3:1,7

Whenever I hear Joan Rivers ask “Can we talk?” I respond with both amusement and discomfort. It reminds me of what it must feel like to come to counseling for the first time and be asked to talk. Many of us have enough built-in skepticism to wonder if those inviting us to talk are not—like Joan—someone just looking for gossip.

It is only fair to expect that whatever we share in counseling will be treated with professional confidence and that our privacy will be respected and protected. The reality, however, is not as simple. When someone comes to counseling they can expect confidentiality that is qualified by law and ethical standards of practice. There is no absolute right to silence as was once promised in the sacrament of the confessional.

In counseling, society’s rights may override those of the individual. Clearly the exceptions made by law and ethical codes of professional practice are not trivial ones... but they are exceptions. There are three primary exceptions to the right to silence—all related to safety:

1. Safety of children and the elderly—When children or the elderly are in danger of abuse or neglect, counselors are mandated to report to the state their belief that abuse and/or neglect are occurring. This activates an investigation and may lead to legal actions and interventions.
   
   
2. Safety of the client—When persons threaten to harm themselves—such as in threats of suicide—counselors are obligated to prevent harm, even to having the client involuntarily hospitalized.
   
   
3. Safety of others—When a person threatens to harm others, counselors have both the duty to warn the intended victim and to take action to protect that person by contacting police and involved agencies or initiating involuntary hospitalization.

While these exceptions may sound extreme, knowing that there are limits is essential for a trusting and helpful relationship to develop. Most of us don’t like surprises.

If an adolescent tells their counselor they have been using drugs and engaging in high-risk behaviors such as unprotected sex, counselors are faced with a complicated decision. If a separated spouse tells their counselor they have been stalking their “ex,” have purchased a gun and have plans to do harm, the counselor is again faced with a complex clinical and ethical decision. If they have talked up front with the client about the limits of confidentiality, their choices are easier and less traumatic to make.

Maintaining a trusting relationship while facing reality directly is often a balancing act. At The Center, when clients are invited to talk, they are informed under what circumstances the information they share can be disclosed, and it is made part of their counseling agreement. Promises of absolute confidentiality cannot be legally or ethically made.

In light of these limits, the question, “Can we talk?” takes on new meaning. Clients must weigh the value of entering a counseling relationship in which they can openly talk about what is going on in their lives over the value of keeping secret important areas of their lives that are affecting them. They need to recognize the dual obligation of their counselor to keep confidences safe while keeping them and others safe as well. Only then can they consent, in an informed way, to talk.

James H. Shackelford, Ph.D.

Why there are Exceptions to Confidentiality...
In the United States, it is estimated that:

	there are 1,900,000 cases of child abuse and neglect annually—2,000 to 4,000 of which result in a child’s death.
	150,000 to 200,000 new cases of child sexual abuse occur annually.
	there is one suicide every 20 minutes—more than 25,000 each year.
	over 40% of the women murdered each year are killed by their husbands or lovers.
	every 15 minutes a woman is battered by her male partner.
	one in three women will be sexually assaulted before they are eighteen.

References
Haas, Leonard J. and Malouf, John L. (1993) Keeping Up the Good Work: A Practitioner’s Guide to Mental Health Ethics. Professional Resource Exchange. Sarasota, FL.

VandeCreek, Leon and Knapp, Samuel (1993) Tarasoff and Beyond: Legal and Clinical Considerations in the Treatment of Life-Endangering Patients. Professional Resource Exchange. Sarasota, FL.

Huber, Charles H. (1994) Ethical, Legal and Professional Issues in the Practice of Marriage and Family Therapy. 2nd Edition. Merrill. New York, NY.

Bush, John C. and Tiemann, William Harold (1989) The Right to Silence: Privileged Clergy Communication and the Law. 3rd Edition. Abingdon Press. Nashville, TN.

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