Understanding Confidentiality: LCSW & MFT Exam Prep

By Bethany Vanderbilt on August 29, 2012

Ok folks, this week we’re diving into the topic of confidentiality.  I might say this every week, but there are few topics on licensure exams that matter more than this one — protecting clients’ privacy and confidentiality is a key ethical standard for both social workers and MFT’s.  Test makers and state licensing bodies want to ensure that you understand the importance of confidentiality and the cases in which there is a “compelling professional reason” to disclose information without consent. Here’s one way this topic might come up on your exam:

Sample:

A therapist specializing in art therapy has been working with a 19 year-old male for two years when the client dies suddenly in a car accident.  The client’s mother, who had previous contact with the therapist when the client was a minor, calls the therapist crying and asks if the therapist has any of her sons drawings that the mother could have.  How should the therapist respond to this request?

A. Explain that her son had not signed a release of information for this disclosure

B. Maintain the client’s confidentiality according to professional standards

C. Release artwork that the client created while the mother had contact with the therapist

D. Empathize with the mother’s request and consult with a colleague about how to provide her with the artwork

Standards of confidentiality with a living adult client are pretty clear, right?  You maintain the client’s confidentiality unless there is a “compelling professional reason” for disclosure, which include the prevention of “serious, foreseeable, and imminent harm to a client or another identifiable person, or laws or regulations that require the disclosure without the client’s consent,” (NASW Code of Ethics, 2008).  But what happens when a client dies?  Do they lose their right to confidentiality?  What about in the situation above, where the parent at one time DID have potential rights to access the information? Neither AAMFT or CAMFT specifically deal with this issue in their respective codes of ethics (as far as I could find, but please feel free to correct me if I’m wrong!).  The NASW Code of Ethics, however, addresses this issue very clearly: “Social workers should protect the confidentiality of deceased clients consistent with the preceding standards.”  It doesn’t matter if the person has been dead for 3 days or 30 years: it’s part of our ethical mandate to protect their confidentiality.  Please visit this website for a digital copy of the NASW Code of Ethics: http://www.naswdc.org/pubs/code/code.asp.

Answer: 

The correct answer to the question above is B: maintain confidentiality according to professional standards.  A is not the best answer because it provides the mother with information that should be kept confidential — we don’t know if the client had informed his mother that he was in ongoing treatment, we only know that treatment began when he was a minor.  C is not the best answer because as far as the question is concerned, the therapist doesn’t have a current release of information — it doesn’t matter if there was a release of information at one time — if it’s expired, it’s expired.  D also goes too far; while emotionally the therapist might want to try to find a way to honor the mother’s request, the first responsibility is to the client and the client’s right to privacy and confidentiality.  It might seem like a case in which an exception should be made, but that would likely be the therapist’s desire to make the mother (or him/herself) feel better in the face of this tragedy coming through.  There is no legal or “compelling professional” reason to disclose confidential information in this case.

Coming up next week: Fees

Think our straightforward, sensible approach could help you PASS your social work or MFT exam? If you’re preparing for a social work exam, check out our Social Work Study Materials. If you’re preparing for an MFT exam, check out our MFT Study Materials. Learn more about our offerings at The Therapist Development Center.

Looking for more practice questions and some study tips? Check out our new Social Work Exam Study Guide:

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