Factors contributing to breaking confidentiality with adolescent clients: A survey of pediatric psychologists.

Abstract

A common ethical dilemma experienced by professional psychologists involves deciding whether to break confidentiality with risk-taking adolescent clients. However, our understanding of the factors that contribute to this decision-making process is limited. The present study surveyed 200 pediatric psychologists (resulting in 74 usable surveys) and identified several items that are perceived to be important to clinicians when they consider the decision to break confidentiality in order to report potentially dangerous behaviors to the parents of adolescent clients. The present study also used exploratory factor analysis to identify 2 underlying factors—Negative Nature of the Behavior and Maintaining the Therapeutic Process—as crucial to the decision-making process. How do psychologists decide whether to break confidentiality in order to inform the parents of risk-taking adolescent clients about the potential harm that may result from the adolescent’s behavior? In order to encourage open communication and trust during treatment, psychologists often assure adolescent clients that confidentiality will be maintained, although there is no legal basis for doing so (Rae, 2001). Parents have the legal privilege to all information about their adolescent, yet in practice this privilege is usually voluntarily waived in order to facilitate the therapy process. Rather than being based on law, this decision is based on the psychologist’s desire to build and maintain an honest therapeutic relationship with the adolescent, in which the client feels safe in revealing sensitive information (Gustafson & McNamara, 1987). However, it is clear that psychologists have an ethical and legal responsibility to break confidentiality when a client’s behavior is deemed dan