ROCKY MOUNTAIN REGION DISASTER MENTAL HEALTH NEWSLETTER

Learning From The Past and Planning For The Future


MENTAL HEALTH MOMENT
May 24, 2002

"The price of greatness is responsibility."
- Winston Churchill

Please remember our Veterans this Memorial Day Week-end.

				
				
				
				
				

				

				

				

					

						

						

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Mental Health Moment Online
						
						

CONFERENCES AND WORKSHOPS:

Challenge the System: 
Open the Door to Victims with Disabilities

June 23 - 24, 2002
 
Parkway Plaza
 
Casper, Wyoming
 
Registration deadline:
 June 14, 2002
 
Registration fee: $125 
Limited Registration Scholarships Request
 
by phone only:
 
307-766-2761 

Accommodations: 

Parkway Plaza 

Casper, WY

$50 + tax, available until June 9, 2002

Phone: 800-270-7829 

Contact:

WIND Receptionist:
 
Phone: 307-766-2761
 
Fax: 307-766-2763 
EMAIL:

wind-challenge@uwyo.edu
  
Mail:
 
WIND-Challenge the System
 
PO Box 4298 

Laramie, WY 82071-4298 


Suicide Prevention Strategies and Helping Those Left Behind Cope          

Wednesday May 29, 2002

8:30 AM to 4:00 PM

Cheyenne, WY

Contact: William Quinn, Southeast Wyoming Mental Health Center

(307) 634-9653

NIMH Meeting Announcements						
						

International Biennial Conference on Self-Concept Research: Driving International Agendas

August 6 - 8, 2002
 
Location:
 
Sydney, AUSTRALIA

Contact: Kate Johnston 
SELF Research Centre
 
University of Western Sydney
 
Australia
Email: k.johnston@uws.edu.au
						

Latino Psychology 2002 Conference 

October 18-20, 2002

Location:

Providence, Rhode Island USA

Contact: Maria Garrido, Chair
 
"Latino Psychology 2002"
 
Adjunct Professor of Psychology
 
University of Rhode Island

Email: mgarrido@etal.uri.edu
						

CAPE COD INSTITUTE:

June 24-August 30, 2002.

25 Timely/Lively Weeklong CE Courses by Master Teachers Behavior On-line, Inc. with Professional Learning Network, LLC

Toll-Free: (888) 394-9293

Email: prolearning@behavior.net. 
						

						
						
						

						
						
						

						
						

				

AG SECRETARY CALLS FOR BIOTERROR READINESS

Bioterrorism is a frightening new word for many Americans. But
experts at a recent Penn State seminar said farmers can use existing
techniques to lessen risks. Pennsylvania Secretary of Agriculture
Samuel E. Hayes Jr. said the state's farmers and food processors are
generally well prepared for a terrorist attack, but both the state
and the nation need more laboratories to combat bioterrorism that
targets agriculture. For the complete story by Gary Abdullah, visit
http://aginfo.psu.edu/News/may02/bioterror.html

INTERVENTION CAN IMPROVE INFANT SLEEP PROBLEMS

Behavioral interventions can significantly reduce sleep problems in
infants, as well as maternal reports of postpartum depression symptoms,
according to a report in May 4th issue of the British Medical Journal.
http://www.medscape.com/viewarticle/433029?srcmp=psy-051002

U.S. SENATE SET TO CONSIDER MENTAL HEALTH 'PARITY' BILL

The U.S. Senate could take up a bill to require "parity" in insurance
benefits for mental illness before Memorial Day.
http://www.medscape.com/viewarticle/432923?srcmp=psy-051002
				

TEAMS USE METADATA TO ORGANIZE DIGITAL RESOURCES

Despite the dramatic evolution in the quantity and quality of digital
technology for educational purposes, many experts believe there has
been little progress made towards a system of classification allowing
educators to efficiently identify, locate and reuse digital
materials. To meet these needs, Penn State researchers are
participating in two projects. One of these, the CIC (Center for
Institutional Cooperation) Educational Resource Repository (CICERO)
project, has created a repository of digital educational materials
stored as metadata, which is essentially "data that describes data."
The second project, The Penn State Visual Image User Study (VIUS),
which is funded by the Mellon Foundation, shares CICERO's goal of
helping scholars more efficiently identify, store and locate learning
resources. VIUS (pronounced "views") focuses specifically on the use,
storage and retrieval of digital images. For the full story by Jenny
Thrasher, visit http://cac.psu.edu/news/metadata.html

MEDICINE PROFESSOR HONORED WITH NATIONAL WOMEN OF COLOR AWARD

Virginia Imadojemu, M.D., assistant professor at Penn State College
of Medicine was recognized recently with a Technology All Star Award
at the 2002 Women of Color Health, Science and Technology Awards
Conference in Nashville, Tenn. This year marks WOC's first-ever
national awards event dedicated to recognizing women of color in
health, science and technology. "Technology All Stars are Women of
Color who have significantly influenced the health community as a
practitioner, administrator, scientist or technologist and whose
contributions continue to advance technical career opportunities for
other women of color." Imadojemu has been funded by the National
Institutes of Health (NIH) to study the neuro-circulatory
consequences of obstructive sleep apnea. She also serves as a mentor
to several medical students each year at Penn State College of
Medicine. Imadojemu is also a pulmonary and critical care physician
at Penn State Milton S. Hershey Medical Center. The full release is
at: http://www.hmc.psu.edu/news/pr/2002/apr/Imadojemu.htm

Lifetimes of Keepsakes Lost in Appalachia Floods
 
More than 1,500 families in Virginia and West Virginia lost loved ones, homes and businesses in the flooding on May 2. 
						

American Red Cross Measles Initiative to Vaccinate 14 Million Children in Kenya During One Week Campaign

Jane Seymour and six Los Angeles schoolchildren will participate in largest measles campaign yet. 

Japanese Invent Dog Language Translator

Forget Dr. Doolittle. Japanese toy maker Takara has invented a device capable of translating a dog's bark into human expressions. The device, called "Bowlingual", is attached to the dog's collar. An internal microphone analyses the dog's bark and allows it to say phrases such as "I've had enough" and "I'm bored, let's play." The Bowlingual also detects feelings and displays them on a screen attached to the unit. It's even possible to set the device to remember all of the emotions your dog has had during the day. 
Although a prototype has been successfully demonstrated at technology fairs in Japan, commercial availability is as yet unconfirmed. The first models are expected to retail for approximately $1000 US. 
						

						
						
					
				
				
				
				
				
					
				


CONFIDENTIALITY IN COUNSELING AND THERAPY

Ethical considerations continue to present complex and often contradictory mandates for mental 
health professionals. Issues such as informed consent, civil commitment, sexual relations 
between client and therapist, and the confidentiality of information discussed in the context
of therapy continue to be subjects of much professional debate. Issues related to the 
confidentiality of information obtained in the context of therapy permeate our professional
lives. These issues arise every time a client enters treatment; whenever homicide, suicide,
or child abuse is involved; and every time a call is received from a family member or
insurance company requesting information. 

It is not a surprise to learn that confidentiality was a consideration even in the very 
earliest days of psychotherapeutic intervention. For example, Freud struggled with this 
issue when he documented his case histories:

If the distortions [of relevant material] are slight, they fail in their object
of protecting the patient from indiscreet curiosity, while if they go beyond
this they require too great a sacrifice.... It is far easier to divulge the
patient's most intimate secrets than the most innocent and trivial facts about
him, for, whereas the former would not throw any light on his identity, the
latter by which he is generally recognized would make it obvious to everyone.
(Freud, 1963).

Confidentiality consists of the ethical obligation that protects clients from unauthorized
disclosures of information that are given in the confidence that they will not be divulged
to others. Privileged communication, on the other hand, involves legal considerations
and enables a client to bar a court from compelling the therapist to disclose information
about him/her.

Philosophical Issues

Historically, the professional's duty to keep information confidential has never been an
absolute principle. When Hippocrates urged medical secrecy, he and his followers were in
a minority. However, according to the Hippocratic oath, the physician pledges, "Whatsoever
I see or hear in the course of my profession in my intercourse with men, if it be what 
should not be published abroad, I will never divulge, holding such things to be holy secret."
As with most ethical codes, however, the oath helps little in deciding when and to whom 
professionals should reveal information because the proscription gives no specific criteria
for determining "what should" be spoken. Quite to the contrary, during the Roman Empire
and Middle Ages, physicians freely disclosed information about patients. However, during
the 16th century, the role of the physician more closely approximated that of the priest 
as the concept of confessional secrecy spread throughout the Catholic countries (Slovenko,
1973). Since that period, the necessity for "secrecy" of information in a therapeutic
setting has been the predominant attitude of the medical/psychotherapeutic community.

Ethical theories provide a set of principles to be used for the assessment of what is
morally "right" or "wrong" with reference to human action. Psychotherapists (through their
own internalized set of moral beliefs) as well as professional organizations (through
their ethical guidelines) use ethical theories to justify the adoption of particular 
positions. 

If one maintains that confidentiality should not be broken under any circumstance,
justification may come through a stance which states that the confidentiality of the
communications in the psychotherapeutic setting is sacrosanct and the interpersonal
relationship that psychotherapy fosters must not be broken. Freedman (1978) defended
the principle of psychotherapeutic confidentiality by viewing it as a corollary to the
pre-eminent moral position of primum non nocere. He claimed that:

Society ought to, and does grant freedom to those with fanatical adherence
to an ideal. We recognize that not all of us have the same moral tasks, 
that some values are especially dear to some of us. When the value is
attached to a profession of great worth to society, the recognition is
yet more clear. By our desire that physicians [and psychotherapists] be
zealots for health, we must allow its corollaries.

His assumption is that psychotherapy is an endeavor of "great worth" to society and that
society must allow psychotherapists, as "zealots", the privilege of totally confidential
communications. There are some who support the same position through a utilitarian view
which maintains that the therapeutic relationship must be preserved even in specific
situations which may indicate breaking the confidential relationship (e.g. suicide). The
potentially negative consequences of breaking confidentiality (e.g. individuals in society
come to fear psychotherapeutic disclosures to commitment officers or police) are such that
under no circumstances must confidentiality be broken. Arguments about the necessity of
confidentiality in psychotherapy are often made from a position which is ultimately
utilitarian in nature (i.e., that confidentiality in psychotherapy promotes other "desirable
goals" such as participation in psychotherapy).

Nevertheless, many clinicians justify breaking confidential communications under certain
circumstances. For example, one position maintains that certain actions (e.g., suicide)
are morally wrong, that individuals attempting such behaviors are not capable of rational
decision making, and that as responsible free-willed agents, practitioners must take steps
to prevent harmful actions regardless of possible negative ramifications to the therapeutic
relationship. On the other hand, a utilitarian might postulate that for the preservation of
an "ordered society", certain behaviors (e.g., potential homicide) fall outside the realm
of acceptability. Therefore, professionals must take steps, for the good of all, to reduce
the likelihood of negative occurrences.

Sharing With Clients

Once the clinician has determined his/her own moral stance about potential limitations to
confidentiality, a decision needs to be made about whether or not to share this decision 
with the client and/or under what circumstances. The question faced by many clinicians is
whether to tell the client, in advance, about the limitations to absolute confidentiality.
For example, Siegel (1976) states that "those who work with me in a clinical situation 
know my position in advance, and know that I will never betray a confidence." There are
also those who support therapeutic confidentiality and maintain that clients should be 
directly informed of the legal and ethical limitations, but believe that there are specific
limitations to the mandate of absolute confidentiality. For example, Everstine et al (1980) 
state:

When in doubt, provide your client with information; this is the "informed" 
aspect of informed consent and implies that almost any kind of information 
concerning the nature of therapy and the therapeutic experience, provided 
to the client in advance, can be beneficial.

Educating clients about the limitations of confidentiality prior to the initiation of therapy
is seen as critical. As Everstine et al (1980) state, the duty to warn "implies an obligation
to warn a client that such a duty exists; it is only fair to let your client know, in advance,
that certain statements are inadmissable to therapy. This means that once uttered, such a
statement will cause at least temporary interruption in the therapeutic process." Nevertheless,
it is implied that the therapeutic relationship can continue despite the limitations delineated
and may indeed benefit from addressing the issues. 

Langs (1982) believes that in some instances exceptions to confidentiality should not be openly
discussed or focused on. For example, in a clinic setting where exceptions to confidentiality
are "apparent" to the client, "the therapist should accept these realizations implicitly,
without direct confirmation to the client, because direct revelation of the existence of these
alterations in the frame tend to be highly disruptive to the patient and the therapeutic
experience" (p. 476). When supervision of a case is necessitated, "it is best...not
to directly reveal this deviation to the patient" (p. 478).

Clearly clinicians and philosophers use a variety of ethical theories to support their particular 
positions regarding confidentiality. Given the disarray in philosophical discussions about
confidentiality, it appears that individuals can justify (or even rationalize) many apparently
discrepant moral positions. While ethical guidelines often note exceptions to the general
principle supporting confidential communications (e.g., imminent dangerousness), individual
practitioners disagree about the moral correctness of any disclosures. 

Summary

The judgment of whether to maintain confidentiality can be both complex and confusing.
Keith-Spiegel (1977) echoed the futility of attempting to set specific standards of professional
behavior when she stated:

The APA ethics committee cannot, unfortunately, offer any rules of thumb to 
assist psychologists with this difficult decision because each case has its
own unique features. What we can say, however, based on our experience, is
that deliberate disclosure should be made only after the utmost consideration,
and psychologists must be able to defend such action. (p. 292)

Though we recognize that our ethical codes specify exceptions to confidentiality, radical
differences exist about the pragmatics of whether we should openly discuss the issue with
clients. If the issue of confidentiality is not discussed, clients may act on incorrect
assumptions about the therapist's position on this matter. Presently, if the issue is
discussed, the effects remain relatively umknown. It may be that only after we determine
the specific effects of limiting confidentiality can potential societal gain be weighed
against the cost to the therapeutic effort.

Due to litigation in the courts, increased attention has been given to the issues of
confidentiality and privileged communications by the legal profession. Unfortunately, the
ramifications of court decisions or statutory law and the ethical responsibilities of
therapists may be at odds. One resaon for this potential conflict is that ethical and
legal statements have differing conceptual bases and pragmatic implications (Schwitzgebel
& Schwitzgebel, 1980). 

Most ethical codes consist of statements that are "guidelines" for minimal standards of
conduct within a profession. Ethical proposals frequently speak of "rights", "duties", 
"intentions", "responsibilities", etc., all of which are based on a subjective, moral
sense of current attitudes or behavior. Therefore, they rarely provide specific guidance
to either practitioners pr clients. However, Associate U.S. Supreme Court Justice Oliver
Wendell Holmes advised that if an individual wishes to understand the law, he/she must
examine it as does an immoral man who cares only for material consequences and not about
the "vaguer sanctions of conscience" (Holmes, 1921). If psychotherapists are to maintain
the therapeutic "privilege", it will be because of "amoral", rather than "immoral", 
research that documents the negative effects of limited confidentiality.

Widiger and Rorer (1984) provide an excellent illumination of the fact that "the torment
[of ethical decisions] is greater than has been acknowledged, because it is not possible 
to have a single set of ethical principles that is consistent with currently extant therapeutic 
[or philosophic] orientations" (p. 513). They further suggest that:

[If] some relativism is unavoidable, then a possible solution would be to
require each therapist to formulate and to leave on file with a designated
ethics committee a set of principles that would be made available to each
prospective client. Each therapist's action would be judged according to
his or her set of ethical principles. (p. 513)

Pending greater clarification (both empirical and philosophical) of these issues, one
possible solution is for each mental health professional to submit a set of ethical
principles to a designated committee and let the committee decide whether or not
one's positions are acceptable for membership in a given organization. Individual
organizations would then have to determine whether therapists must disclose ethical
positions with clients.

These types of ethical issues are affectively laden and theoretically complex. They have
vaguely formulated questions and, as yet, demonstrate little in the form of conventional,
"scientific" answers. Therefore, it should not be surprising that precious little 
systematic attention has been given to the issue of confidentiality. While acknowledging
inherent difficulties, mental health professionals must continue efforts to increase the
clarity and breadth of knowledge in this area. The topic has affected and will continue
to affect how clinicians conduct their day to day functions, as well as what messages
they send to society about their professional obligations about the ethical aspects of
psychotherapy.
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REFERENCES

Everstine, L., Everstine, D., Heyman, G., True, R., Frey, D., Johnson, H., & Seiden, R. 
(1980). Privacy and confidentiality in psychotherapy. American Psychologist, 35, 828-840.

Freedman, B. (1978). A meta-analysis for professional morality. Ethics, 89, 1-19.

Freud, S. (1963). Three case histories. New York: Collier.

Holmes, O.W. (1921). Collected legal papers. New York: Harcourt Brace Jovanovich.

Keith-Spiegel, P. (1977). Violations of ethical principles due to ignorance or poor 
professional judgment versus willful disregard. Professional Psychology, 8, 288-296.

Langs, R. (1982). Psychotherapy: A basic text. New York: Jason Aronson.

Schwitzgebel, R.L. & Schwitzgebel, R.K. (1980). Law and psychological practice. 
New York: Wiley.

Siegel, M. (1976). Confidentiality. The Clinical Psychologist. 30 (1), 23.

Slovenko, R. (1973). Psychiatry and the law. Boston: Little, Brown.

Widiger, T.A. & Rorer, L.G. (1984). The responsible psychotherapist. The American Psychologist, 
39, 503-515.
To search for books on disasters and disaster mental
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topics and purchase them online, go to the following url:

https://www.angelfire.com/biz/odochartaigh/searchbooks.html
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               Contact your local Mental Health Center or   
               check the yellow pages for counselors, psychologists,   
               therapists, and other Mental health Professionals in   
               your area for further information.
**********************************************************************
                        George W. Doherty
                        O'Dochartaigh Associates
                        Box 786
                        Laramie, WY 82073-0786

MENTAL HEALTH MOMENT Online: https://www.angelfire.com/biz3/news