Scenario 2a: a woman contacts her therapist about a friend of her son's "martyrdom mission.".
Problem: This situation is not covered explicitly by the American Psychological Association's (APA's) Ethical Principles of Psychologists and Code of Conduct. Pertinent portions of this Code are as follows:
5.05 Disclosures. (a) Psychologists disclose confidential information without the consent of the individual only as mandated by law, or where permitted by law for a valid purpose, such as (1) to provide needed professional services to the patient or the individual or organizational client, (2) to obtain appropriate professional consultations, (3) to protect the patient or client or others from harm, or (4) to obtain payment for services, in which instance disclosure is limited to the minimum that is necessary to achieve the purpose. 8.01 Familiarity With Ethics Code. Psychologists have an obligation to be familiar with this Ethics Code, other applicable ethics codes, and their application to psychologists' work. Lack of awareness or misunderstanding of an ethical standard is not itself a defense to a charge of unethical conduct. 8.02 Confronting Ethical Issues. When a psychologist is uncertain whether a particular situation or course of action would violate this Ethics Code, the psychologist ordinarily consults with other psychologists knowledgeable about ethical issues, with state or national psychology ethics committees, or with other appropriate authorities in order to choose a proper response.
Comments (Robert Kinscherff, Director of forensic training at the Law and Psychiatry Service of the Massachusetts General Hospital; senior forensic psychologist for the Boston Juvenile Court Clinic; member of the faculty of Harvard Medical School, communication to Susan Brandon, May 5, 2002):
I do not believe that the Ethics Code explicitly mentions mandated reporting of child abuse, elder abuse, etc. Rather, the Code handles it by obligating psychologists to be aware of and to utilize whenever appropriate or mandated the exceptions to confidentiality found in the law. This is partly because most of the relevant law is state law and these laws governing confidentiality and permitted/mandated exceptions to confidentiality differ in their specific details. The law that permits or requires a psychologist to break confidentiality in order to protect third parties from potential violence is the closest body of law to the scenario. However, this law contemplates that it is the client/patient who poses the serious threat of harm to a third party; it does not contemplate violation of the confidentiality of the client/patient if the client/patient is not the source of the risk of harm. There is no specific mention of national-security related issues in the Code, and I am unaware of any APA policy document or guidelines document that refers to national security issues as they might arise in the practice of psychology. The Code as currently worded would actually permit breaking of confidentiality despite the patient's/client's wishes in the "national security risk from a third party" scenario BUT ONLY IF there were applicable state or federal law that MANDATED the breaking of confidentiality or PERMITTED the breaking of confidentiality in order to protect the client/patient or others (see, for example, 5.05(3) which permits disclosure to protect others if mandated or permitted by law).
Problem: Where might a psychologist help, such as by providing telephone numbers for tip lines, going to the police with the client, etc.? Are there rules for such actions?
(Kinscherff:) There are no written rules for these steps. However, each of these steps [referred to above] presumes that the patient/client will be taking the affirmative actions, not the psychologist. The psychologist would only be acting in a supportive role by providing information (telephone number) or support (going to the police with the client). This situation is not unlike those situations in which a client/patient may disclose being victimized by domestic violence; the psychologist might help the client/patient access further supports by locating shelter services or other related services, or might support the client/patient by going with them to file a police report regarding the domestic violence. In either case, the psychologist is not violating the confidentiality of the professional communications without the consent of the patient/client.
Strategies: Seek guidance from the American Psychological Association and state psychological associations to consider:
* Including statements regarding information related to national security in its code of ethics;
* Broadening training programs to include instruction on how to deal with such situations, and
* Teaching clinicians and clinical students how to become familiar with various law enforcement agencies and rules, and how to deal with third parties such as probation officers.
Problem: What information about the family might be useful to law enforcement agencies?
Strategies: The woman and her son appear amenable to approach by law enforcement for several reasons. First, both are naturalized citizens of the United States and have lived in this country for many years. Second, the mother being in therapy suggests a significant degree of acculturation of the family. Third, the fact that the son approached his mother with his fears about his friend indicates that the son regards his mother as a confidant and perhaps an authority figure.
Implications for practice, training and research:
This scenario highlights the fact that law enforcement may be in situations that challenge current views of confidentiality. It would be useful to look at the literature regarding precedents with organized crime.
Investigation is needed that compares the development and maintenance of informants in counter-terrorism efforts with the support of informants in other contexts, such as organized crime and narcotics.
One might ask how the appropriate response of the psychologist would be changed by a reduction in the age of the child (e.g., from 19 to 15), or by the assumption that the community in which the family lives is rural or middle America, where Christian fundamentalist groups are known to be more likely to have strong support.
There is a need for the American Psychological Association and state psychological associations to develop an ethical code for practitioners for instances where a client may have information relevant to terrorism (similar to other mandates that already exist, such as those for instances of abuse of children and the elderly and a client's intention to harm himself or another person). Such instances are peculiar because they involve third-party harm. Psychologists need to be trained for what behaviors to look for, and how to report information to law enforcement while protecting the client and their family and community. This may include some kinds of cross-cultural training. The APA may have to work with legislatures and licensing boards regarding some of these issues. Similar training and issues of confidentiality need to be considered for the training of clergy, teachers, and physicians.