This survey of mental health professionals in North Dakota examined their knowledge of and attitudes toward three important ethical-legal issues: confidentiality, privilege, and disclosure of information to third parties. The results of the survey demonstrated agreement on the importance of confidentiality in the therapeutic relationship. With regard to privilege, a wider range of variance among respondents suggested that the ramifications of privilege statutes (as well as those professions included or not included) are blurred among mental health professions. The results also suggested the need for clients to be informed about the conditions under which exceptions to the general principle of confidentiality will occur.In recent years, increased attention to and discussion of ethical issues surrounding the psychotherapist-client relationship has generated a growing concern for the status of client rights and protections. S/asz (1960, 1970) has argued that the concept of mental illness is a myth and is a means by which societal forces can deprive an individual of rights without legal protections. Halleck (1971) has posed significant cjuestions regarding the "double agent" role of the therapist, that is, when the therapist responds to societal pressures for information about a client or accepts a client for therapy at the request of a third party. The question of informed consent to psychotherapy was raised by Noll (1974). Early studies of responses of mental health professionals revealed little agreement on proper courses of action when confronted with these and other ethical problems (e.g., Little & Strecker, 1956), and the issues raised are subject to continuing discussion (Redlich & Mollica, 1976).Concomitant with the discussion of ethical issues has been the increasing involvement of legal scholars in the mental health process. Kittrie (1971) has analyzed the psycholegal ramifications of enforced therapy and suggested the need for legal limitations beyond which therapists in institutions should not go. Attorneys have become active in litigation surrounding such issues as right to treatment, the right not to be treated, involuntary commitment, quality of care, and a host of others (Miller, Dawson, Dix, & Parnas, 1976). Thus, it is becoming increasingly important for mental health professionals to deal with these ethical and legal issues.These influences have caused a reexamination of professional beliefs and practices on the part of mental health service providers. The increasing influence of consumer protection and litigation has challenged traditional approaches. Nowhere, perhaps, have these influences been felt more acutely than in the areas of confidentiality, privilege, and the growing psycholegal issues surrounding the duty of the therapist to warn third parties of pending danger and to report knowledge of certain classes of behavior (e.g., child abuse) to the authorities (Bersoff, 1976;Noll, 1976).
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