Factors Related to Family Therapists' Breaking Confidence When Clients Disclose High‐risks‐to‐hiv/Aids Sexual Behaviors

Abstract

This national survey of 309 marriage and family therapists examined what therapists do when their HIV-positive clients disclose that they are engaging in high-risk sexual behavior. The participants were given vignettes in which a fictitious client told the therapist about engaging in unprotected sex. Although the basic situations were the same, the client variables of age, gender, race, sexual orientation, and HIV status were systematically varied. The participants were more likely to break confidence regarding unsafe sex practices when their clients were male, young, gay, or African American. Moreover, therapists who were more likely to disclose were older, female, had less experience with gay/lesbian populations, were Catholic, were very religious, and were more likely to practice in urban areas. The authors discuss the implications of these and other findings.

Family Therapists' Ethical Decision‐making Processes in Two Duty‐to‐warn Situations

“…Legal consid-erationsAaws of the State was ranked significantly more important in the child abuse scenario than in the HIV scenario and, alternately, that persondtherapeutic response was ranked significantly more important in the HIV scenario than in the child abuse scenario. The differences in mean rank of legal considerationsflaws of the State and personaUtherapeutic response may point to family therapists relying on personal feelings concerning the HIV dilemma (Pais & Piercy, 1998;Smith et al, 1991;) and, alternately, reliance on the law in the child abuse scenario (Haas et al, 1988).…”

“…Violating client confidences when "mandated by law" appears to be straightforward except for the potential ambiguity of the interpretations concerning what exactly is the type of injury or the magnitude of injury that is reportable to authorities. Definitions of clear and immediate danger are not explicit (Totten, Lamb, & Reeder, 1990) and may be construed differently by different therapists (Millstein, 2000;Pais & Piercy, 1998). For instance, what is the extent of harm to a child that should be reported?…”

A Systematic Review of Gay, Lesbian, and Bisexual Research Samples in Couple and Family Therapy Journals

“…Ten (6.5%) articles used a random sample in which every member of a given population had an equal chance of being selected. Six of these used a random sample of therapists from professional mental health organizations, such as the American Association for Marriage and Family Therapy (AAMFT; Pais, Piercy, & Miller, 1998) or the American Psychological Association (APA; Kilgore, Sideman, Amin, Baca, & Bohanske, 2005;Kozlowski, Rupert, & Crawford, 1998;Liszcz & Yarhouse, 2005;Sherry, Whilde, & Patton, 2005). Two utilized secondary data from a large representative random sample such as the MacArthur Foundation National Survey of Midlife Development in the United States (Cochran, Sullivan, & Mays, 2003) the San Francisco Men's Health Study (Hays, Turner, & Coates, 1992).…”

With Due Consideration: Australian Human Service Practitioners’ Understandings of Confidentiality and Disclosure Obligations in Regard to Cases Concerning Gambling-Related Theft

“…Accumulating studies and clinical commentaries have now linked a range of factors to decisions regarding disclosure. These factors include judgments about the kind and level of risk involved (Kampf et al, 2008;Lindenthal & Thomas, 1980;Totten, Lamb & Reeder, 1990); the imminence of danger to third parties (McGuire, Nieri, Abbott, Sheridan & Fisher, 1995); victims' potential to be identified (Totten et al); client characteristics (Kampf et al;Jensen & Nicholas, 1984;Pais et al); and attributes of the therapist (e.g., theoretical orientation and personal value preferences) (Neukrug & Lovell, 1996;Mattison, 2000;McMahon & Knowles, 1995;Pais, Piercy & Miller, 1988). Findings also indicate that disclosure is less likely when practitioners have sketchy information and foresee that clients will be lost or harmed (Rodríguez, Wallace, Woolf & Mangione, 2006).…”