Forensic Psychology Ethics: Confidentiality, Relationships, and Boundaries

Introduction

• These videos cover common ethical issues for psychologists in forensic settings:
  • Confidentiality
  • Relationships
  • Boundaries
• The videos form the basis for a case study discussion.

Confidentiality, Risk, and Reporting

• Client trust is essential for effective counseling.
• Counselors must clarify the limits of confidentiality from the start:
  • Obligation to report
  • Circumstances requiring reporting
• Transparency ensures a trustworthy environment.

Video: Confidentiality vs. Prison Security

• Common misconception: prisoners lose all confidentiality rights.
  • This belief comes from the perceived need to maintain strict control.
• This belief conflicts with the psychologist's code of ethics.
  • Psychologists are ethically bound to protect client confidentiality.
• Psychologists balance confidentiality with prison security needs.
  • Requires careful judgment and ethical adherence.
• Example: Not disclosing the reason when calling prisoners.
  • Use vague explanations like "medical appointment" to protect privacy while satisfying security.
• Prison staff needs to know who psychologists are meeting with for security reasons.
  • Helps manage movements, prevent disturbances, and ensure staff safety.

Limits to Confidentiality in Prison

• Similar to community settings, but more stringent due to security needs.
• Confidentiality may be breached to ensure safety if a prisoner discloses risk to themselves or others.
• Three categories of risk:
  • Risk to self: suicidal ideation, self-harm.
  • Risk to others: threats to harm prisoners, staff, or individuals outside the prison.
  • Risk to the security and good order of the prison: planning riots or escapes.

Risk to Self

• Example: prisoner disclosing suicidal feelings.
  • Immediate action is required, including assessment and potential intervention.
• Prisoners are often unwilling to disclose due to fear of being placed in a "canvas cell."
  • Canvas cell: suicide-proof cell lacking proper bedding and having no hanging points, generally a depressing environment.
• Fear can deter prisoners from reporting suicidal ideation.
  • Building a trusting relationship is crucial to encourage disclosure.
• Example: prisoner fearing harm from another prisoner.
  • Protective measures may be necessary.
  • Reasons include enemies arriving or unpaid drug debts.

Risk to Others

• Prisoner discloses plans to harm someone else.
  • Duty to protect the potential victim supersedes confidentiality.
• Examples:
  • Planning to attack another prisoner.
  • Assaulting a staff member.
  • Planning to commit a crime after release.
    • Requires careful assessment of the credibility and potential impact of the threat.

Risk to Security and Good Order of the Prison

• Specific to the prison setting.
• Ensuring the prison operates safely and securely, an overriding concern guiding decisions regarding confidentiality.
• Examples:
  • Prisoner planning to escape.
  • Awareness of a planned riot.
  • Knowledge of drug trafficking methods within the prison.

Risk Assessment and Reporting

• When risk is disclosed, a risk assessment is conducted with the prisoner.
  • Comprehensive evaluation to determine the severity and immediacy of the risk.
• Assessment involves determining:
  • Intended victim
  • Means to carry out the plan
  • Existence of a plan
  • Timeline
• Consultation with supervisor is standard practice.
• Relevant guidelines and legislation are consulted.
• In cases of imminent risk, the prisoner is not allowed to leave the counseling room.
• Standard processes for reporting risk:
  • Suicidal risk reported to psychiatric nurses in the medical team.
  • Other risks reported to the prison intelligence unit.
  • Escalation to Victorian Police may occur for serious criminal threats.

Other Issues to Consider

• Drug use: requires careful assessment of the prisoner's state and potential risks.
• Disclosing past, unprosecuted crimes: ethical considerations exist regarding reporting obligations.
• Balance between the level of risk and potential damage to the therapeutic relationship if confidentiality is breached.
• Transparency with clients is preferred when reporting risk.
  • Inform the client before and after reporting, if possible.
• Exceptions are made when there are fears for personal safety.

Prisoner Manipulation

• Consider the possibility of manipulation by prisoners; requires maintaining professional skepticism.
• Example: prisoner claims ex-partner is neglecting/abusing children.
  • Requires reporting to appropriate authorities and careful verification.
• Question whether the prisoner is attempting revenge on their ex-partner.

Information Storage and Confidentiality

• Centralized online database: CBIMS (Corrections Victoria Information Management System).
  • Streamlines information sharing and accessibility within the prison system.
• Assessments and case notes are uploaded to CBIMS.
• Accessible to any clinician within the public prison system.
• This raises confidentiality concerns and is a subject of debate among clinicians.

Multiple Relationships

• It is a counselor's responsibility to avoid overlapping duties, roles, or relationships with their clients.
• When working with several prisoners in the one site, it's inevitable and unavoidable that clients will have some kind of connection to other clients you may be working with.
• Since resources are limited, referring a client on is not often an option in these settings.
• Counsellors also have to manage their relationship with both prisoners and officers and be conscious of how visible those relationships are and the risks with appearing overly familiar to either.

Boundaries and Grooming

• Many clients in prison populations have developed a keen sense of manipulativeness to ensure their survival and safety.
• Counselors can be targets for manipulation which can take the form of testing boundaries and grooming behaviour.
• This is often done in order to secure favors or some sort of privilege (e.g., preferential treatment or a helpful diagnosis).

Video

Defining Boundaries

• Boundaries are personal limits that define what we are willing to do or disclose to clients.
• Critical for maintaining professional integrity and fair treatment.
• In a prison setting, strict boundaries are crucial.
  • Avoid disclosing any personal information.
  • Do not do favors for prisoners.

Importance of Boundaries

• Easier to loosen boundaries than to tighten them.
• Vital for personal safety, protecting you.
  • Prevent prisoners from tracking you down outside the prison.
  • Guard against manipulation.

Grooming Behavior

• Prisoner attempts to make you vulnerable and easily manipulated.
• Subtle process to gain your trust to exploit you.
• Prisoners may subtly gather personal information through casual conversation.
  • Example questions: How long did it take you to drive to work today? Do you know that kebab shop on Latrobe Street?
  • They watch your reactions and body language.
• Goal: To get you to engage in unethical behavior that benefits the prisoner.
  • Trafficking prohibited items.
  • Inappropriate relationships.

Warning Signs of Grooming

• Pay close attention to how you feel around a client.
  • If you feel "creeped out" or uncomfortable, it is a significant red flag.
• Be wary of thinking, "That was a really great session. He's such a nice guy," as it might indicate you are being manipulated.
• Notice if you are doing more for one client than others or bending rules for specific individuals.
• Changes in presentation by the prisoner:
  • Flirtatious behavior.
  • Presenting as vulnerable or childlike.
  • Displaying angry or intimidating behavior.

Personal Disclosure

• Necessary to build a therapeutic relationship but must be carefully managed.
• Anything you tell one prisoner should be considered known by all.
• Examples of acceptable disclosures should be limited to non-sensitive topics:
  • Liking cats.
  • Supporting a particular sports team, such as Carlton.
• Use these facts in team-building activities to build rapport and trust.

Working in Clinical Settings

• Clinical psychologists work with a range of mental health concerns.
• Settings include hospitals, community health centers, primary care practices, and rehabilitation facilities.
• They often work as part of multidisciplinary teams.
• In hospitals, they may support with acute mental illness, chronic health conditions, neurological disorders, or adjustment to injury.
• In community settings, they often focus on early intervention, relapse prevention, and supporting clients across the lifespan.
• Their work may involve individual or group therapy, standardized assessments, and tailored evidence-based interventions.
• Clinical practice demands strong ethical reasoning, cultural competence, and the ability to engage sensitively with diverse populations.

Common Multidisciplinary Dilemmas

• Ethics are woven into almost every decision psychologists make.
• They shape how we show up for our clients, how we protect their trust, and how we work alongside others in complex systems.
• Ethics are not just rules, they’re about people, relationships, and responsibility.
• Examples:
  • A workplace psychologist is asked by HR to provide feedback from confidential staff wellbeing sessions to help identify “problem teams.”
    • The request risks breaching employee trust.
  • In private practice, a therapist working with a couple finds out that one partner has been secretly recording sessions.
    • The psychologist is left wondering: how do I manage trust, privacy, and fairness here?
  • In a school setting, a Year 6 student shares something deeply personal: she’s scared about what’s happening at home.
    • She begs the school psychologist not to tell anyone. The psychologist knows that keeping it private might not be safe, but sharing it could break the student’s trust.
• These situations don’t come with simple answers.
• Developing an ethical mindset, one that’s thoughtful, compassionate, and grounded in professional principles, is so important.

Working with Other Practitioners and Colleagues

• Psychologists often work within multidisciplinary teams.
• Understanding each practitioner’s role, responsibilities, and constraints is vital.
• The care of patients hinges on effective collaboration.

What is effective collaboration?

• Collaboration is foundational to ethical psychological practice.
• Effective collaboration is built on and includes:
  • Communicating roles clearly to each other and clients
  • Maintaining cultural safety
  • Reflective practice
  • Supporting others through supervision or mentorship
  • Clear, respectful, and timely communication
  • Acknowledging and praising others’ contributions
  • Modelling ethical behaviour
  • Abiding by standards and codes
  • Responding to harmful behaviours
  • Comprehensive handovers to colleagues

Standard and codes

• Psychologists are expected to uphold professional standards in all forms of communication, including digital platforms, and to avoid exploiting professional relationships for personal or commercial gain.
• Psychologists remain individually accountable for their own conduct and client care, even when working in a team.
• The AHPRA Code of Conduct for Psychologists is one set of standards psychologists refer to, and emphasizes the importance of collaboration, recognizing that strong professional relationships enhance client care.
• The Code also firmly addresses the need to prevent and respond to harmful behaviors.

Harmful behaviours

• Harmful behaviors between colleagues, such as discrimination, bullying, or harassment not only harms individuals but undermines client safety and team effectiveness.
• Psychologists must uphold a culture of respect and intervene or report concerning behaviors when appropriate, especially in leadership roles.

Handover to others

• When delegating, referring, or handing over care, psychologists must ensure the receiving practitioner is appropriately qualified, and must communicate all necessary information to ensure a safe and seamless continuation of care.
• Delegation does not remove overall responsibility, reinforcing the psychologist’s duty to manage services ethically and competently.

Lecture Effective Practice & Relationships

• Effective practice requires high standards of personal conduct, respect, and empathy.
• Treat clients according to their specific needs and circumstances.
  • Practice in a culturally safe manner if the client has a different cultural background.
  • Take considerations when dealing with children, including advocacy and protection.
• Support clients to be engaged and informed about their well-being and use that information in their decisions. (APRA Code 0.42 - Informed Consent)
• Recognize the power imbalance in the psychologist-client relationship and avoid exploitation (physically, emotionally, sexually, or financially).

Ethics as Protection in Action

• Focus on four ethical principles:
  • Confidentiality
  • Multiple Relationships
  • Protection of Children
  • Protection of Others
• Ethics is not just rule-following but protection in action.

Confidentiality

• Psychologists have ethical and legal obligations to protect client privacy.
• Clients have a right to expect their information is held securely and in confidence.
• Exceptions to confidentiality:
  • Harm to themselves
  • Harm to others
  • Authorized by law
  • Necessary for emergency service provision
• Seek informed consent regarding information handling.
• Clients (and associated parties like parents of underage children) should be adequately informed about the limits of confidentiality and likely uses of information.
• Before collecting information, inform clients how it will be recorded, used, and stored.
• Before disclosing information, inform clients about the nature and purpose of the disclosure.
• Obtain consent from clients before disclosing information gained about them.

Multiple Relationships

• Psychologists should discontinue or avoid multiple relationships unless ethically, legally, or organizationally obliged to continue.
• Consider what an experienced practitioner would do and whether it's reasonable to enter into multiple relationships.
• If entering such an agreement:
  • Make contemporaneous records demonstrating the reasonable belief that it is okay.
  • Keep records of how you intend to protect the interests of clients, former clients, or third parties.
  • Ensure no violation of privacy and awareness among all parties involved.
  • Monitor and take steps to protect the interests of clients, former clients, and third parties.
• Avoid multiple relationships as much as possible to prevent complaints to APRA.

Additional Needs & Protection

• Consider clients with additional needs:
  • Children and young people
  • Elderly
  • People with disabilities
  • People with impaired decision-making ability
  • People at higher risk of family violence

Ethical Issues in Different Contexts

Working in Schools

• Psychologists work in schools in various contexts (outpatient or within the school setting).
• Ensure children are protected and feel safe to build a trusting relationship.
• Ethical dilemma: A child confides about being bullied but swears secrecy.
• Balance confidentiality with duty of care.
• Clients are often minors; consent, disclosure, and best interests are filtered through parents, teachers, and the law.
• Protecting the young may require acting even if the child feels betrayed momentarily.
• Ensure the child understands you are responsible and safe.
• Be honest, transparent, document everything, and involve guardians appropriately.
• Be clear from the start about the limits to confidentiality, especially when someone is at risk.
• Build trust through honesty, not false reassurance.
• Psychologists must be truthful in their interactions.

Working in Rural Communities

• Dual relationships are almost inevitable.
• Transparency is key; have frank discussions with clients about the limits of confidentiality in dual roles.
• Document everything.
• When ethical purity is not possible, ethical clarity is the next best thing.
• Prevent harm, maintain boundaries, and manage dual relationships with transparency.
• Dual roles aren't always unethical but are always ethically sensitive.
• Discuss boundaries with clients openly.
• Anticipate overlap, consult, document, and prioritize client welfare over convenience.

Working in Forensic Settings

• Ethical practice can feel complex due to requests to assess risk, inform parole decisions, or offer therapy to those with violent pasts.
• Balance therapeutic goals with institutional demands.
• Ethics involves client well-being, justice, fairness, and systemic transparency.
• Remain person-centered, even when the environment is not.
• Informed consent, respect for dignity, and constant reflection are crucial.
• Be aware of potential manipulation from clients.
• Confidentiality is still important; build trust but report threats and manage risk.
• Job is part healer, part sentinel.
• Clarify confidentiality boundaries early and remind clients often.
• Follow up every decision with reflection and supervision.
• Act decisively, especially in high-risk situations.
• Disclose risk, even if it strains the therapeutic relationship.
• Being a fair player is respected; integrity is valued.

The Tarasoff Case and Duty to Warn

• In 1969, Prosenjit Poddar confided intent to kill Tatiana Tarasoff to his therapist.
• The therapist warned campus police, but Tatiana was not warned and was murdered.
• The case established the duty to warn can override confidentiality.
• If someone is planning harm to someone, you must act with due diligence.
• When a client poses a serious and imminent threat to others, you are legally and ethically compelled to break confidentiality.
• Breaking confidentiality may affect the relationship but is about doing what's right.
• Become familiar with the law regarding the safety of individuals.

Moral Courage & Ethical Practice

• Ethical practice requires moral courage.
• We hold power as guardians of public good alongside other health professionals.
• Breaking confidentiality might be necessary to protect life.
• In Australia, risk is weighed through clinical judgment and legal framework.
• When silence has the potential to put someone in danger, we cannot remain silent.

Confidentiality as a Cornerstone of Trust

• Confidentiality builds trust and allows clients to speak freely.
• The majority of client disclosures do not involve harm.
• Providing confidence that clients can speak up and whatever they tell us can remain safe is important.
• Confidentiality is not absolute; when someone is at risk, especially a child or vulnerable adult, we must shift to protection.
• This shift needs to be done with empathy, honesty, and the wisdom to know when protecting someone means having the courage to break that silence.
• Revisit confidentiality limits regularly.
• Handle self-harm topics with empathy and honesty. Most people who talk about self-harm are expressing a desire for their situation to change and what we must do is to send the message that finding a permanent solution to what is in fact a temporary issue may not be the best strategy.
• Psychologists are protectors; we protect secrets until keeping them could cost someone a life.
• Ethics is people work; when in doubt, ask, what action will protect this person best?
• Act with integrity and heart.
• Confidentiality builds trust; protection builds safety; ethics is the glue that holds them both.

Working Collaboratively

• Work respectfully and within the boundaries of your ethical code, referring back to section five of the upper code.
• Consider the various professionals you may collaborate with (GPs, psychiatrists, pediatricians, teachers, social workers, case managers, advocates, cardiologists, oncologists, pain management specialists, etc.).

Working in Rural, Regional, and Remote Communities Overview

• Watch this video by the APS which provides a brief overview of what it's like working as a psychologist in a rural or remote setting.

Video: Mental Health Services in Rural and Remote Australia

Disparities in Australia: Metropolitan vs. Rural/Remote

• Significant inequities exist in Australia, creating a divide between metropolitan areas and outer regional, rural, and remote settings.
• Discrepancies in health status are substantial, with mental and general health conditions being notably worse in regional, rural, and remote Australia.
• Mortality statistics are concerning, highlighting the urgent need for improved healthcare access and resources in these areas.

The Vital Role of Community Mental Health in Rural and Remote Settings

• Community mental health plays a crucial role across Australia, but its importance is amplified in rural and remote settings due to limited access to specialized services.
• The role of mental health professionals in these areas is diverse and demanding, requiring adaptability and the ability to address a wide range of issues.
• Work schedules can vary significantly, from assessments and sessions in cities to providing care in remote Indigenous communities alongside other medical specialists.
• The exposure to a range of issues and dysfunctions is greater in rural and remote settings compared to metropolitan areas, offering unique professional development opportunities.

Challenges and Responsibilities in Remote Areas

• Mental health professionals, including psychologists, are often the only point of contact for individuals in remote areas.
• Responding to crises, such as suicide prevention situations, may involve extensive travel through difficult terrain.
• Example: Traveling 70 kilometers through rain and mud to reach someone in need is not uncommon, highlighting the dedication required.
• The distances involved can be significant, with travel times comparable to flying from Melbourne to Sydney.

Impact of Drought on Communities

• Drought conditions have a widespread impact, affecting not only people living on the land but also support services in regional and remote areas.
• The consequences extend beyond agricultural stations, impacting the entire community and its resources.

Alice Springs: A Unique Environment

• Alice Springs is an iconic Australian town that offers unique learning opportunities, particularly regarding Aboriginal cultural issues.
• Hearing Australian languages other than English spoken in Alice Springs is a privilege, reflecting the rich cultural diversity of the area.
• The area presents challenges but is also incredibly rewarding for those who work there.

Community and Advocacy

• There is a strong sense of community among psychologists working in rural and remote areas, with efforts to connect and support each other.
• It is crucial for psychologists in these areas to advocate for their communities and ensure their voices are heard, as metropolitan-centric solutions may not always be appropriate.

Taking the Plunge into Rural and Remote Work

• While some individuals may be hesitant to work in rural and remote settings, the rewards and personal growth opportunities are significant.
• Working in these areas can be a "happy place," offering a fulfilling and meaningful career.

Lived experience

• This video is an interview with a past FedUni Clinical Masters student about her experiences and the ethical dilemmas she faced.
• She talks about some of the challenges faced working in a small community.
• You may also find it useful to read the APS Ethical guidelines for psychological practice in rural and remote settings, which you can request from the Federation University library.

Video: Ethical Considerations in the Workplace

• Ethical dilemmas are common in the workplace and extend beyond simply referring to a code of ethics.
• Need to integrate organizational requirements, client issues, and placement expectations.
• Dilemmas are complex due to organizational demands, human factors, and relationship dynamics.

Multiple Relationships in Aboriginal Health

• Scenario: 18 months after placement, being asked to interview the sister of a former client.
• The interviewer had provided long-standing counseling to the sister, who had also attended sessions in a support role.
• Ethical concern: The desire to know how the former client was doing, but recognizing it would be unethical to ask the potential colleague.
• It's essential to protect the former client's privacy.
• Blurring professional boundaries by seeking information linked to the past counseling role.
• Team members and supervisors need to be informed about the issues.
• Colleagues should lead in sharing information, and one should refrain from asking directly.
• Challenge: Helping the colleague relate as a colleague, not as a counselor or a support person.

Aboriginal Health Setting Considerations:

• Small community with many connections and family relationships.
• Expectation for clinicians to be involved in the community.
• High rates of relatedness among clients and staff.
• Need to manage relationships while respecting privacy and confidentiality.
• Necessary to discuss cases involving related clients and staff in supervision meetings, sometimes omitting names or details to protect privacy.
• Communicate with clients beforehand about shared info and why.
• Be cautious about conversations and aware of relationships to avoid inappropriate disclosures.

Record-Keeping Challenges:

• Using online communication systems with different access levels.
• Example: Client's mother working in another area of the health service.
• Had to consider the level of security for each note, especially with the mother's potential access to information.
• Requires careful thought in every action.

General Challenges and Learnings:

• Cultural diversity and management of multiple relationships.
• Balancing expectations within the Aboriginal health setting and the code of ethics.
• Separate roles to manage work and placement effectively.

Managing Workload and Self-Care

• Feeling pressured due to workload is common during placements.
• Okay to acknowledge when it's too much and to "wave the white flag."
• Balance placement requirements with self-care.
• Negotiate personal and interpersonal strategies to manage workload.
• Reduce work done at home.
• Address feelings about workload with supervisors.

Assertiveness and Boundaries:

• Be assertive in saying no to extra tasks or appointments.
• Challenge: Overcoming feeling not allowed to say no, disappointing supervisors, pressure to get hours.
• Assertiveness can be seen as a sign of maturity and self-care.

Setting Up Sustainable Practices:

• Set up arrangements to manage the number of clients and build in time for notes and supervision.
• Regular, adequate supervision is essential.
• Set boundaries, such as leaving work at a specific time and not doing work at home.

Confidentiality and Record Safety:

• Maintain confidentiality and keep records safe when working from home.

Balance and Well-being:

• Balance extra work at home with family life and personal well-being.
• Avoid overworking to maintain the ability to be present with clients and manage the emotional load.

Tutorial Activity

Scenario 1

• You are the school psychologist at a high school. During a regular check-in, Jordan you've been seeing for anxiety, becomes distressed.
• He shares that he was shown a private group chat among other boys which had circulated nudes of a female classmate, without her knowledge or consent.
• Jordan's upset and unsure what to do. He begs you not to tell anyone. "If anyone finds out I told, I'm destroyed socially," he says. "This could ruin my life."
• Later, a teacher casually mentions to you that Mia has become withdrawn in class, but they're not sure why

Scenario 2

• Glynda is a psychologist working in private practice and their client Oz, is a 42-year-old referred by his GP for depression.
• Oz has been attending therapy regularly and recently started discussing childhood trauma he's never disclosed to anyone before.
• Oz signed a general release of information, allowing Glynda to communicate with his GP for continuity of care.
• One morning, Glynda receives a voicemail from Oz's GP saying Oz seemed flat at their appointment and mentioned he was doing some deep work in therapy. The GP asks for a summary of what they're doing in this deep work.