10.1177/1066480705282060THE FAMILY JOURNAL: COUNSELING AND THERAPY FOR COUPLES AND FAMILIES / January 2006Bass, Quimby / SECRETS IN COUPLES COUNSELING
❖ Ethics
Addressing Secrets in Couples Counseling: An Alternative Approach to Informed Consent
Barry A. Bass Julie L. Quimby Towson University
This article presents an alternative approach to informed consent that addresses unique concerns regarding confidentiality in marital and relationship counseling. Professional ethics codes rarely pro- vide therapists with specific guidance on how to respond to clients who wish to keep secrets from their spouse or partner. Moreover, scholars writing about confidentiality frequently offer contradictory advice on how to ethically treat those couples presenting with se- crets. This article suggests that regardless of one’s viewpoint on the issue of secret keeping in counseling, therapists best serve couples by advising them at the onset of treatment of the counselor’s policies regarding confidential communication. In addition to discussing is- sues regarding privacy and confidentiality in couples counseling, this article presents one example of an informed consent document designed to address this important concern.
Keywords: confidentiality; privacy; ethics; family secrets; cou- ples counseling
Mental health professionals working with couples andfamilies frequently are confronted with moral and eth- ical issues not faced by therapists or counselors treating indi- viduals. Writers addressing the complicated issues surround- ing privacy and confidentiality when treating married and unmarried couples have described the minefields conscien- tious therapists must navigate (Gottlieb & Cooper, 1993; Hare-Mustin, 1980). Others have mapped out some of the pathways around these obstacles (Karpel, 1980; Patten, Barnett, & Houlihan, 1991). One particularly thorny issue
likely to present itself to counselors working with couples concerns the topic of secrets shared with the therapist by one client but withheld from the client’s spouse or partner (Brendel & Nelson, 1999; Glass, 2002). Indeed, there has been considerable debate on whether counselors should reveal client secrets (Margolin, 1982). Professional ethics scholars emphasize the importance of establishing clear poli- cies regarding confidential communication when working with couples (Margolin, 1998; Vangelisti, Caughlin, & Timmerman, 2001). However, a search of the literature found no explicit written examples of such policies to guide thera- pists when working with couples. Thus, the purpose of this article is to present one approach to informed consent that addresses unique concerns regarding confidentiality in marital and relationship counseling.
A carefully constructed confidentiality agreement becomes essential when therapists agree to treat clients indi- vidually as well as conjointly with their spouse or significant other. Although none of the ethical codes indicate that con- ducting concurrent individual and conjoint counseling is unethical, many organizations caution their members about the ethical pitfalls inherent in doing so. Thus, counselors working with couples will likely, perhaps inevitably, find themselves grappling with the issue of one person’s right to privacy versus a partner or spouse’s right to obtain access to information relevant to their personal well-being. Although marital and relationship counselors encourage open and hon- est communication, they occasionally compromise and con- cede to requests from their clients to keep certain information secret. Often, this means withholding important, sometimes critical data involving highly charged topics such as infidelity from the innocent or naïve partner or spouse (Weeks, Gambescia, & Jenkins, 2003).
There are additional concerns when the disclosures relate to illegal activities. For example, adultery is considered a crime in some states. As a result, it is possible that keeping a
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THE FAMILY JOURNAL: COUNSELING AND THERAPY FOR COUPLES AND FAMILIES, Vol. 14 No. 1, January 2006 77-80 DOI: 10.1177/1066480705282060 © 2006 Sage Publications
Authors’ Note: Please address correspondence concerning this manuscript to Julie L. Quimby, Ph.D., Department of Psychology, Towson University, Towson, MD 21252-0001. Dr. Quimby may be reached by e-mail at jquimby@towson.edu. The editor of this sec- tion welcomes future discussion on the alternate approaches that professionals take in addressing secrets and confidential informa- tion in couple counseling. Please submit discussion to Fran Steigerwald at fjsteiger@radford.edu.
secret of illegal activity from a spouse could result in being charged with conspiracy or “alienation of affection.” Although this charge is highly unlikely, some writers have argued that counselors must not condone illegal activity by keeping secrets (Cottone, Mannis, & Lewis, 1996). There- fore, counselors should be familiar with their state laws and ethical standards.
ETHICAL STANDARDS CONCERNING CONFIDENTIALITY IN COUPLES COUNSELING
The ethical codes of conduct address, with varying degrees of specificity, appropriate therapist behavior relating to confi- dentiality when working with couples. For example, the American Counseling Association (1995) stated unequivo- cally that “information about one family member cannot be disclosed to another member without permission” (p. 6). Similarly, the code of ethics for the therapists of American Association of Marriage and Family Therapy (2001) required that “therapists may not reveal any individual’s confidences to others in the client unit without prior written permission of that individual” (p. 3). The International Association for Mar- riage and Family Counselors (1993) likewise recommended that “unless alternate arrangements have been agreed upon by all participants, statements made by a family member to the counselor during an individual counseling or consulting con- tact are to be treated as confidential and not disclosed to other family members without the individual’s permission” (p. 2). In contrast, the American Psychological Association (2002) suggested that psychologists clarify their role and their use of information, but it does not explicitly prevent psychologists from sharing material divulged by one family member in an individual session with the other family members in therapy.
Because of differences among professional organizations and state licensing boards regarding appropriate ethical behavior, it seems likely that counselors would receive con- flicting and contradictory messages about this issue. One position is that counselors should refuse to keep secrets (American Counseling Association, 1995). From this per- spective, secrets are seen as counterproductive to open and honest communication that is necessary for successful coun- seling. For example, Pittman (1987) wrote, “the secret doesn’t belong to the adulterer or to the therapist but is the property of the marriage” (p. 121). Likewise, Weeks et al. (2003) recom- mended that counselors should terminate conjoint treatment if the client refuses to divulge the secret information. On the other hand, others argued that maintaining secrecy, at least some of the time, allows the therapist to get more honest and complete information from family members, increases the likelihood of accurate assessment, and facilitates successful therapy (Corey, Corey, & Callanan, 2003). Still, others have made the case for a third position, stressing the need for flexi- bility and encouraging counselors to use their professional judgment when determining whether to reveal or maintain a
secret. In effect, this middle-ground approach argues that counselors should make the decision in accordance with the greatest benefit for the couple and the therapeutic process (Remley & Herlihy, 2005).
Even the most conscientious counselors often disagree about the best course of action when determining whether or not to reveal a secret. For example, marital and relationship counselors may find themselves working with someone who insists on keeping secret certain information that is vital to their partner’s well-being. In situations such as these, coun- selors often use their professional judgment to determine whether or not to break confidentiality (Remley & Herlihy, 2005). They may also consider options such as (a) maintain- ing confidentiality, (b) encouraging or perhaps insisting on full disclosure, (c) referring the couple to another therapist, or (d) revealing the secret to the naïve partner (Weeks et al., 2003). Regardless of one’s decision, it is critical that counsel- ors communicate their policy on such matters before the onset of counseling. As Margolin (1982) stated, “The most difficult predicament for the therapist would be if she or he failed to convey a policy on confidentiality” (p. 792). Indeed, when secrets such as physical or sexual abuse, sexual orientation, infection with a sexually transmitted disease, or drug abuse are revealed to counselors, they must be prepared to reiterate their policy on confidentiality and to follow the policy that was agreed on by all parties prior to starting treatment.
ONE CLINICIAN’S APPROACH TO INFORMED CONSENT WITH COUPLES
Although ethics scholars in family counseling recommend a comprehensive approach to informed consent on issues of confidentiality (e.g., Lakin, 1994), no publication has pro- vided a written guide for counselors to use when working with couples. This article presents one document for counsel- ors and therapists to consider. Before reading the following informed consent document, it is important that readers under- stand the perspective from which the authors approach these and related ethical issues.
We do not believe that there is but one right or ethically appropriate way to resolve the kinds of issues discussed in this article. However, we do share one primary therapeutic assumption, which guides us in our work. Specifically, we believe that it is an ethical and moral obligation to act within the best interests of our clients. In addition, we believe that practice in this field requires an awareness of our own values and how these values intersect with issues presented by our clients. Indeed, even professional judgments are influenced by personal values. Thus, it is imperative that counselors clar- ify their position on a variety of issues concerning, for exam- ple, the value and importance of friendship, love, and mar- riage, especially as they relate to the mental health of our clients (Walen & Bass, 1986).
In conclusion, determining whether or not to reveal a cli- ent’s secret involves careful assessment of the potential risks
78 THE FAMILY JOURNAL: COUNSELING AND THERAPY FOR COUPLES AND FAMILIES / January 2006
and benefits. We understand that certain approaches bring with them greater risk than others. However, the least risky intervention may not always be the most therapeutic. Thus, counselors should minimize the potential for harm by estab- lishing a pretreatment contract that outlines and addresses such concerns with their clients.
An informed consent document, written by Barry A. Bass, a licensed psychologist and certified sex therapist of the American Association of Sex Educators, Counselors, and Therapists with 35 years of clinical experience, is included as an appendix. This document, which supplements a more generic privacy and confidentiality agreement that is given to all prospective clients, deals exclusively with those privacy issues specific to couples.
APPENDIX AN INFORMED CONSENT DOCUMENT
FOR INDIVIDUALS IN COUPLES COUNSELING
This document deals with privacy issues specific to couples and supplements the document already given to you that deals with related issues in therapy. Please read it carefully and jot down any questions you might have so that we can discuss them at our next meeting. When you sign this document, it will represent an agree- ment between us.
First of all, I wish to reassure you that I am personally and profes- sionally committed to protecting your privacy. I realize that therapy can only take place in a setting in which everyone feels secure in the knowledge that his or her thoughts and feelings will remain pro- tected and secure within the confines of the therapy office. To protect your privacy, I have put the following policies into effect.
To prevent an inadvertent breach of confidence, I have a policy of not greeting a client whom I meet outside of my office. Thus, should we happen to meet in public, I will intentionally not say hello to you, in order to protect your confidentiality. You may, however, feel free to greet me in public if you so desire.
My office has been designed to protect your privacy in that patients leaving my office will leave through a different door than the one by which they arrived. This arrangement spares you from bumping into someone with whom you are acquainted in the waiting room.
Issues concerning personal privacy and professional confidenti- ality are somewhat more complicated when working with married or unmarried couples. In addition to the exceptions to confidentiality outlined to you in the document titled “Welcome To My Office,” work with couples sometimes requires certain additional compro- mises in privacy.
