Privacy and Confidentiality in Psychotherapy: Conceptual Background and Ethical Considerations in the Light of Clinical Challenges

2020 ◽  
Author(s):  
Anke Maatz ◽  
Lena E. Schneller ◽  
Paul Hoff
Keyword(s):  
Clinical Practice ◽  
Therapeutic Relationship ◽  
Therapeutic Process ◽  
Psychological Function ◽  
Ethical Considerations ◽  
Psychotherapeutic Practice ◽  
Ethical Conflicts ◽  
Conceptual Background ◽  
Case Vignettes ◽  
Privacy And Confidentiality

This chapter situates privacy and confidentiality as central ethical, legal, and anthropological concepts for psychotherapeutic practice. It first provides some conceptual background and clarification of the concepts before considering their specific relevance in the context of psychotherapy. In particular, it explores a unique significance that, it is argued, privacy and confidentiality acquire in the therapeutic process to do with the anthropological dimension of privacy, its psychological function, and the specific dynamics of the therapeutic relationship. Based on four case vignettes, potential ethical conflicts about privacy and confidentiality are then discussed. Finally, principles that can guide practitioners in responding to ethical conflicts about privacy and confidentiality in clinical practice are provided.

Termination

2013 ◽  
Author(s):  
Michelle S. Ballan ◽  
Maria S. Mera
Keyword(s):  
Clinical Practice ◽  
Therapeutic Relationship ◽  
Therapeutic Process ◽  
Systematic Research ◽  
Successful Termination ◽  
Termination Phase ◽  
Termination Process

The termination phase of clinical practice is an important component of the therapeutic process. The ending of the therapeutic relationship, whether planned or unplanned, can elicit feelings of loss, separation, and guilt, impacting both the client and the practitioner. The reasons for ending service and preparation for termination can affect the client's gains. Systematic research on the termination process and the maintenance of gains is needed to further determine variables for successful termination.

The analyst as “boundary artist”: how does Winnicott’s theoretical and clinical work affect our perception of boundaries in the therapeutic relationship?

2019 ◽  
Vol 4 (1) ◽  
Author(s):  
Antoine Gordon
Keyword(s):  
Clinical Practice ◽  
Therapeutic Relationship ◽  
Therapeutic Process ◽  
Clinical Work ◽  
Transitional Space ◽  
Boundary Crossings ◽  
Relational Psychotherapy ◽  
Work Affect ◽  
Therapeutic Frame

Winnicott positioned his psychoanalytic style as distinct from Freudian and Kleinian theory, while his clinical practice was viewed by many as too enigmatic from which to establish a suitable theoretical framework. This article explores the role of boundaries within his practice and discusses whether he could be considered a “boundary artist” in the analyst’s chair. Winnicott’s underlying philosophy and clinical approaches are examined in relation to the analyst’s intrapsychic boundaries and the permeable border between the roles of analyst and analysand—particularly with regard to his notion of transitional space. Despite Winnicott exhibiting narcissistic tendencies that may have blurred the boundaries of the therapeutic frame, this critique demonstrates how he used his unique skill set to ensure boundary crossings could benefit the therapeutic process whilst avoiding harmful violations. Additionally, we will also consider the more problematic implications of Winnicott’s practice on modern relational psychotherapy.

An introduction to advance care planning: practice at the frontline

2018 ◽  
Author(s):  
Anjali Mullick ◽  
Jonathan Martin
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Communication Skills ◽  
Advance Care Planning ◽  
Use Case ◽  
Care Planning ◽  
Practical Advice ◽  
Future Care ◽  
Case Vignettes ◽  
Advance Care

Advance care planning (ACP) is a process of formal decision-making that aims to help patients establish decisions about future care that take effect when they lose capacity. In our experience, guidance for clinicians rarely provides detailed practical advice on how it can be successfully carried out in a clinical setting. This may create a barrier to ACP discussions which might otherwise benefit patients, families and professionals. The focus of this paper is on sharing our experience of ACP as clinicians and offering practical tips on elements of ACP, such as triggers for conversations, communication skills, and highlighting the formal aspects that are potentially involved. We use case vignettes to better illustrate the application of ACP in clinical practice.

Flexible eclectic psychotherapy (FEP): A model for psychotherapy integration

2016 ◽  
Vol 33 (S1) ◽  
pp. S558-S558 ◽  
Author(s):  
D. Coira ◽  
M. Grady
Keyword(s):  
Clinical Practice ◽  
Therapeutic Process ◽  
Supportive Therapy ◽  
Active Role ◽  
Psychotherapy Integration ◽  
Clinical State ◽  
Training Methods ◽  
Case Examples ◽  
Cost Effective Treatment ◽  
New Generation

IntroductionMost experienced psychotherapists use an eclectic approach in their practice, combining techniques of different schools of psychotherapy to treat their patients. However, there are no good teaching models to train the new generation of psychotherapists in the technique of psychotherapy integration. FEP is a form of psychotherapy that combines techniques from four different psychotherapies: psychodynamics, CBT, IPT and supportive therapy. It also incorporates mindfulness, motivational interviewing, exercise and nutrition. A strong therapeutic alliance is crucial to the success of FEP. Techniques are tailored to the patient's current clinical state. Several techniques from different psychotherapies may be used in the same session. The therapist is empathic, flexible adaptive to the patient's needs and assumes an active role in the therapeutic process.ObjectiveTo present a model of psychotherapy integration that can be used by psychotherapists in their clinical practice.AimsWe aim to present a model of psychotherapy integration that can be taught and implemented by psychotherapists in their clinical practice.ResultsWe present ten case examples were FEP was effective clinically and we compare it to the standard of care received by these patients and show the savings to the healthcare system.ConclusionThe results of our study suggest that FEP could be a cost effective treatment that could be added to the psychotherapists toolbox. Teaching and training methods, like manuals and workshops can be developed to train the new generation of psychotherapists.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Boundary violation and sexual exploitation in psychiatry and psychotherapy: a review

2004 ◽  
Vol 10 (4) ◽  
pp. 312-320 ◽  
Author(s):  
Sameer P. Sarkar
Keyword(s):  
Health Care ◽  
Clinical Practice ◽  
Empirical Study ◽  
Sexual Exploitation ◽  
Professional Roles ◽  
Professional Boundaries ◽  
Boundary Violation ◽  
Psychotherapeutic Practice ◽  
The Subject ◽  
Sexual Boundary Violations

In psychiatric and psychotherapeutic practice, ‘boundaries' delineate the personal and the professional roles and the differences that should characterise the interpersonal encounters between the patient/client and the professional. Boundaries are essential to keep both parties safe. The author outlines the various types of boundary violation that can arise in clinical practice, their consequences (both clinical and legal), how professionals can avoid them and how health care institutions might respond, should they occur. He concentrates on sexual boundary violations, because these have been the subject of most empirical study.

scholarly journals Use and understanding of functional cognitive disorder terminology in United Kingdom clinical practice - a survey

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S277-S277
Author(s):  
Alexandra Nash ◽  
Jon Stone ◽  
Alan Carson ◽  
Craig Ritchie ◽  
Laura McWhirter
Keyword(s):  
United Kingdom ◽  
Cognitive Impairment ◽  
Clinical Practice ◽  
Mild Cognitive Impairment ◽  
Old Age ◽  
Cognitive Disorders ◽  
Cognitive Disorder ◽  
Cognitive Symptoms ◽  
Case Study Methodology ◽  
Case Vignettes

AimsThis study aimed to explore the terms used by old-age psychiatrists and psychologists to describe subjective and mild cognitive impairment and functional cognitive disorders (FCD) in clinical practice.MethodParticipants were selected from across the United Kingdom based on their clinical involvement in the assessment of cognitive complaints. 9 old-age psychiatrists and 4 psychologists were interviewed about their use of terminology in clinical practice and their awareness and understanding of FCD terminology via semi-structured interview questions and case vignettes. Interviews were conducted between December 2020 and February 2021 using online platforms Zoom and Microsoft Teams. Participants were recruited by email and Twitter. All questions were asked verbally; however, the four case vignettes were displayed via screen-share. All discussions and answers were transcribed and transcripts were coded manually using the exploratory case study methodology in order to identify themes in participants’ responses.ResultThis study has highlighted the variable use of terms used to describe and diagnose patients presenting with symptoms of cognitive disorders. The terms ‘mild cognitive impairment’, ‘subjective cognitive decline’ and ‘functional cognitive disorder’ were used most commonly amongst participants, though the terms ‘subjective cognitive impairment’ and ‘pseudodementia’ were also presented. This theme of language discontinuity is underscored by participants’ varying use of terminology when describing or presenting their diagnoses for the case vignettes. The data also reveals a sub-theme of variability in application of the term FCD. Whilst all participants gave similar definitions for this term, the application of FCD as a diagnosis in practice was inconsistent. Six participants described FCD as associated with or secondary to other functional or psychiatric conditions, four participants viewed FCD as an isolated diagnosis, and one participant considered FCD to be either part of another illness or a separate diagnosis. Two participants neither used nor recognised the term FCD.ConclusionIt is evident that there is varied use of terms describing or diagnosing forms of cognitive symptoms. The findings of this study highlight the need for a clear, adoptable definition of FCD in practice as well as implementable management plans for FCD patients. This is critical in order to avoid misdiagnosis and mismanagement, which may have harmful effects on patients living with debilitating cognitive symptoms.

Phase 2

2021 ◽  
pp. 89-104
Author(s):  
Frederic N. Busch ◽  
Barbara L. Milrod ◽  
Cory K. Chen ◽  
Meriamne B. Singer
Keyword(s):  
Therapeutic Process ◽  
Phase 2 ◽  
Ptsd Symptoms ◽  
Middle Phase ◽  
Identification With The Aggressor ◽  
Working Through ◽  
Case Vignettes ◽  
Intrapsychic Conflicts

This chapter provides an overview of the central psychodynamic techniques of the middle phase of TFPP. Core intrapsychic conflicts that contribute to PTSD symptoms are identified and actively addressed. Interpretation of defenses aids in the elucidation of conflicts. A prominent defense in PTSD, identification with the aggressor, is described in more depth. Exploration of the transference is discussed with attention to the ways in which core conflicts emerge with the therapist. Patients with PTSD trigger particularly intense countertransference reactions, knowledge of which furthers the therapeutic process. The technique of working through is articulated, in which the therapist and patient elucidate how various conflicts and defenses emerge across a range of symptoms, contexts, and relationships. Case vignettes are used to illustrate these approaches.

Forensic psychiatry

2020 ◽  
pp. 347-362
Author(s):  
Stephen H. Dinwiddie
Keyword(s):  
Clinical Practice ◽  
Personality Disorder ◽  
Antisocial Personality Disorder ◽  
Mental State ◽  
Forensic Psychiatry ◽  
Practical Interest ◽  
Antisocial Personality ◽  
Conceptual Space ◽  
Fitness To Stand Trial ◽  
Ethical Conflicts

Forensic psychiatry exists within the ever-changing social and conceptual space where issues of law and mental state meet. Though generally associated with issues such as the insanity defence, fitness to stand trial, and the like, forensic psychiatry includes within its ambit many aspects of everyday clinical practice—issues such as risk prediction, antisocial personality disorder, decisional capacity, and identifying and resolving ethical conflicts. Rather than focusing on topics of little practical interest to the general clinician, articles for this chapter were chosen to address these everyday issues.

Four Relational Experiences in Music Therapy with Adults with Severe and Profound Intellectual Disability

2019 ◽  
Author(s):  
Maybelle Swaney
Keyword(s):  
Intellectual Disability ◽  
Music Therapy ◽  
Good Life ◽  
Emotional Health ◽  
Therapeutic Process ◽  
Clinical Work ◽  
Carl Rogers ◽  
Relational Experiences ◽  
Client Population ◽  
Case Vignettes

Abstract This paper describes a conceptual framework in music therapy with adults with severe and profound levels of intellectual disability. Drawing from Carl Rogers’ person-centered work and his notion of the good life as a direction, the author presents four core relational experiences (curiosity, invitation, celebration, and recognition) that underpin the therapeutic process with this client population. Case vignettes from the author’s clinical work illustrate how core experiences are presented through improvisational musical experiences. Considerations are given to the clinical significance of good-life-oriented experiences on the emotional health of individuals with severe and profound intellectual disability, and to its implications beyond the music therapy space.

Ethical Considerations in Cross-Linguistic Nursing

2009 ◽  
Vol 16 (6) ◽  
pp. 813-826 ◽  
Author(s):  
Franco A Carnevale ◽  
Bilkis Vissandjée ◽  
Amy Nyland ◽  
Ariane Vinet-Bonin
Keyword(s):  
Empirical Evidence ◽  
Nursing Care ◽  
Codes Of Ethics ◽  
Self Determination ◽  
Patient Privacy ◽  
Ethical Considerations ◽  
International Council ◽  
Linguistic Barriers ◽  
Ethical Norms ◽  
Privacy And Confidentiality

This article reviews empirical evidence and ethical norms in cross-linguistic nursing. Empirical evidence highlights that linguistic barriers between nurses and patients can perpetuate discrimination and compromise nursing care. There are significant organizational and relational challenges involved in ensuring adequate use of interpreters by nurses. Some evidence suggests that linguistic barriers are particularly problematic for nurses when compared with physicians. A comparative analysis of nursing ethical norms for cross-linguistic nursing was conducted using the codes of ethics of the American Nurses Association, the Canadian Nurses Association, and the International Council of Nurses. Five principal ethical norms for cross-linguistic nursing were identified: (1) respect for the patient as a unique person; (2) respect for the patient’s right to self-determination; (3) respect for patient privacy and confidentiality; (4) responsibility for one’s own competence, judgment, and action; and (5) responsibility to promote action better to meet the needs of patients, families, and groups.

Sign in / Sign up

Export Citation Format

Share Document