The Ethics of Sharing Client Stories

One approach to handling confidentiality when we teach workshops or classes.

Posted Oct 21, 2016

Guest Blog by Lana Gollyhorn, MA

Blogger’s Note:  Many mental health professionals conduct workshops or classes for parents, teachers, and other members of the public.  They frequently share examples from their caseload.  I’ve asked Lana Gollyhorn to share her approach.  She is a former student of mine, and a very thoughtful professional (although these two facts are not related to each other…).

Mitch

Teaching parents how to better understand their teenagers is one of the most rewarding aspects of my job as a therapist. In my workshops and classes, I love sharing stories that capture the essence of adolescent thought and behavior. How can I use my clients as examples in my teaching, while simultaneously honoring my clients’ confidentiality and therapeutic experience? What are the ethical limits to telling clients’ stories?

When I’m planning a parenting class or workshop, my first ethical consideration is Standard 4.07 from the American Psychological Association (APA) Code of Ethics:

Use of Confidential Information for Didactic or Other Purposes– Psychologists do not disclose in their writings, lectures or other public media, confidential, personally identifiable information concerning their clients/patients, students, research participants, organizational clients or other recipients of their services that they obtained during the course of their work, unless (1) they take reasonable steps to disguise the person or organization, (2) the person or organization has consented in writing, or (3) there is legal authorization for doing so.

To meet the APA Standard, I’ll either get permission to share the client’s story or change identifying details. Here’s how this looks in practice:

Lana Gollyhorn, used with permission
Lana Gollyhorn, MA
Source: Lana Gollyhorn, used with permission

When a client shares a poignant insight, or a child responds well to a new parenting technique, I’ll ask for permission to share it as a teaching example. I’ll ask clients after the therapy session or at the end of treatment. However, I will ask for permission only if the request does not conflict with the therapeutic process. Even when I get permission, I never share names. If clients deny permission, I do not use the story.  

Sometimes I think of a story for a teaching example later, and I’m unable to contact the client for permission. In these situations, I change identifying details. This can be tricky, because simply omitting the name, time, and place of the event you’re describing is not enough to ensure that someone who knows the client well would not recognize the story. Certain details, like a unique physical trait combined with a sport or interest could be enough to identify the client. Therefore, I change those types of details as well.   

As part of my ethical decision-making process I ask myself the following questions that go beyond the letter to the spirit of the APA Ethics Code:

Does telling the story respect the client?

  • If the story could be perceived as shameful, blaming, or unflattering to the client, then I don’t use it.
  • Another consideration is timing. Is the client still struggling with that issue? I like to use examples highlighting the journey from struggle to success.
  • Even when I have de-identified the client by changing details, I also ask myself if the client would still recognize his/her own story even though the audience does not. And if so, how would the client feel? I hope clients would feel comfortable and respected if they were sitting in the room listening, and this consideration influences how I tell the story.

What is my purpose for telling the story?

  • What is the take-home message I am aiming for? Am I teaching a developmental stage, highlighting a child’s thought process, normalizing a parent-child interaction, or connecting research to a client experience? My goal is to use only clinical examples that enhance understanding. I don’t want to tell stories just because they are interesting or humorous.
  • Is any part of my sharing the story for my own ego or benefit? For example, am I really trying to get them only to attend other talks, sign up for a class, etc.? I want to avoid having these goals overshadow the goals that attendees have for coming.
  • Will telling a story change the way I think about, or act towards, a client? If so, then I shouldn’t share it.

Does the clinical example consider the audience’s experience?

  • I stay away from the most extreme examples. They are memorable; however, I want to avoid creating unreasonable fear or unrealistic hope about treatment. In other words, I do not sensationalize either psychopathology or therapy.  
  • In the same vein, I prefer not to use an especially traumatic clinical example, even if I have permission from the client. Issues of trauma certainly come up, but I believe there are better ways of dealing with those issues than sharing client stories.

Does the clinical example uphold the mental health profession?

  • I always tell my attendees either that I have permission to share a story, or that I’ve changed identifying information. I do this so attendees understand that I am following a protocol for sharing that respects my clients as well as the attendees.  I don’t want to discourage someone from seeking help for fear of being used as an example in a class or workshop.
Mitch Handelsman
Source: Mitch Handelsman

I often handle these ethical considerations via self-reflection, in thought or writing. Sometimes, though, self-reflection isn’t enough; something doesn’t feel right to me. In those cases I seek consultation with colleagues. My own personal "ethics board" includes 12 professionals I call for consults. The list includes child psychologists, an addiction therapist, a pediatrician, psychiatrists, school counselors, and a psychologist with expertise in ethics. Talking with these professionals is always beneficial because it allows me to explore new angles, my own biases, and additional questions to consider.

The ethical decision-making process I’ve described pushes the boundaries of my professional growth when I’m choosing clinical examples to use in my teaching. By making informed and thoughtful decisions about what, when, and how to share my case examples, I do my best to respect my clients, my audience, and myself.

===============================================

Lana Gollyhorn earned her B.A. in Psychology with an emphasis in biological studies from Michigan State University in 1995, and a M.A. in Clinical Psychology from the University of Colorado at Denver in 2001.  She is trained in evidence-based therapeutic approaches including cognitive behavioral therapy and brief psychodynamic therapy. Ms. Gollyhorn has a private psychotherapy practice, conducts parenting workshops, and consults at a school in Denver.

Mitch Handelsman is professor of psychology at the University of Colorado Denver.  With Samuel Knapp and Michael Gottlieb, he is the co-author of Ethical Dilemmas in Psychotherapy: Positive Approaches to Decision Making (American Psychological Association, 2015). Mitch is also the co-author (with Sharon Anderson) of Ethics for Psychotherapists and Counselors: A Proactive Approach (Wiley-Blackwell, 2010), and an associate editor of the two-volume APA Handbook of Ethics in Psychology (American Psychological Association, 2012).  But here’s what he’s most proud of:  He collaborated with pioneering musician Charlie Burrell on Burrell’s autobiography.  

© 2016 by Mitchell M. Handelsman. All Rights Reserved