Informed Consent, Confidentiality, and Privileged Communication
Informed consent
Before services, obtain consent covering the nature and purpose of services, risks and benefits, alternatives, fees, confidentiality limits, right to withdraw, and emergency procedures. For minors or incapacitated adults, obtain guardian consent and the client's assent; clarify who is the client when parents are divorced or when a third party pays.
Confidentiality and privilege
Confidentiality is the ethical duty not to disclose; privilege is the client's legal right under Kentucky Rule of Evidence 507 to prevent testimony. The client holds privilege and may waive it. Disclose only with a valid written authorization or a recognized legal exception, such as suspected abuse, serious threat of harm, court order, or a Board investigation.
Exceptions and limits
Mandatory reporting, duty to protect, involuntary hospitalization under KRS Chapter 202A, and litigation in which the client puts mental condition at issue can override confidentiality. Tell clients these limits in plain language at intake.
Worked example
A subpoena demands the full record, but the client has not authorized release. The psychologist should not mail the record; instead, assert privilege, notify the client, and seek a court order or client authorization. Producing records in response to a subpoena alone can be a violation.
Traps
Promising absolute confidentiality; discussing a case in a waiting room; releasing records to a school or attorney without proper authorization; assuming a minor's record belongs solely to the parent.