Module 1 Exercise
Competing Obligations
A confidentiality request that cannot be granted, arriving in the middle of work that is going well. Five decisions follow, working through the CPA Ethical Decision-Making Model. The last one is the one that matters most, and it is about what should have happened before the session ever took place.
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The Scenario
You have been seeing a couple in conjoint sex therapy for eleven weeks. The work is going well. Both partners report improved communication, and the presenting concern, a longstanding desire discrepancy, has begun to shift.
You hold an individual session with each partner as part of the assessment. In hers, one partner discloses that she has been having an affair for the past four months. It is ongoing. She tells you she is not going to end it yet, that she does not want it raised in the conjoint sessions, and that she is telling you because she trusts you and because she needs somewhere to talk about it.
She then says: "This is confidential, right? You can't tell him."
The Four Principles
I. Respect for the Dignity of Persons and PeoplesIncludes confidentiality, informed consent, and self-determination. Generally given the heaviest weight.
II. Responsible CaringCompetence, benefit, and the avoidance of harm to those served.
III. Integrity in RelationshipsHonesty, straightforwardness, avoidance of conflict of interest and of incomplete disclosure.
IV. Responsibility to SocietyThe profession's obligations to the wider community.
The ordering carries weight in the Code, but it is not a mechanical tiebreaker. Where principles conflict, the model requires you to work through the steps rather than to rank and stop.
0 of 4 answered
Final Task
What would you say, in the moment?
She has just asked you a direct question and is waiting. Write your answer as you would actually say it.
One Way to Say It
I want to answer that carefully, because it matters. What you tell me in an individual session is confidential from everyone outside this work. It is not confidential from the therapy itself, because in couples work the two of you together are my client, and the individual sessions are part of that, not separate from it. So I cannot hold this and keep working with the two of you as though I do not know it. That is not me deciding to tell him. It is me telling you that I cannot carry it. What I can do is work with you on how and when you want to bring it into the room, and I can give us some time to do that. What I cannot do is sit in a session next week and help you two build intimacy while holding this.
What this does. It answers the question rather than deflecting, separates confidentiality from the wider world from confidentiality within the therapy, and refuses the secret without threatening disclosure. It also gives her agency over the how and the when, which is the only part still available to her. What to avoid. Two failures in opposite directions. Saying yes in the moment to keep the alliance, then discovering you cannot practise inside that promise. And responding with a policy statement about your confidentiality agreement, which is accurate, cold, and will read as being handled.
The Point of the Exercise
By the time she asks the question, every good option has already been foreclosed or preserved by a document you wrote weeks earlier. Ethical decision-making models are usually taught as something you apply during a crisis. Most of their value is in what they cause you to establish before one.
Reference
Canadian Psychological Association. (2017). Canadian code of ethics for psychologists (4th ed.).