In this month’s ASWB exam prep blog, we cover one of the most important topics in social work: confidentiality issues. It is pretty much a guarantee that questions around confidentiality issues will show up on your LMSW and LCSW exams. And for good reason! The ASWB wants to ensure that you 1. understand the importance of confidentiality and 2. know what the limits to confidentiality are.
So what are some key considerations?
We should always cover confidentiality issues with our clients in the very first session. We want them to understand not only what will be kept confidential, but what will not be kept confidential as well. (More on that in a bit). It’s essential in building rapport with clients that they know what will kept in confidence between them and their therapist. While most things can be kept confidential, there are several limits to confidentiality:
Limits to confidentiality
- Social workers are mandated reporters. If a client reports child abuse or neglect (or elder/dependent adult abuse or neglect), we have to report this. Even if they aren’t the ones who committed the act of abuse or neglect, we are mandated reporters. So, if a client tells us that another family member (neighbor, coworker, etc.) abused or neglected a child, we have to report that.
- If a client makes a threat of imminent, serious violence towards an identifiable victim, we have a duty to warn.
- When a client intends to end their life, we break confidentiality.
- If a court subpoenas a client’s record, we have to turn it over to the court. (That being said, if we think it would be damaging to do so, we can advocate for a limited release/confidentiality of the record. But if the court denies this, we have to turn the record over.
- When working with minors, parents have a right to access their child's record. (This is a tricky area that we recently wrote a blog on as well.
In addition to limits to confidentiality, there are some instances where you may think you need to break confidentiality, but you don't.
When to keep confidentiality
- Domestic violence: We are not mandated reporters for domestic violence. If a client wants out of a domestic violence situation, we will of course provide support in this. What this is referring to is the fact that we are not mandated reporters for domestic violence. So if a client reports they were physically assaulted by their partner, but does not want to do anything about this, we have to respect that.
- Domestic violence witnessed by children: we do not report domestic witnessed by children. Only if a child is physically harmed during an instance of domestic violence do we report. (While there is some slight variance state-by-state regarding this topic, keep in mind this exam is national and does not test state laws).
- When a client dies: even when a client dies, we still maintain their confidentiality. Our code of ethics addresses this issue, explaining that social workers should protect the confidentiality of deceased clients. We are ethically mandated to protect our deceased client’s confidentiality. Only with a signed release from the executor of the deceased client's estate can we release a deceased client’s record.
ASWB practice question on confidentiality issues
A social worker in private practice meets with a 42-year-old client who presents with issues of depression, anxiety, and relational challenges. During the assessment, the client appears guarded and states ‘I don’t want to say anything that will get myself in trouble.’ The social worker should:
A. Explain social workers are required to maintain confidentiality of what their client share
B. Show the client where they keep locked files
C. Inquire what the client thinks may get them in trouble
D. Explain the limits of confidentiality
(scroll down for answer)
The correct answer is D, to explain the limits of confidentiality. A and B ignore the limits to confidentiality. This incorrectly suggests anything the client tells the social worker is kept confidential. We should not do C without first doing D. C does not address the limits to confidentiality.
ASWB masters and clinical exam preparation
Do you feel ready for questions on confidentiality for your exam? Whether you feel ready to go or need more practice, TDC’s ASWB exam prep gives you all the information and practice needed around confidentiality issues for the exam.
We know this is a challenging time with the temporary closure of Pearson testing centers due to COVID-19. Know that no matter how long this lasts, TDC is with you until you pass. Unlike many companies out there, we never charge for extensions (not before COVID-19 and not now). If you’re ready to pass your exam with CONFIDENCE, TDC is here to give you the knowledge and reasoning skills needed to pass your exam.
We know life is overwhelming right now, so we give you everything you need and nothing you don’t, so your studying can be as focused as possible. And one of the best parts of TDC? Email your coach anytime you have questions as you go through the program. Our coaches are licensed clinical social workers and passed their exams with at least a 90%. TDC has helped THOUSANDS of social workers successfully pass their licensure exams. Are you next?