Confidentiality versus the duty to protect in psychotherapy with HIV-infected clients

Eleanor Dwyer Rigby, Fordham University


The present study attempted to investigate psychologists' likely behavior when presented with the dilemma of confidentiality versus the duty to protect in psychotherapy with HIV-infected clients. Specifically, this study investigated the influence of degree of dangerousness, legal guidelines, and therapist characteristics in psychologists' decisions to breach or maintain confidentiality. A questionnaire consisting of experimentally controlled vignettes and demographic/therapist characteristics questions was designed for this study. The subjects received two case vignettes; one depicting a client who used safer sex procedures and one in which the client did not. For both cases the client was unwilling to inform his sexual partner of his HIV diagnosis. Subjects were also presented with one of four legal guidelines conditions representing a combinations of the following: An HIV Confidentiality Law which prohibits psychologists from warning sex partners of an HIV individual of their potential risk of HIV exposure or one which permits this warning, and A Duty to Protect Statute which requires a duty to protect or does not. Participants were asked to rate on a 7 point Likert scale the likelihood of their breaching confidentiality. Four hundred and sixty Ph.D. level psychologists participated representing a return rate of 56.8%. Data was analyzed utilizing a 2 x 2 factorial analysis of variance with repeated measures on one factor. Results indicated, as predicted, that subjects reported a greater likelihood of breaching confidentiality when the client presented with a higher degree of dangerousness as defined by not using safer sex procedures. With regard to the Legal Guidelines, both Confidentiality Laws and Duty to Protect Statutes significantly affected projected likelihood of breaching confidentiality in the predicted direction: Psychologists were more likely to breach confidentiality when the Confidentiality Law permitted it and when there was a Duty to Protect Statute. It was also found that the Confidentiality Law had a greater effect on psychologists' decisions than the Duty to Protect Statute. Therapists' characteristics, even having experience with HIV-Infected clients, were not significantly associated with clinicians' decisions to breach confidentiality. The findings of this study have implications for the development of specific guidelines for psychologists treating HIV-infected clients.

Subject Area


Recommended Citation

Rigby, Eleanor Dwyer, "Confidentiality versus the duty to protect in psychotherapy with HIV-infected clients" (1994). ETD Collection for Fordham University. AAI9425204.