Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)




This study is part of the growing interest in ethical issues in clinical practice. Confidentiality is of particular concern, being regarded by many mental health professionals as a prerequisite for successful treatment. However, conflicts of interest inevitably arise and confidentiality must be weighed against other values. How to deal with these dilemmas has been a matter of considerable debate among professionals; interestingly, the views of clients on these issues have rarely been investigated.

The purpse of the study was to explore the attitudes and expectations of human service/mental health center clients regarding confidentiality. A 36 item scale, consisting primarily of 20 Likert format items, was carefully developed to assess these views, particularly the circumstances under which confidentiality should be broken. It proved highly reliable and had a distinct factor structure. The questionnaire was adminstered as part of routine intake procedures at 7 North Dakota human service centers; 465 clients responded.

The major finding was that clients are very much concerned about confidentiality and value it highly. Although three quarters expressed a preference for absolute confidentiality, they were willing to have it broken in a few circumstances, primarily when the safety of third parties was involved. For example, they felt child abuse should be reported and threatened third parties protected. On the other hand, they disapproved of some routine professional practices, such as sending personally identifiable data on clients to central registries. To these clients, confidentiality was not an absolute, but was situational and relative to a given context.

Clients very much wanted to be informed about any limits on confidentiality that might exist. While they generally expected confidentiality, they also reported having been in a significant number of situations where it was broken; perhaps as a result, they often hesitated to enter treatment. Their views were compared with those of professionals and nonprofessionals in previous studies. Suggestions were offered for further work, to help actualize ethics in theory, research, and practice.