Confidentiality In Clinical Social Work: An Opinion of the United States Supreme Court

Abstract

Late in 1995, the U.S. Supreme Court heard the case of Jaffee v. Redmond, over the issue of psychotherapy-patient confidentiality and specifically whether a clinical social worker and her client had the right to withhold case notes in a federal court proceeding. In early 1996 the Supreme Court ruled that, in all federal courts, the principle of privacy and confidentiality of therapeutic disclosures trumped the evidentiary value of such notes (with very limited exceptions). The present publication is intended to provide teachers, students, and other readers with an introduction to the case and its issues, including salient materials from Jaffee v. Redmond, as a means of examining the issue of confidentiality and its clinical and legal importance.

Introduction

Jaffee vs. Redmond was a landmark case decided by the U.S. Supreme Court in 1996 over the testimonial privileges issue of whether a clinical social worker had a right to refuse, in court proceedings, to disclose the content of case notes. In its decision, the Court affirmed that right for clinical social workers as well as psychiatrists and psychologists. This case also underscored the crucial importance of clinical social workers referring to themselves as such, and not employing the short-hand reference of social worker when clinical social worker is what’s meant.

The case arose from a June, 1991, incident in which Illinois police officer Mary Lu Redmond responded to a fight in progress call at an apartment complex. As she arrived, two people ran toward her squad car shouting about a stabbing inside. Redmond summoned an ambulance, then walked toward the apartment building. Several men ran out, one grasping a length of pipe. She ordered them to get on the ground, but they ignored her. Redmond drew her service revolver. Two more men emerged, one, Ricky Allen, waving a butcher knife and chasing the other. Allen disregarded Redmond’s repeated commands to drop the weapon. Trying to prevent a homicide, she shot Allen, who died at the scene. People poured out of the buildings and surrounded Redmond in a threatening crowd.

In the following weeks and months, a distraught Officer Redmond made use of the psychotherapeutic services of a clinical social worker, Karen Beyer, to deal with the many issues provoked by the taking of a life and the fact that the Allen family had brought suit against her and her department in federal court for wrongful death. When the case came to court, Beyer was ordered to produce her case notes. She refused, on the grounds that she and Redmond had a psychotherapist-patient privilege of confidentiality. The judge disagreed. In federal courts, there was a tradition of balancing, in which each judge could determine, case by case, whether the value of case-notes as evidence (to be disclosed in court) outweighed the patient's privacy interests (note: the word patient is used in this piece because of legal context; in clinical social work practice, a patient is always referred to as a client).

When Beyer still refused to turn over her notes, the judge threatened her with imprisonment, and instructed the jury to assume that Redmond had incriminated herself in her psychotherapeutic disclosures. The result was a guilty verdict, which was appealed. The appeal was successful, but was overturned at the next level. That decision too was appealed and overturned, meaning that the judge ruled that Beyer was correct in maintaining the confidentiality of the case notes; but a new appeal led to the U.S. Supreme Court, which had been looking for a case in which to rule on the issue of a privilege for psychotherapeutic communications—whether they should be protected consistently, and which classes of psychotherapist might claim confidentiality. It was widely assumed, but not actually established, that psychiatrists and psychologists could claim that right; however, it was not clear that clinical social workers like Karen Beyer could do the same.

The case of Jaffee vs. Redmond was heard by the U.S. Supreme Court early in 1996. The arguments specific to it were augented by briefs from friends-of-the-court (amici curiae) submitted by various organizations and consortia, all in favor of a broad privilege for psychotherapist-patient communications. None argued that clinical social workers should be excluded from such a privilege. One such brief, which would be cited in the Majority Opinion of the Court, was submitted by a consortium of clinical social work and social work organizations, including ACSWA’s sister organization, the American Board of Examiners in Clinical Social Work. That brief is included in this pamphlet. It does not refer to clinical social workers consistently, because representatives of one organzation in the amici consortium insisted on referring to social workers instead.

Most of the U.S. Supreme Court justices favored the cause of police officer Mary Lu Redmond and clinical social worker Karen Beyer; and their Opinion established a broad privilege of confidential communications between patients and psychiatrists, psychologists, and clinical social workers. Part of the Opinion reads: Like the spousal and attorney-client privileges, the psychotherapist-patient privilege is ‘rooted in the imperative need for confidence and trust.’ Trammel, 445 U. S., at 51. Treatment by a physician for physical ailments can often proceed successfully on the basis of a physical examination, objective information supplied by the patient, and the results of diagnostic tests. Effective psychotherapy, by contrast, depends upon an atmosphere of confidence and trust in which the patient is willing to make a frank and complete disclosure of facts, emotions, memories, and fears. Because of the sensitive nature of the problems for which individuals consult psychotherapists, disclosure of confidential communications made during counseling sessions may cause embarrassment or disgrace. For this reason, the mere possibility of disclosure may impede development of the confidential relationship necessary for successful treatment.