The relationship between therapist beliefs : values and ethical decision making in AIDS-related psychotherapy

The relationship between therapist homophobia and decisions to breach confidentiality in AIDS-related clinical contexts was assessed. Also assessed were the effects of perceived level of dangerousness and client type on decisions to breach confidentiality. Licensed psychologists in Florida received a survey which included; six scenarios to be rated in terms of likelihood of breaching confidentiality, demographic information sheet, and a 28 - item Experimental Attitude Survey which assessed Homophobia, Traditional Family Ideology, and Religious Ideology. Data from 625 participants was collected. There was a positive correlation between homophobia and likelihood of breaching confidentiality (LBC). Those with high homophobia were more likely to breach than low homophobia. High perceived client dangerousness resulted in higher LBC scores than low dangerousness. Also, LBC scores for the Prostitute and Hemophiliac types were higher than the Homosexual client type. There were significant interactions between homophobia and type, and dangerousness and type. In the high homophobia condition LBC scores for the Homosexual type were lower than LBC scores for either the Prostitute and Hemophiliac types. In the low dangerousness condition, LBC scores in the Prostitute and Hemophiliac types were higher than the Homosexual type. There was an interaction between gender and type. Males had higher LBC scores in the Prostitute condition than females. In both high and low dangerousness conditions, the majority of participants chose to warn rather than detain the client. If therapists choose to work with HIV-positive clients, they need to evaluate personal attitudes, have a working knowledge of the laws of their state, and be prepared to make decisions that are potentially opposite from their personal beliefs