06 Jun 2017

Protecting Patient Privacy When the Court Calls

Protecting Patient Privacy When the Court Calls

Psychologists are obligated to protect their clients' records. So what do they do when they are presented with a subpoena or asked to testify?

Over the course of their careers, many psychologists will receive subpoenas directing them to disclose or testify about a client's records or test data. Such requests can put psychologists in a quandary: As practitioners, they are well versed in the ethical, professional and legal obligations related to maintaining patient confidentiality, so how can they release such records?

In an effort to guide psychologists in this area, APA's Committee on Legal Issues recently updated its article on understanding subpoenas, seeking to offer strategies that psychologists may use to respond to subpoenas or compelled court testimony. While this article is not intended to establish standards of care or conduct for practitioners, it seeks to address several common questions psychologists have when responding to such legal requests. It is important to note that this article does not provide legal advice, nor is it intended to be or substitute for the advice of an attorney.

Psychologists who receive a subpoena or other legal process that requires or is likely to require production of client/patient records or test data, manuals, protocols, or other test information are encouraged to consult legal counsel who can review the pertinent law and facts and provide appropriate legal assistance.

Understanding subpoenas

From the legal system's perspective, the more relevant information that a judge or jury considers in a court case, the fairer the decision. To obtain this material, the court may issue subpoenas (legal commands to appear to provide testimony) or subpoenas duces tecum (legal commands to appear and bring along specific documents). A court may also issue a court order requiring a party to provide testimony or produce documents.

Unless the issuing attorney or court excuses the psychologist, the psychologist must respond to a subpoena — that is, to be at a particular place at a particular time. Responding to the subpoena, however, does not necessarily mean that the psychologist must disclose confidential information requested in the subpoena. Before a psychologist does so, he or she should ensure that the subpoena is valid and that the conditions for disclosing confidential information are met — such as with a client's consent, a protective order or other legal mandate. In contrast to a subpoena, when a court order for testimony or documents is issued and any attempt to have the court vacate or modify its order has been unsuccessful, a psychologist may be held in contempt of court if he or she fails to comply with the court order.

Unfortunately, the demands of the legal system may conflict with psychologists' responsibility to maintain client confidentiality. This responsibility arises from tenets of good clinical practice, ethical standards, professional licensing laws, and other applicable statutes and legal precedent. In many contexts, client information may also fall under an evidentiary privilege, which protects the client information from being considered as evidence by the legal fact-finder in the case.

Most state and federal jurisdictions allow a client to prevent confidential material that he or she has conveyed to a psychologist from being communicated to others in legal settings, but there are some variations from state to state and between some state and federal courts, and there are significant exceptions (such as cases where the client herself has put her mental health at issue in the litigation). In general, the psychologist has a responsibility to maintain confidentiality and to assert the psychotherapist–patient privilege on behalf of the client unless the client has explicitly waived privilege or signed a valid release, a legally recognized exception to privilege exists, or the court orders the psychologist to turn over the client's information.

The clinical record, any separately kept psychotherapy notes, client information forms, billing records and other such information usually may be turned over to the court with appropriate authorization by the client or with a court order. Psychologists required to comply with provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) would need a HIPAA-compliant authorization form to release such information, and a separate authorization for release of psychotherapy notes if those notes are developed in strict compliance with the HIPAA definition of psychotherapy notes.

Otherwise, notes of psychotherapy sessions are treated in the same manner as the remainder of the clinical record or file. In cases in which clients do not authorize release of their records, HIPAA details procedures that a psychologist may follow upon receiving a subpoena not accompanied by a court order to disclose those materials. These issues emphasize an important practice tip: At the beginning of treatment, psychologists should inform their clients in the informed consent document and first session discussions of the risk that their confidential information may be disclosed in response to a subpoena or court order.

A request for psychological test data and test materials present other concerns. Although a client's test data (including raw and scaled scores and client responses to test questions or stimuli) may be released in response to a proper subpoena, the disclosure of test materials (including manuals, instruments, protocols and test questions) may require the safeguard of a protective order from the court. The APA Ethics Code requires psychologists to "make reasonable efforts to maintain the integrity and security of test materials and other assessment techniques consistent with law . . ." in order to not threaten the validity of psychological tests and their value as a measurement tools (APA Ethics Code, Standards 9.04, 9.11).

Psychologists have numerous ethical, professional and legal obligations related to the release of client records, test data and other information in the legal context. Many of these obligations may favor disclosure, including, in particular, the general obligation of all citizens to give truthful and complete testimony when required to do so. But there are often conflicting duties and principles that favor withholding such information. These may include obligations to:

  • Clients or other individuals who receive treatment and/or are given psychological tests.
  • The public (to avoid public dissemination of test items, questions, protocols or other test information that could adversely affect the integrity and continued validity of tests).
  • Test publishers, including contractual obligations between the psychologist and test publishers not to disclose test information and obligations under the copyright laws.
  • Other third parties, such as employers.

A special type of third-party obligation may arise in forensic contexts if, for example, a psychologist performed work with a litigant for an attorney. In such cases, the key concern is whether records from that work with the litigant is protected from disclosure under the attorney work product privilege.

Strategies for dealing with subpoenas

Psychologists, in consultation with an attorney if needed, should consider six strategies when issued a subpoena:

1. Determine whether the request for information carries the force of law

The psychologist must establish whether he or she has received a legally valid demand for disclosing test data and client records. For example, to be valid, a subpoena should generally allow sufficient time to respond to the demand for materials and provide for some time for the opposing side to quash such a demand if appropriate. If a demand is not legally enforceable for any reason, then the psychologist has no legal obligation to comply with it and may have no legal obligation to respond.

Even a demand that claims to be legally enforceable may not be. For example, the court issuing the subpoena may not have jurisdiction over the psychologist or his or her records: A subpoena issued in one state, for example, may not be legally binding on a psychologist who lives and works in another state. Or, the subpoena may not have been properly served to the psychologist — some states may require service in person or by certified mail. A psychologist should consult with an attorney in making such a determination.

If the psychologist concludes that the demand is legally valid, then a formal response to the attorney or court is required, whether it is compliance with or opposition to the demand, in whole or in part. A psychologist's obligation to respond to the subpoena is not necessarily the same as those under a court order (see below under "File a motion to quash the subpoena or file a protective order").

2. Contact the client

Clients may have a legally protected interest in preserving the confidentiality of their records. So, if a psychologist receives a subpoena or notice requiring that he or she divulge a client's records or test data, the psychologist may discuss the implications of the demand with the client (or his or her legal guardian). The psychologist may also consult with the client's attorney when appropriate and with the client's valid consent.

When talking with the client, the psychologist should explain which information has been demanded, the purpose of the demand, the entities or individuals to whom the information is to be provided, and the possible scope of further disclosure by those entities or individuals. After that discussion, a legally competent client or the client's legal guardian may consent to allow the psychologist to produce the data. Generally, such consent is required to be in writing, which helps to avoid future conflicts or legal entanglements with the client over the release of confidential tests or other records. The client's consent may not, however, resolve the potential confidentiality claims of third parties (such as test publishers).

The psychologist may want to emphasize to the client that when he or she agrees to release information requested, he or she cannot specify or limit which information is released. Rather, the entire record — including psychotherapy notes, billing records, administrative notes and more — will be available. The scope of the release may be the subject of negotiation among attorneys, however, so if the psychologist believes that a release would harm the client, he or she should voice his or her concerns and object to the release on that basis.

3. Negotiate with the requester

If a client does not consent to release the requested information, the psychologist — often through counsel — may seek to prevent disclosure through discussions with legal counsel for the requesting party. The psychologist's position in such discussions may be bolstered by legal arguments against disclosure, including the psychologist's duties under evidence rules regarding psychotherapist–patient privilege. These rules often allow the psychologist to assert privilege on behalf of the client in the absence of a specific release or court order. (Some possible arguments are outlined in the section below, "Consider possible grounds for opposing or limiting production of client records or test data.") Such negotiations may explore whether there are ways to achieve the requesting party's objectives without divulging confidential information, perhaps by disclosing nonconfidential materials instead. Psychologists may also be able to negotiate to avoid compelled testimony.

4. File a motion to quash the subpoena or file a protective order

If negotiation is not successful, it may be necessary to file a motion for relief from the obligations imposed by the demand for confidential records.

motion to quash is a formal application made to a court or judge to have a subpoena vacated or declared invalid. There may be grounds for asserting that the subpoena or request for testimony should be quashed, in whole or in part. For example, the information sought may be protected by the psychotherapist–client privilege and therefore may not be subject to discovery, or it may not be relevant to the issues before the court (see below in the section "Consider possible grounds for opposing or limiting production of client records or test data"). This strategy may be used alone or in combination with a motion for a protective order.

A motion for a protective order assumes that the psychologist will produce the information asked for by the subpoena but asks that the court protect it from the untoward consequences of disclosing information. The primary focus of this strategy is to prevent or limit the number of people who see sensitive client and test information. A motion for protective order can establish procedures to note the materials as confidential and have them placed under seal, which prevents their disclosure to the public.

Generally, the motion may state that the psychologist is ethically obligated not to produce the confidential records or test data or to testify, unless compelled by the court or with the consent of the client. It may include a request that the court consider the psychologist's obligations to adhere to federal requirements (such as HIPAA) and to protect the interests of the client, the interests of third parties (such as test publishers), and the public's interest in preserving the integrity and continued validity of the tests themselves. The motion might also attempt to suggest ways to minimize the adverse consequences of a disclosure. For example, the psychologist may suggest that the court:

  • Direct the psychologist to provide test data only to another appropriately qualified professional designated by the court or by the party seeking the information.
  • Limit the use of client records or test data to prevent wide dissemination. For example, the court might order that the information be delivered to the court, be kept under seal, and be used solely for the purposes of the litigation and that all copies of the data be returned to the psychologist after the litigation is terminated.
  • Limit the categories of information that must be produced. For example, client records may contain confidential information about a third party, such as a spouse, who may have independent interests in maintaining confidentiality, and such data may be of minimal or no relevance to the issues before the court.
  • Determine for itself, through a nonpublic hearing or a review by the judge in chambers, whether the use of the client records or test data is relevant to the issues before the court or whether they might be insulated from disclosure, in whole or in part, by the therapist–client privilege or another privilege (such as attorney–client privilege).
  • Deny or limit the demand because it is unduly burdensome on the psychologist (see, e.g., Federal Rule of Civil Procedure 45(c)).
  • Shield "psychotherapy notes" if the psychologist keeps separate psychotherapy notes as defined by the Privacy Rule (see Security and Privacy, 2015).
5. Determine whether to testify

If a psychologist is asked to disclose confidential information during questioning at a deposition, he or she may refuse to answer the question only if the information is privileged. If there is a reasonable basis for asserting a privilege, the psychologist may refuse to provide test data or client records until ordered to by the court.

A psychologist who refuses to answer questions without a reasonable basis may be penalized by the court, which may include requiring the psychologist to pay the requesting parties' costs and fees in obtaining court enforcement of the subpoena. For these reasons, it is advisable that a psychologist be represented by his or her own counsel at the deposition.

6. Consider possible grounds for opposing or limiting production of client records or test data

There are several options for resisting a demand to produce confidential client information. They include that:

  • The court does not have jurisdiction over the psychologist, the client records, or the test data or the psychologist did not receive a legally sufficient demand asking him or her to produce the information.
  • The psychologist does not have custody or control of the records or test data that are sought — for example, they may belong to the psychologist's employer, not to the psychologist.
  • The therapist–client privilege insulates the records or test data from disclosure. The rationale for the privilege, recognized in many states, is that the openness necessary for effective therapy requires clients to expect that all records of therapy, contents of therapeutic disclosures and test data will remain confidential. Disclosure would be a serious invasion of the client's privacy. The psychologist is under an ethical obligation to protect the client's reasonable expectations of confidentiality (APA Ethics Code, Ethical Standards, Section 4). There are important exceptions to this protection that negate the privilege. For example, if a client or former client is a party to the litigation and has raised his or her mental state as an issue in the proceeding, the client may have waived the psychotherapist-patient privilege. This varies by jurisdiction, with most jurisdictions holding a broad patient-litigant exception to privilege, with a few construing the patient-litigant exception much more narrowly. It is important that the psychologist be aware of the law in the relevant jurisdiction since this may ultimately control the issue about release of (otherwise) confidential client information. In this circumstance, the fact that a client who is a party to a legal case does not want to consent to release of information may not ultimately be dispositive on the issue. In such a case, the psychologist should discuss the issue of potential patient-litigant exception with the client's attorney, to determine if the records will need to be turned over due to the exception and to obtain any needed authorizations from the client.
  • The information sought is not relevant to the issues before the court.
  • Public dissemination of test information, such as manuals or protocols, may harm the public interest because it may affect responses of future test populations.
  • Test publishers have an interest in the protection of test information, and the psychologist may have a contractual or other legal obligation (e.g., copyright laws) not to disclose such information.
  • Psychologists have an ethical obligation to protect the integrity and security of test information and data, including protecting the intellectual property and unauthorized test disclosure, and to avoid misuse of assessment techniques and data. Psychologists are also ethically obligated to take reasonable steps to prevent others from misusing such information.
  • Some court rules allow the party receiving the subpoena to object to the subpoena's demand or ask that the demand be limited on the basis that it imposes an undue burden on the recipient (see, e.g., Rule 45(c) of the Federal Rules of Civil Procedure, 2014).

Ultimately, the judge's ruling controls in a court. Psychologists who are not violating human rights and who take reasonable steps to follow Standard 1.02 of the Ethics Code and inform the court of their requirements under the Ethics Code will not be subject to disciplinary procedures for complying with a court order directing them to produce information. Protecting patient privacy when the court calls can be complicated. To respond appropriately, psychologists should weigh ethical responsibilities and legal demands. Psychologists who have questions should consult legal counsel.

By APA’s Committee on Legal Issues


This article is condensed from "Strategies for Private Practitioners Coping With Subpoenas or Compelled Testimony for Client Records or Test Data or Test Materials," which appeared in Professional Psychology: Research and Practice, Vol. 47(1), Feb 2016, 1–11. To read the full article, which includes all citations and appendices, go to www.apa.org/about/offices/ogc/private-practitioners.pdf (PDF, 260KB).

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01 Jun 2017

5 Ways to Avoid Malpractice

5 Ways to Avoid Malpractice

Experts share the most common pitfalls that make practitioners vulnerable to malpractice claims and licensing board complaints — and how to avoid them.

Throughout their careers, psychologists are faced with myriad ethical questions or challenges, potential complaints to licensing and regulatory authorities, and possibly even threats of legal action. According to estimates by The Trust, which provides professional liability insurance and financial security products for psychologists, over a 20-year career, 40 percent of psychologists will receive a licensing board complaint. Significantly fewer, just under 2 percent, will have a malpractice lawsuit filed against them.

But even a letter of reprimand, the lowest form of disciplinary action from a licensing board, can have serious emotional and financial consequences for a practitioner, says Jana N. Martin, PhD, CEO of The Trust.

"The impact of a licensing board complaint can often be pretty severe in terms of continuing to practice because if you're found guilty or in violation, your license can be suspended or revoked," Martin says. "While it's not likely that a successful malpractice suit will have a direct impact on a psychologist's license, it can sometimes have indirect consequences on licensure."

Martin notes that the top reason for disciplinary sanctions from licensing boards — as well as malpractice complaints — is sexual misconduct and other boundary crossing or multiple relationship violations. Other common reasons for discipline include participating in child custody disputes (particularly when it's outside one's area of expertise), breaches of confidentiality, and patient suicide or attempted suicide.

"We're taught in grad school that the No. 1 malpractice offense is inappropriate sexual relationships with clients, and I think many of us have an image in our head about what kind of psychologist would engage in that — and that it's not us," says APA Practice Director of Research and Special Projects Vaile Wright, PhD. "But the reality is that we're all human, so it's important for early career psychologists to make sure they're familiar with these ethical issues and what the Ethics Code has to say about them."

What do you need to know? We've asked several of psychology's leading ethics experts to share their advice on how practitioners can avoid the misunderstandings, hurt feelings and sticky situations that lead to hearings before ethics boards, lawsuits, loss of license or professional membership, or even more dire consequences.

1. Understand what constitutes a multiple relationship

Engaging in a sexual relationship with a client is the multiple relationship most of us think of, but this category is broader than that. It refers to having more than a therapeutic relationship with a client or trainee, "such as hiring your patient to be your gardener or seeing your gardener as a patient," Martin says. This often becomes most problematic in rural settings, but it's an area where a psychologist needs to be cautious and realize that he or she is increasing the probability of a board complaint if he or she engages in these relationships, she adds.

Martin also says The Trust has started seeing more boundary violations related to the use of technology — particularly social media.

"If a psychologist has a Facebook page, the decision about whether or not to allow a client to friend you on Facebook can lead to a multiple relationship and a loss of objectivity on both sides, and confidentiality can also be compromised in that kind of relationship," Martin says. It's important to discuss social media and let clients know the risks of interactions in that space in your informed consent (see Step 2).

2. Set clear guidelines up front

During your first session with a client or patient, establish distinct boundaries as to what services you will provide, and what you can't or won't do, says Stacey Larson, PsyD, JD, APA's director of legal and regulatory affairs.

"A lot of what we see are difficulties with not using a really good informed consent," she says. "It happens with both new and experienced psychologists, particularly those working with children whose parents are divorced or divorcing. They are hired as the child's therapist but then they get drawn into advocating for one parent or the other in a custody dispute, and that's outside the purview of what they do."

Having a comprehensive informed consent is also important when using technology with clients, particularly when it comes to how clinicians deal with emails and texts from clients, Larson says. She encourages psychologists to familiarize themselves with the APA Practice Organization's "Guidelines for the Practice of Telepsychology," and also points to effective informed consent and social media policies by San Francisco-based clinical psychologist Keely Kolmes, PsyD.

Martin agrees, noting that texting with a client — especially if your phone is not encrypted or you are not 100 percent positive the person you're texting is indeed your client — can make a practitioner vulnerable to confidentiality violations.

3. Practice self-care

Psychologists, of course, have much more going on in their lives than their careers. Spouses, friends, children, parents and illness can stress even the most balanced psychologist. The stressors can be particularly acute among early career psychologists who may be experiencing the stresses and excitement of getting married, buying a first home and starting a family, Wright says. The convergence of these stressful personal and professional experiences can often lead to burnout, and perhaps poor judgment.

"All of these new stressors can affect the work that you do, so it's really important for psychologists to think about the importance of self-care, and have strong knowledge of their own limits," she says. That means being able to recognize the warning signs — such as headaches, an upset stomach, a lack of concentration, irritability or anxiety, particularly during sessions with clients or interactions with coworkers or supervisees, which can indicate your personal problems might be seeping into your work. It's at these times that practitioners might be more likely to fall prey to ethical violations, such as inaccurate or careless charting and billing, inappropriate or excessive self-disclosure with a client, or confidentiality breaches, such as leaving client documentation in a public place, Wright says.

4. Make sure you're covered

Too often, business-of-practice issues such as professional liability and how to protect yourself aren't discussed during in doctoral training, Wright says.

"Because of that, I think malpractice insurance isn't always on people's radar," she says. "I know when I was working at the hospital before coming to APA and someone would ask me about malpractice insurance, I would say, ‘Oh, I'm covered by my organization.' But I'm not sure I actually knew what that meant."

She recommends that psychologists who are employed by others understand exactly what their employers' coverage includes, and determine whether there are gaps in that coverage that they might need to fill with their own malpractice insurance policy.

For example, you want to know what your liability limits are, what happens if the legal costs exceed your employer's limits, and if these limits are shared with other defendants. You should also consider that your employer's insurance may need to act in the best interest of the employer, instead of yours. These factors could increase your own personal financial liability if something happens, Wright says. Other questions to ask include whether you are covered for off-duty work, such as volunteering in a professional capacity, and whether your employer's malpractice policy provides license coverage, in the event that a client or colleague files a complaint with the state licensing board against you.

"That's not a lawsuit per se but your license has been questioned and you will likely still need to consult with a lawyer," she says.

When in private practice, it's also important to think about the kind of coverage you need given the work you do and your finances, and then shop around, Wright says. Cheaper is not always better, she says, and she encourages psychologists to factor in policyholder benefits, such as the availability of consultation services, she adds, noting that The Trust's Advocate 800 Consultation Service provides free confidential ethical and risk management consultation from licensed psychologists.

Psychologists who work with high-risk populations such as patients with personality disorders, severe mental illness or who are suicidal may want to increase their coverage, Martin says.

"There are many things that can go wrong very quickly with these patients, leaving psychologists who work with them more vulnerable to board complaints and malpractice claims," she says.

5. Stay connected

Given how often changes occur at the state and federal levels when it comes to laws and licensing board issues, it's critical for psychologists to stay informed, Wright says.

Belonging to professional groups — such as APA's Practice Organization and your state psychological association — that keep members up to date on changes that affect practice is a great way for practitioners to stay informed, she says.

Doing so can also lower your malpractice risk. A 2012 study found that the likelihood of being disciplined by a state board of psychology was lower for psychologists who belonged to their state psychological association (see Resources at bottom). What's more, many state associations also offer a mentorship program where early career psychologists can get one-on-one guidance on malpractice and other business of practice issues from a seasoned practitioner.

Larson also recommends contacting your state's licensing board with questions about state-specific policies, such as those about recordkeeping, confidentiality, general licensure requirements, renewals and continuing education. While APA provides guidance on many of these issues, each state has its own requirements governing how psychologists should practice lawfully and ethically.

"The licensing board seems a little scary at first, but they are the experts on the state law. So if you have a question about what the law asks you to do, they can be a really good resource," she says.

The APAPO, a companion organization to APA, advocates on behalf of practicing psychologists.

Resources

  • Knapp, S., & VandeCreek, L. (2012). Disciplinary actions by a state board of psychology: Do gender and association membership matter. In G. Neimeyer & J. Taylor (Eds.). Continuing professional development and lifelong learning: Issues, impacts and outcomes (pp. 155–158). Hauppauge, NY: NOVA Science Publishers.
  • Knapp, S., Younggren, J. N., VandeCreek, L., Harris, E., & Martin, J. N. (2013). Assessing and managing risk in psychological practice: An individualized approach (2nd ed.). Rockville, MD: The Trust.
  • Pope, K., & Vasquez, M. (2016). Ethics in psychotherapy and counseling: A practical guide (5th ed.). Hoboken, NJ: Wiley.

By Amy Novotney


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14 Feb 2017

Thomas Plante Investigates the Ethical Life

Thomas Plante Investigates the Ethical Life
Over his career, APA Fellow Thomas Plante has studied various social issues through the prism of ethics.

Thomas G. Plante, PhD, a San Francisco Bay–area psychologist and Fellow of the American Psychological Association, writes often about the practicalities of living an ethical life.

“Treat everybody with respect and compassion, even if you don’t like them or agree with them,” says Plante. “That’s certainly how I organize my life.”       

Plante is the Augustin Cardinal Bea, S.J. University Professor in psychology at Santa Clara University (SCU) in Santa Clara, Calif., a researcher, clinician and author of 21 books and more than 200 scholarly professional articles and chapters.

Plante says our society has moved away from endorsing positive practices such as “goodness,” which he defines as behavior that is not only respectful and compassionate, but also “civil and gracious, working for the benefit of the whole, acknowledging that we all have a part to play.” He thinks we need to bring goodness back into style.

Plante’s latest book, Graduating with Honor: Best Practices to Promote Ethics Development in College Students, written with his wife, Lori G. Plante, PhD, also a psychologist, centers on interviews the two did with students at SCU, a Jesuit school where ethics is a required course for every student, and Dartmouth College, a secular Ivy League school in Hanover, N.H., where their son is an undergraduate.

What the Plantes found was that “students at both places can see that ethics could be helpful to them,” but the Dartmouth students, who are not required to take ethics courses, were “like a dry sponge” on the topic, “excited” to hear about how they might operate decently and meaningfully in the world, Plante says. He found that heartening, and would love to see all students at all educational levels receive ethics training. He doesn’t envision ethics training as telling them what to do, but rather as giving them the tools to make “thoughtful” decisions.

“Ethics are just the tools, a way to be intentional about who you become. In our heart of hearts, we all want to strive toward goodness,” he says.

Ethics is only one of Plante’s specializations. His dissertation was on the psychological effects of aerobic exercise, and he is still professionally interested in health. Religion has become a major focus, though. Psychology and religion have had “a tumultuous relationship,” but religion has a role to play in an ethical life, Plante says. “How does that impulse get nurtured? Where do you go when you struggle? How are you inspired? It’s harder to do when you’re all by yourself,” he says.

Plante is a leading expert on one of the most demoralizing scandals of our time—the sexual abuse of minors by members of the clergy. In 1989, when Plante was a fledgling ethics instructor at Stanford University, he fell into the assignment that would impact his career for decades to come.

“A Catholic priest friend who knew I was a psychologist called and said, ‘We have some guys who are being accused of being sexually inappropriate. Can you see if there’s anything to this?’” he recalls.

Plante quickly got to work and found that sexual abuse by priests was real, and that it was not rare. He also realized there wasn’t a body of research on the topic. He rounded up several other psychologists around the country who were also looking into the issue, and by the late 1990s, they had enough collective knowledge to put together a book, Bless Me Father For I Have Sinned, which Plante contributed to and edited. By that time, Plante and his colleagues could estimate with some confidence that between 2 and 6 percent of Catholic clergy members had had a sexual experience with a minor. “The actual figure wound up at 4 percent,” he says.

The research team thought their book would create a sensation when it came out in 1999, but only two low-level reporters even attended the press conference they hosted. Only when “the stars aligned” in a “confluence of factors” that included the fact that Boston, Mass., was a “Catholic-dense area” did clerical abuse finally get the attention it deserved, after the Boston Globe’s 2002 Pulitzer Prize–winning Spotlight investigation. “It should have hit the press in a big way before then,” Plante says.

Once clergy sexual abuse came to the attention of the public, though, for a while “I did nothing but talk to the media [about the topic], teach classes and see my patients,” he says.

Plante has written two more books on the sexual abuse scandal in the Catholic Church, one in 2004 and one in 2011. Even now, it’s a “hot, hot topic,” he says. Plante points out that many people still feel tremendous anger toward the church, not only for the fact of the abuse, but also for the avoidant way bishops and other church officials handled it. “Hard data” shows that sexual abuse among the Catholic clergy, while “horrific,” is roughly what occurs among the clergy of other faiths, and is significantly lower than for the adult male population at large, Plante notes; he treats many clerics for issues like alcohol and pornography addiction, depression and anxiety. “We forget that those [clerics] are very human people, with the problems and issues anybody has.”

Plante himself is an “engaged” Catholic, “more of a Vatican II, peace, social justice, Dorothy Day Catholic.” His family belongs to both a Catholic parish and a Jewish congregation (his wife is Jewish). He grew up in Providence, R.I., in a latticework of light and dark, as he remembers it, created in large part by the “interesting juxtaposition” of the Catholic Church and organized crime in the city’s life.

“Everybody went to church,” but quite a few of them were criminals, too, he says. Like most people he knew, Plante’s family was Catholic, of Irish and French Canadian stock. His father was a builder, “but he only built in certain towns outside the circle of Providence, the ones that weren’t influenced by the mob,” he recalls.

The influence of this “quirky place” may be one reason Plante is not surprised when he finds the bad and the good jumbled together in the same institution, or the same person. People want to be good but sometimes “lose their way,” he says.

“It keeps coming back to this question: How do you want to be in the world?” he says. In a time when “everything has turned tabloid, ethics could be a terrific tool to get ourselves back on course.”

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