Confidentiality Secrets: What the NCE REALLY Expects You to Know

Summary

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NCE Study Guide — Episode Summary

Podcast: NCE Study Guide
Host: Glenn Ostlund
Episode: Confidentiality Secrets: What the NCE REALLY Expects You to Know
Date: February 26, 2026

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Episode Overview

This episode explores the nuanced and high-stakes topic of confidentiality as it relates to the National Counselor Exam (NCE) and the counseling profession at large. The hosts break down where the boundaries of confidentiality lie, when those boundaries must be crossed, and the exam’s expectations for informed consent, privileged communication, duty to warn and protect, mandated reporting, and the complex gray areas involving minors. Through conversational dialogue, they offer memorable scenarios, key distinctions, and actionable strategies designed to help listeners master one of the NCE’s most challenging ethical domains.

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Key Discussion Points & Insights

1. Setting the Stage: Why Confidentiality Matters

• Confidentiality is the bedrock of counseling trust.
  • “Without it, there is no therapy. If a client doesn’t believe their secrets are safe, they simply won’t do the work.” (A, 02:54–03:19)
• Confidentiality is not absolute—client welfare trumps secrecy.
  • Hierarchy of Values:
    1. Protect client welfare
    2. Maintain confidentiality
    3. Break confidentiality only when legally or ethically required
  • “Client welfare actually trumps secrecy.” (B, 03:46–03:49)
• NCE focuses on gray areas, not obvious breaches.
  • “They’re going to ask you about the gray areas where your duties collide.” (A, 01:09–01:13)

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2. Informed Consent: The Starting Point

• Confidentiality starts before the first session—at paperwork.
  • “It starts in the paperwork. Informed consent is your contract.” (A, 04:05–04:17)
• Exam strategy: Always review informed consent first, not just build rapport.
  • “The answer is almost always, review informed consent.” (A, 04:59–05:14)
• Scenario: Failing to explain confidentiality limits beforehand can damage trust if disclosure is necessary.
  • “You were in trouble because you violated the client’s autonomy by not warning them up front.” (A, 05:47–05:59)

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3. Confidentiality vs. Privileged Communication

• Ethics vs. law distinction:
  • “Confidentiality is about ethics. Privileged communication is about the law.” (A, 06:29–06:36)
  • “Privilege belongs to the client, not the counselor. The client owns the privilege… You assert privilege on their behalf until they explicitly tell you otherwise.” (A, 07:07–07:25)
• Subpoena scenario — Always consult, don’t immediately comply:
  • “First, you consult. Call your supervisor or your legal counsel. Second, you contact the client… If a judge orders you to release it… You release the minimal necessary information.” (A, 08:08–08:53)
• Key quote:
  • “You are complying with the law while still acting as a shield for the client’s privacy to the greatest extent possible.” (A, 09:06–09:14)

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4. Duty to Warn and the Tarasoff Standard

• Origin: Tarasoff case created the legal precedent for duty to warn/protect if a client poses foreseeable danger to an identifiable person. (A, 09:19–09:52)
• Risk assessment is key: Only break confidentiality for a “serious and foreseeable risk to an identifiable person.” (A, 09:55–10:06)
• Sample dialogue:
  • Host B offers two scenarios:
    • Vague threat: Don’t report — continue assessment
    • Specific plan with means and target: Duty to warn is triggered
  • “Your job there is to continue assessment, explore the anger. If you called the police on that, you’d be breaching confidentiality unethically.” (A, 10:22–10:39)
  • “You have a plan... means... timeline... identifiable victim... Duty triggered? Absolutely.” (A, 10:49–11:02)
• Action Steps for Duty to Warn:
  1. Assess seriousness
  2. Consult
  3. Warn victim and authorities
  4. Document everything
  • “If you didn’t write it down, it didn’t happen.” (A, 11:25–11:29)

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5. Mandated Reporting

• Focus: Applies to suspected or known abuse of children, elderly, or dependent adults.
• Standard for action is 'reasonable suspicion' not absolute proof:
  • “The standard is reasonable suspicion. It is not proof beyond a reasonable doubt. You are not the judge and you are not the detective.” (A, 11:59–12:10)
• Exam trap: Don’t investigate or interrogate further, just report.
  • “Those are almost always wrong answers. Because that’s investigating. Your job is to report to child protective services.” (A, 12:21–12:23)
• Scenario: Child discloses uncomfortable touching by a relative—immediately report, don’t ask clarifying questions. (A/B, 12:36–12:47)

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6. Minors: Navigating Parental Rights & Adolescent Confidentiality

• Minors’ privacy vs. parents’ rights—navigate collaboratively.
  • “The general strategy here is answers that emphasize collaboration with parents while still protecting the minor’s welfare are usually best.” (A, 13:22–13:37)
• Classic pregnant teen scenario:
  • Pregnancy alone does not trigger mandated reporting unless safety or abuse is involved; maintain confidentiality unless state law directs otherwise.
  • “Your job is to assess safety. If she is safe, you encourage open communication... But you don’t just pick up the phone and out her.” (A, 14:39–14:50)
  • “We facilitate the family system. We don’t detonate it.” (A, 15:13)

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7. Synthesis: The Exam-Day Decision Ladder

• Crisis? Protect client welfare first.
• Otherwise, follow ethical code, legal exceptions, and consult/document.
  • “It flows like this: Protect client welfare, then follow the ethical code, then no legal exceptions, and finally, consult and document.” (A, 15:26–15:42)
• Exam tip: If torn between answers, the one involving consultation is usually correct.
  • “If you are torn between two answers and one of them involves consultation, choose the consultation one.” (B, 15:54–16:03)
  • “The NCE loves counselors who seek supervision.” (A, 16:03–16:11)

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Notable Quotes & Memorable Moments

• “Trust is the currency of the trade.” (B, 03:19–03:22)
• “No gotcha moments.” (A, 05:59–06:01)
• “It’s about being a gatekeeper, not a sieve.” (B, 09:03–09:06)
• “Confidentiality ends where public peril begins.” (B, 09:52–09:55)
• “If you didn’t write it down, it didn’t happen.” (A, 11:25–11:29)
• “We facilitate the family system. We don’t detonate it.” (A, 15:13)
• “Don’t be a hero. Be a professional.” (B, 17:02–17:05)

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Timeline & Timestamps for Key Segments

| Timestamp | Segment | |-----------|-----------------------------------------------------------| | 00:44 | Definition of confidentiality and central ethical dilemma | | 02:08 | Structure of the episode introduced | | 03:32 | NCE’s hierarchy of values for confidentially | | 04:05 | Informed consent explained | | 05:14 | Scenario: Failing to review informed consent | | 06:16 | Confidentiality vs. Privileged Communication | | 07:43 | Handling subpoenas and privilege | | 09:19 | Tarasoff and duty to warn | | 10:10 | Examples: Threat assessment in practice | | 11:29 | Four-step duty to warn protocol | | 11:35 | Mandated reporting vs. duty to warn | | 12:36 | Mandated reporter scenario: Reporting child abuse | | 13:09 | The “minors” confidentiality challenge begins | | 13:42 | Pregnant teen scenario | | 15:26 | Synthesizing exam-day strategy | | 15:54 | Exam tip: Consultation answers |

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Final Thoughts & Exam Takeaways

• Always start with client welfare and informed consent.
• Understand and clearly differentiate legal and ethical concepts (privilege vs. confidentiality).
• Know your reporting duties, triggers, and when to document and consult.
• For minors, balance parental involvement with adolescent privacy—facilitate, don’t fracture.
• When in doubt, consult and document—it’s the Scantron shortcut.
• “Knowing your limits is just as important as protecting client secrets. You don’t have to carry the burden alone. That’s why consultation exists.” (A, 16:49–17:02)

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This accessible but deeply informative episode is essential listening for anyone preparing for the NCE, and its practical, scenario-based strategies make complex ethical rules clear and memorable—even for those far from the exam room.

Transcript

[A]

He may even identify himself with it

[B]

and believe that he is what he appears to be. Welcome to the NCE Study Guide. I'm really looking forward to this one because frankly, we are tackling a subject that keeps a lot of counseling students up at night.

[A]

Oh, absolutely. It is a massive stressor.

[B]

Yeah, it really is. It's one of those topics where your gut instinct as just a helpful, transparent human being can actually lead you straight into a trap on the exam that is completely accurate.

[A]

I mean, it's the area where being nice often directly conflicts with being ethical. We're talking about the legal and ethical minefield of confidentiality.

[B]

Right. Because we all know the baseline rule. Right. What happens in the session, stays in the session. Zip it, lock the file. But the, the central tension we are unpacking today, for everyone listening, is what happens when keeping a secret is actually the wrong thing to do.

[A]

That is the exact pressure point. And this is where the NCE really tests your mettle. You know, they aren't going to ask you easy questions like should you gossip about your client at a party?

[B]

Right. The obvious stuff.

[A]

Exactly. They're going to ask you about the gray areas where your duties collide.

[B]

So let's make it official. What is the title of the module we are diving into today?

[A]

We are covering confidentiality secrets. What the NCE really expects you to know. And if you are following along with the content outline, which you absolutely should be, this hits sections 1 1.6 through 1 1.10. The heavy hitters, the heaviest. And I want to set the stakes here for everyone listening. This isn't just about, you know, avoiding a lawsuit though. That's obviously nice.

[B]

Definitely a plus, right?

[A]

The NCE tests on a very specific hierarchy of values. If you can master the nuances of confidentiality, like knowing exactly when to hold it and exactly when to break it, you're going to answer a huge percentage of the ethics questions correctly. It is an incredibly high yield topic.

[B]

That is exactly what we like to hear. High yield.

[A]

Yeah.

[B]

So here is how we are going to structure this deep dive today. We're going to start with the foundation, which is informed consent.

[A]

Yep.

[B]

Sounds a little boring, but it's actually your first line of defense. Then we are going to untangle the absolute mess that is the difference between confidentiality and privileged communication.

[A]

Oh, man. That distinction alone trips up probably half the students taking the exam.

[B]

Right. It's so confusing. And then we're going to get into the scary stuff. Duty to warn the Tarasoff standard and mandated reporting. And finally we will wrap up with what I honestly think is the trickiest area minors. You know, that tug of war between parent rights and kid privacy.

[A]

It is a packed agenda, but I promise, if we follow the logic, it all fits together into a really coherent framework.

[B]

Okay, let's dive into section one, the foundation. Give us a little context here. Why is confidentiality the hill we die on in this profession?

[A]

Well, historically speaking, confidentiality is the thing that actually separated counseling from other helping roles, like the clergy you're teaching. It is the absolute bedrock of the therapeutic alliance. Because without it, without it, there is no therapy. If a client doesn't believe their secrets are safe, they simply won't do the work. They won't disclose the vulnerable. Really painful stuff if they think you're going to blab to their boss or their spouse.

[B]

Right. Trust is the currency of the trade.

[A]

Exactly. But. This is the big but for the exam. It is not absolute. The NCE assumes you understand a specific hierarchy of values.

[B]

Okay, lay it on us. What is this hierarchy?

[A]

Okay, visualize this like a ladder. The top rung, the most important thing is protect client welfare. That is number one.

[B]

Okay.

[A]

The second rung is maintain confidentiality. And the third is break confidentiality only when legally or ethically required.

[B]

So client welfare actually trumps secrecy.

[A]

Always. If keeping a secret hurts the client or hurts someone else, the hierarchy shifts immediately.

[B]

Okay, that makes sense. So let's talk about where this starts. Practically informed consent. I feel like a lot of people think confidentiality starts when the client sits on the couch, grabs a tissue and starts crying.

[A]

And that would be a fatal flaw in the exam. Confidentiality starts before therapy begins. It starts in the paperwork. Informed consent is your contract. It tells the client the rules of the road before they even turn on the engine.

[B]

What specifically does the NCE want to see in that document? Like, what are they testing for?

[A]

They look for specific elements you need. The nature and purpose of counseling, the fees and billing, your recordkeeping practices, client rights, and most importantly for this discussion, the limits of confidentiality.

[B]

That limits part is crucial. I've seen this come up as a specific strategy tip for the exam.

[A]

Oh, absolutely. Here is a pattern you will see over and over. You get a question that asks, what should the counselor do first in a new professional relationship? Or a client comes in for their first session, what's the priority?

[B]

And my instinct is always, you know, build trust, establish rapport. But that's not the answer, is it?

[A]

It is almost never the answer. The answer is almost always, review informed consent. Because if you don't establish the rules. You can't enforce them later without completely destroying the relationship. You have to tell them when you will break their trust before you actually do it.

[B]

Let's play out a scenario just to make this concrete. Let's say I'm a counselor, and I didn't do a great job reviewing the paperwork. I just sort of slid it across the desk and said, sign here.

[A]

Happens all the time, right?

[B]

So a few months later, my client tells me something that triggers a mandated report, maybe involving child abuse. I have to report it. So I do. The client comes back, looks at me and says, whoa, you never told me you were going to call the cops on me. I thought this was private.

[A]

That is the nightmare scenario right there.

[B]

Yeah.

[A]

And ethically, you are in big trouble.

[B]

Because I reported it.

[A]

No, not because you reported it. You had to do that. You were in trouble because you violated the client's autonomy by not warning them up front. The NCE expects you to have that conversation before the disclosures happen.

[B]

So basically, no gotcha moments.

[A]

Exactly. Informed consent. Inform isn't just a legal shield for you to hide behind. It's a respect mechanism for the client.

[B]

I really like that framing. Okay, moving on to section two. This is one that confuses people constantly. Confidentiality versus privileged communication.

[A]

Yes. This is a very technical distinction, but you absolutely need to know it for the test.

[B]

Because to the average person, these sound like synonyms, right? It's confidential, it's privileged, it's private. It all means the same thing. What is the actual difference?

[A]

Think of it. This. Confidentiality is about ethics. Privileged communication is about the law.

[B]

Okay, unpack that a bit more.

[A]

Confidentiality is your ethical obligation as a counselor. It's your job description. It's what the code of ethics says you must do. And it applies everywhere. In your office, in the grocery store, at a dinner party.

[B]

You can't just gossip about your clients at the gym.

[A]

Exactly. Now, privileged communication is a legal concept. It is what prevents the courts from forcing you to reveal information in a legal proceeding.

[B]

Okay, so confidentiality is what happens in my office, and privilege is what happens in a courtroom.

[A]

That's a really good shorthand.

[B]

Yeah.

[A]

And here is the major aha moment for the test. Privilege belongs to the client, not the counselor.

[B]

Wait. Explain that. I hold the secret, but I don't hold the privilege.

[A]

Correct. The client owns the privilege. They are the ones who get to decide if they want to waive that protection or not. You are just the guardian of it.

[B]

Okay?

[A]

You assert privilege on their behalf until they explicitly tell you otherwise.

[B]

So let's look at a scenario. Because the NCE loves to throw legal trouble at you. I'm a counselor. I'm sitting in my office drinking my coffee, and a process server walks in and hands me a subpoena for a client's records.

[A]

Classic test scenario.

[B]

What do I do? Because my instinct says, well, it's a legal document. I have to comply or I'm going to jail. But my other instinct says I have to protect my client. Do I just ignore it? Do I shred it? Do I hand over the file immediately?

[A]

Well, ignore it is rarely the right answer on the nce. You never just ignore a legal document, but you also definitely don't just hand over the file.

[B]

So I'm stuck in the middle.

[A]

Here are the exact steps the NCE wants to see. First, you consult. Call your supervisor or your legal counsel.

[B]

Okay.

[A]

Second, you contact the client. You tell them, hey, I got this subpoena. Do you want me to release these records or do you want to claim privilege?

[B]

And if they say no way, don't

[A]

show show them anything, then you assert privilege on their behalf. You write back to the court saying, I cannot release these records because they are privileged. Now, if a judge orders you to release it.

[B]

Wait, an order is different from a subpoena?

[A]

Yes. A subpoena is often just from a lawyer. A court order is from a judge. But let's say you are eventually forced by a judge to release the info. The final key test point is this. You release the minimal necessary information.

[B]

You don't dump the whole file on their desk.

[A]

Never. You provide exactly what is asked for and nothing more. If they want dates of attendance, you give them dates of attendance. Do not send them the deeply personal trauma narrative.

[B]

I love that distinction. It's about being a gatekeeper, not a sieve.

[A]

Precisely. You are complying with the law while still acting as a shield for the client's privacy to the greatest extent possible.

[B]

Alright, let's get into the really heavy stuff. Duty to warn. This sounds like a movie plot.

[A]

It does. But it comes from a very tragic real life situation. The Tarasov case from 1976.

[B]

Give us the quick backstory on that.

[A]

Without getting too bogged down in the legal history, the gist is that a client told a university psychologist he intended to kill a woman named Tatiana Tarasov. The psychologist did tell the campus police, but nobody actually warned Tatiana or her family.

[B]

Oh, wow.

[A]

Yeah. And the client killed her. So the courts eventually ruled that the psychologist had a duty to warn or a duty to protect the Intended victim.

[B]

So confidentiality ends where public peril begins.

[A]

Right. But the NCE is very specific about the trigger. You don't just break confidentiality for any bad thought someone has. It has to be a serious and foreseeable risk to an identifiable person.

[B]

Okay, I want to test this. I going to act out two clients. You tell me if the duty is triggered.

[A]

Let's do it.

[B]

Client A says, I hate my boss. He is ruining my life. Honestly, sometimes I just wish he would disappear or get hit by a bus.

[A]

Okay, verdict on that one is do not report.

[B]

Why? I said I want him to disappear.

[A]

Because it's vague. There's no plan. There's no foreseeable imminent action. It's just an expression of frustration. Your job there is to continue assessment, explore the anger. If you called the police on that, you'd be breaching confidentiality unethically. You might actually lose your license for reporting that.

[B]

Got it. Okay. Client B says, I'm done. I bought a gun yesterday. I'm going to my boss's house tomorrow at 3pm when he gets home, and I'm going to shoot him.

[A]

Duty triggered? Absolutely.

[B]

Because it's highly specific.

[A]

Yes. You have a plan. You have the means that you have a gun. You have a specific timeline, which is tomorrow at 3. And you have an identifiable victim, the boss.

[B]

So once that alarm bell rings in your head during the exam, what is the action plan?

[A]

The NCE looks for a clear sequence. First, assess seriousness, which you just did. Second, consult. Always get a second opinion if you can. Third, warn the victim A and the authorities. You usually have to try to notify the person in danger and call the police. And finally, document everything you did.

[B]

Document seems to be the answer to almost everything in ethics.

[A]

If you didn't write it down, it didn't happen. You need to prove you took steps to protect the public.

[B]

Okay, let's slide into section four, Mandated reporting. Now, this is different from Tarasoff, right?

[A]

Yes. Tarasoff is usually about preventing future violence regarding a specific threat. Mandated reporting is usually about responding to ongoing or past abuse of vulnerable populations. So children, the elderly and dependent adults.

[B]

The big question I always hear from students is about the standard of proof. Do I need to prove the abuse actually happened before I make the call?

[A]

No. And this is a huge trap on the exam. The standard is reasonable suspicion. It is not proof beyond a reasonable doubt. You are not the judge and you are not the detective.

[B]

So if I try to play detective, I'm actually doing it wrong?

[A]

Yes. There are questions on the exam that will give you options like ask the child more questions to verify the story or call the parents to clarify what happened. Those are almost always wrong answers.

[B]

Because that's investigating.

[A]

Right? Your job is to report to child protective services or the appropriate agency. They are the investigators. If you start asking too many questions, you might contaminate the investigation or even tip off the abuser.

[B]

So let's look at an example. A 7 year old says, my uncle touches me in ways I don't like when he babysits.

[A]

That is reasonable suspicion.

[B]

Boom. Call immediately.

[A]

Immediate report.

[B]

Yeah.

[A]

You don't call the mom to ask if the uncle is a weird guy. You don't ask the kid to draw a diagram. You call cps.

[B]

It feels aggressive, but I see why the line is drawn there. The safety of the child is the top rung of that ladder we talked about earlier.

[A]

Exactly. Client welfare overrides absolutely everything else.

[B]

Alright, Section five, the grayest of the gray areas. Minors.

[A]

This is tricky because you have two competing forces. You have the parents who usually hold the legal rights to the records and you have the minor who really needs privacy to be able to trust you.

[B]

And the NCE loves to put you right in the middle of that tug of war.

[A]

They do. The general strategy here is answers that emphasize collaboration with parents while still protecting the minor's welfare are usually best. You aren't trying to lock the parents out, but you aren't just a snitch for the parents either.

[B]

Let's look at the classic pregnant teen scenario. I mean this shows up in almost every study guide.

[A]

It's a classic for a reason. It tests multiple boundaries at once.

[B]

Okay, here's the scene. You have a 16 year old client. She tells you she is pregnant. She is terrified. She says, you cannot tell my parents. They will kill me.

[A]

Okay, let's pause on kill me. If she means that literally, like her life is an actual danger, that's a safety issue. But usually in this scenario she means they will be angry and disappointed. She is not in physical danger.

[B]

Right. Just normal teenage fear of getting grounded for life. So does the counselor tell the parents?

[A]

The knee jerk reaction for some is well, she's a minor, tell the parents. But the correct NCE analysis is usually protect confidentiality.

[B]

Wait, really? Even though she's pregnant?

[A]

Pregnancy itself does not trigger mandated reporting. Consensual sex between peers, assuming it doesn't violate specific age gap laws or pregnancy isn't abuse in the legal sense for reporting purposes.

[B]

So you don't call CPS because a teen is pregnant?

[A]

Correct. So Your job is to assess safety. If she is safe, you encourage open communication. You work with her to figure out how she might tell them. But you don't just pick up the phone and out her.

[B]

Because if you do that, you've blown the therapeutic alliance, she's never coming back,

[A]

and then she has no support system at all. The counselor is a balanced, ethical decision maker, not a tattletale. Unless there is a specific state law mentioned in the question that says otherwise, you lean toward maintaining the trust.

[B]

That is such a crucial distinction. It goes back to that investigator trap we talked about earlier. We aren't the morality police. We are support.

[A]

Precisely. We facilitate the family system. We don't detonate it.

[B]

Man, we've covered a lot of ground today. We've gone from the paperwork to the courtroom to the playground. What is the big takeaway here? How do we synthesize all of this for exam day?

[A]

If you are panicking in the middle of a question, I want you to remember this bottom line formula. It flows like this. Protect client welfare, then follow the ethical code, then no legal exceptions, and finally, consult and document.

[B]

That flowchart saves lives and grades.

[A]

It really does. Always start with welfare. If welfare is fine, look at the ethics. If the law intrudes like a subpoena, handle it. And always, always consult.

[B]

That brings me to my favorite exam strategy takeaway. If you are torn between two answers and one of them involves consultation, choose the consultation one.

[A]

It shows you know your limits. It shows you aren't a lone wolf trying to solve everything yourself. The NCE loves counselors who seek supervision.

[B]

I call my supervisors. Basically the C answer on a Scantron. That's always right.

[A]

Pretty much.

[B]

Well, this has been a fantastic review. I feel smarter already.

[A]

Me too. It's always good to refresh these things

[B]

before we sign off. I want to remind you. Yes? You listening right now? If this deep dive helped you make sense of the chaos, please give the show a five star rating and join Patreon to gain access to a growing library of study modules and meditations that cover the entire spectrum of the NCE core competencies.

[A]

The meditations are a game changer for test anxiety.

[B]

Seriously, they really are. They help you get out of your head and into the exam zone. Any final provocative thought to leave us with?

[A]

I'd say this. We focus so much on keeping secrets in this field. But remember, knowing your limits is just as important as protecting client secrets. You don't have to carry the burden alone. That's why consultation exists.

[B]

Love that. Don't be a hero. Be a professional.

[A]

Exactly.

[B]

Thanks for listening to this deep dive on confidentiality. Good luck with your studying and we will catch you in the next module.

[A]

Take care everyone.

[B]

One, two, three.