Confidentiality

For therapy to be effective, the client needs to feel free to talk about their issues.  These issues often arise because of the sense of shame which prevents the client from talking them through with others. Thus the client needs to know that whatever is disclosed in therapy remains confidential.  For this very reason therapists are rightly very protective of their clients’ confidentiality. There are however a few exceptions to this rule. This week’s blog explores the limits of our confidentiality.

Supervision:– The therapist will identify the client by a first name only, and give enough detail about the client’s life to help the supervisor understand the background to the process unfolding between the therapist & the client. The supervisor is also bound by their professional code of ethics to maintain confidentiality.  See the earlier blog entry on Supervision for more details.

Risk:- If I have concerns about the safety of the client or of those around them, I may, if the circumstances are appropriate breach confidentiality by expressing my concerns with the client’s GP. This is a last resort and even then, the only information disclosed would be the minimum sufficient to advise the GP of the nature & degree of risk involved, so they are best placed to manage that risk.  If at all possible, I would encourage the client to seek help directly themselves to manage their risk, e.g. take themselves to the Accident and Emergency Department of their local hospital, contact their local GP or out of hours service.  If I felt that the client was unable, unwilling or unlikely to do this, then I would seek their permission to contact their GP on their behalf.  If that permission were denied and I was seriously concerned for their immediate safety I would then contact their GP. This is never undertaken lightly and in practice is quite rare. See the earlier blog entry on Managing Risk for more details.

Legal Requirements:- There are a number of laws which may require the therapist to breach confidentiality. This may be around disclosures of impending terrorist activity or of an ongoing child protection issue. My first reaction would be to encourage the individual to report the matter to the appropriate authorities e.g. the police or social services. Only if they were unwilling to do so would I seek their permission to disclose the information on their behalf, and failing that advise them that I will be breaching confidentiality in the interests of safety. It is also possible (albeit extremely remote) that a therapist’s client notes will be subject to a subpoena from the courts. For this reason, client notes are usually limited to recording brief details of what the client disclosed and no conjecture about the client by the therapist.

In summary, breaches of confidentiality are rare and in the best interests of the client. Therapists are highly protective of their clients' confidentiality as it is the basis of trust in the relationship.


If you have any questions about this blog or any of the issues raised please feel free to contact me via my website: http://www.garycooktherapy.co.uk