“Respecting clients’ privacy and confidentiality are fundamental requirements for keeping trust and respecting client autonomy. The professional management of confidentiality concerns the protection of personally identifiable and sensitive information from unauthorised disclosure. Disclosure may be authorised by client consent or the law. Any disclosures of client confidences should be undertaken in ways that best protect the client’s trust and respect client autonomy”.
How is confidentiality protected?
I can only speak for myself and my policy on confidentiality; other therapists and coaches may, and do, differ in their approach. This is how I protect my clients’ confidentiality:
- I keep the client information sheets (containing your contact details etc) separate from the client notes from each session
- The client notes have only a first name attached and nothing that could connect the notes to that person’s information sheet. As a general principle I try not to take notes.
- When I talk to my supervisor, I only use first names or a pseudonym for my clients, and I don’t reveal any identifying details.
- If I happen to bump into a client – or former client – outside the counselling room (for example at the cinema or out shopping) then I wouldn’t say hello or acknowledge them in any way unless they did so first. This isn’t me being rude! This is me respecting your right to decide whether you wish to keep our professional relationship under wraps
- I don’t talk about my clients – who they are, what they’ve come to talk about, etc – outside the counselling room except in very specific circumstances
When can confidentiality be broken?
This is probably considered the most complex ethical question that therapists and coaches have to deal with. After all, clients put their trust in us to help them recover from whatever has brought them to counselling in the first place, and a cornerstone of that trust is confidentiality. And whilst it might be reassuring to say to a client, “I’ll never pass on anything of what we talk about in our sessions”, that would be misleading and in fact untrue.
So when can I break client confidentiality? Let’s get the legal bits out of the way first.
The law and confidentiality
The law around confidentiality is complicated and not always clear-cut, but there are certain circumstances in which a therapist and coach is legally obliged to pass on information, even if that means breaking confidentiality. The information here is derived from an information leaflet published for members of the BACP:
- If a client told me that they were involved in, or had information about, acts of terrorism either being planned or which had already taken place, then I would be legally obliged to contact the police about it, without informing the client that I had done so (Terrorism Act 2000, section 38B)
- If a client told me that they had been the driver involved in a road traffic collision, and I was then approached by the police for further information about the incident, I would be legally obliged to pass on what I had been told (Road Traffic Act 1991, section 21)
- If a client told me they had information about the whereabouts of a missing child who is in care, under police protection or subject to an emergency protection order, I could be obliged by order of the Family Court to pass on that information (Children Act 1989, section 50)
Ethics and confidentiality
If the law around confidentiality is complex, then the ethical dilemmas are even more so – as they can go to the very heart of the therapist coaches’s own belief system and values.
My ethical code isn't written down here, as to me, ethics are dependant on the situation. It's tempting to say I have a different code of ethics for each client, but I think that is overly simplistic. It's a moving, intangible thing. Some clients I hug, others I've never touched.
So, what does this mean in practice?
Suppose a client came to me and said they were contemplating suicide – what’s my moral and ethical duty as a therapist and coach in that situation?
I'd talk it over with you.
I've sat with many suicidal people at Maytree, and have been suicidal myself, so I know I can hold the conversation. What if you were still determined to kill yourself?
Personally I think you have a choice around your life and what you do with it. There is an ethical position that would hold this is a risk of immediate harm, and I should call the emergency services. I generally disagree with that, unless you tell me you want me to. I would try and get you to stay with your feelings and to talk about how you intend to kill it.
Can I imagine myself as a therapist/coach/counsellor deciding that I would breach my client’s confidentiality, despite knowing that he or she was intent on taking their own life? Maybe. Ultimately I would talk it through with you though. Not to do that, would be unprofessional and unethical from my perspective.
Risk of harm to others
Are there other situations – other than risk of harm to yourself as a client – where I would consider breaking confidentiality? According to the BACP’s detailed guidance, there’s something called the ‘public interest defence':
“The balance of public interest favours the prevention and detection of serious crime over the protection of confidences. … [For example] Murder, manslaughter, rape, treason, kidnapping, child abuse or other cases where individuals have suffered serious harm may all warrant breaching confidentiality.”
Suppose a client told me that they had information about a murder or other violent crime; what’s my ethical and moral duty there? How do I weigh up my duty of care to my client and his or her right to confidentiality against the public interest in seeing violent offenders caught and prevented from harming anyone else?
What if, by disclosing what my client has told me, I put him or her at risk? What if, by not disclosing, it means other people are at risk of being harmed because the information has not been passed on?
There are no easy answers to this dilemma, and I would always try to discuss with you, my client, and my supervisor, before making any decision.
I personally believe counselling and psychotherapy should be confidential, and that overrides a lot of my other concerns. To break confidentiality would mean imposing my own morals onto you, which also flies in the face of my desire to see the world through your eyes, not tell you how you should be.