Tell clients confidentiality has limits

Therapists often assure clients that the information they provide is confidential. Confidential is defined as “intended to be kept secret”. Whether the information will be kept as secret as the client (or therapist) imagines depends upon the therapist and the service.

Confidentiality in the strictest sense implies that only the therapist will be privy to the information provided by the client. In practice this level of confidentiality is impossible to offer, as therapists have professional and legal obligations to uphold.

Most professions and services require that clients give informed consent to all assessments and treatments, which includes basic information gathering. Clients must therefore understand the limits upon the confidentiality you can offer before beginning to discuss their case. Clients who provide information which necessitates breaking confidentiality may feel betrayed by their therapist if not first advised of their therapist’s obligations.

Therapists are required to document their contacts with clients and this documentation can be obtained from the therapist or service by an appropriate court order. Vague documentation is no defence as therapists must answer direct questions posed by a court. Local laws may grant some leeway but if in doubt it is best to assume that the court can order total disclosure.

Therapists are also obliged to report various circumstances (ie: child abuse, suicidal and homicidal intent) to the relevant authorities (ie: Social Services, Responsible Medical Officers and the Police respectively). Again, exact responsibilities may vary between professions, services and countries. You should be aware of your own obligations.

Where information is unlikely to be of interest to statutory services, total secrecy still cannot be assured. Administrative support staff have access to casenotes and letters (hence the term “secretary”, meaning “one who keeps secrets”). Supervisors also have access to therapists’ records for supervision and audit, as will subsequent therapists occupying the same post.

Explaining the limits of your assurance of confidentiality may often seem unnecessary and forbidding, but protects both you and the client. I have an information leaflet which is sent to clients with their first appointment. Knowing how few people read leaflets thoroughly, I also begin each initial assessment by explaining that the information given to me

  • will be kept in my files and seen only by me, my supervisor and anyone who succeeds me
  • will only be shared with other professionals with the client’s consent
  • can be requested by court order in the event of a court case, as can any medical record
  • must be passed to the relevant authorities if I am told of child abuse or suicidal or homicidal intent, but that I will not do so without first informing the client.

How clear are you as to the limits on your client’s confidentiality? How confident are you that you can explain these limits clearly and simply to your clients?

2 thoughts on “Tell clients confidentiality has limits

  1. Wow, that’s a big question, even if limited just to the sharing of information. Most services have guidelines for working with people whose comprehension and /or capacity for consent is limited, but what do you do with someone who comprehends the issue, has the capacity to make a decision but withholds consent?

    Respect their decision.

    If this brings you into conflict with colleagues or prevents you from taking the approach which you believe is in the client’s best interests, you may want to discuss their reasoning but be clear: you’re not trying to change their mind, you’re trying to understand their decision. Too many staff think that their role is to obtain consent, and therefore to bring round clients who withhold consent.

    Though it may feel otherwise, clients aren’t trying to make your life more difficult: they have enough problems already.

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