What you need to know about confidentiality
Most people give little thought to confidentiality because they assume that it goes without saying that what is said in the sanctity of the therapy or supervision session will not be repeated elsewhere.
I am writing about confidentiality here, because I want to avoid starting our sessions in full bureaucratic mode, covering the minutiae around this complex and constantly evolving issue, which may include aspects with little relevance to your situation. Please follow the headlines to where your interest lies. If I make any changes to this statement, I will notify you.
Supervision
I am required to discuss my work in supervision. I have several supervision arrangements, including informal individual supervision with peers, a primary supervisor, and supervision received in the context of TSTA training days (where trainers and supervisers go to do their ongoing training and to practice their teaching and supervision skills). I disclose only what is strictly relevant for colleagues to understand the treatment direction and aspects of the therapeutic relationship. I do not give a full biography and full physical description of my clients. Neither do I mention their location or place of work.
Academic writing and teaching
I am a writer and a teacher so inevitably I use reflections about my clinical work and the cases I deal with to advance knowledge in the field of psychotherapy, education, and supervision. I have written case studies with the client's full consent. More likely, I may use brief and heavily anonymised vignettes in articles on topics of clinical relevance, that appear in peer-reviewed journals. These journals are available to a specialist audience, through personal or university subscriptions.
I would never describe clinical stories in newspapers, magazines, podcasts or on television.
Tapes
When I work on a piece of research such as a case study I will be recording sessions, however, you will be giving you an information sheet and consent sheet at the beginning of therapy and will ask for your explicit consent. There is another process at the end of therapy where the therapist/researcher asks you to give your consent again, in writing to listen to and analyse the tapes.
If you want to record your therapy or supervision tapes for your own use, please be free to do so. It can be very useful to listen to oneself back and reflect on your process and how you come across in social interactions. Be mindful however of how you store such very sensitive material, and who has access to it.
Sessions are confidential, but not privileged
The concept of confidentiality has been eroded in recent years because of increasing pressure on therapists to disclose information that may relate to investigations into serious crime and prevent harm and terrorist activity. Therapists have a duty to disclose present and ongoing abuse and neglect of children and vulnerable adults. Supervisors are compelled to report if supervisees are financially or sexually exploiting a client.
Therapists may also be compelled by the courts to make their notes available or to testify when the public interest overwhelms the individual claim to privacy, and failing to do so may incur a fine or even prison time. In other words, information shared in sessions is confidential, but not privileged.
My stance right now is that I would rather incur a penalty than disclose information that might be prejudicial to my clients and supervisees, however I would disclose to the police imminent and planned threats of murder, serious harm, rape, large-scale terrorist attacks, or disclosure of previous involvement in such serious criminal activity.
Preventing harm
I would consider communicating with your GP or another mental health practitioner (psychiatric nurse, CMH) involved in managing your wellbeing if I felt you were at serious and imminent risk of suicide. However, I would do everything I can to get you onboard before contacting your doctor.
Access to your data
You are entitled to access any electronic notes I keep; usually, these are very succinct (one or two lines), objective, and devoid of personal opinion. They may mention a topic discussed and significant in-session events, but the narrative will be minimal. These notes are not a window into my mind; there will be no mention of my feelings or personal attitude towards you in these notes.
Court battles with third parties
If you are involved (or expecting to be involved) in a divorce, custody battle, or and accident claim, it may be very tempting to agree to your lawyer's suggestion that therapy notes be used as evidence. I am not required by the law to comply with such requests. My sense is that using therapy as evidence seriously modifies the orginal purpose of therapy and the role of the therapist in ways I am personally uncomfortable with. You should also consider that such evidence can be dismissed as second-hand knowledge and hear-say in the sense that the therapist has not actually witnessed the events described; they are only witnessing your take on events. What you say in therapy will not always present you in the best light; we are all fallible and imperfect and always make our own contributions to conflict and mistakes. It is far better for me to write a brief report of our work, which you can veto before sending it to your lawyer.
Complaints
If you are thinking of making a complaint against me and want to use my notes as evidence, please consider first giving me a fair opportunity to acknowledge your hurt and to apologise. I am usually approachable and non-defensive and quick to notice any negative impact I am having and to own my mistakes. Going through a UKCP complaints procedure with its quasi-legal confrontational set-up is usually bruising for both client and therapist. Discontent can be better addressed through conversations mediated by a third party.
Questions?
This is not an exhaustive account of confidentiality. There may be matters arising in therapy or supervision which I have not anticipated here. There are some excellent books out there - anything by Tim Bond is very informative.
If you want further information about any aspects of confidentiality I am addressing here, please let's discuss them during our next session.
(Last updated March 2024)