Confidentiality is probably the most frequently raised ethical issue by practitioners of counselling and psychotherapy, worldwide. Clients trust us with their secrets, they may be talking about things that they’ve never talked about with other people and may not have even voiced themselves, so confidentiality is an important thing that we offer in our services in order to make the work possible, and so we are professionally committed to protecting a client’s confidentiality and privacy.
Part of that has to be how do we manage the tensions between respecting that privacy and confidentiality but at the same time creating the conditions to ensure we are adequately supported to take on the work through supervision, possibly discussing issues in training, or sometimes when we need to communicate information to other people. And a lot of that has to be managing client’s expectations so they understand both what is protected and also what may need to be communicated and under what conditions it’s communicated. So that we let the client know any reasonably foreseeable limits to confidentiality in advance of that arising or we remind them of that when they move into areas when those conditions might arise.
Now one of the things that’s emerged from researching members’ experiences is that it is very often practitioners are working in a complex series of contractual situations, so they have a contract with a client, they have a contract with an agency, and so what we need to ensure is that there is a degree of compatibility between those and so that the practitioner is not put in a situation whereby if they comply with one contract they’re breaking another contract and then having to make decisions about what is the best thing to do, and it also avoids confusion in the client’s mind and secures their expectations.
Probably another important element in confidentiality is that the management of it, is best based on client consent. Client consent and agreement is often the best way through any dilemmas around confidentiality, because they then are on board with whatever needs to happen, both in terms of protecting their confidentiality, but also in terms of what is communicated about them elsewhere.
Q1: Is discussing clients in supervision or as part of my training compatible with the ethic of confidentiality?
Any communications to a third party including supervisors or in a training context are in a sense a breach of confidentiality. So how do we make that legitimate? And the way to do that is through clients are alerted to this as a possibility, that they consent to it and ensuring that those communications are adequately protected, through the person receiving them observing conditions of confidentiality. It’s a balance, we don’t want to be so obsessed with confidentiality that that is all we do, because we want to be therapeutically effective and sometimes that does require us to have the opportunities to discuss issues with other people who are professionally trained, to make sure we are not missing something or to check that there isn’t a better way of addressing that need. So, so long as clients understand what we will communicate, it’s done respectfully, if the client’s interests are protected by confidentiality, yes there is an ethical compromise involved there, but it’s within the scope of ethical practice.
Q2: Why does this section talk about contractual compatibility? Can you give some examples of problems that have arisen due to contractual incompatibility?
Yes, so classic example of contractual incompatibility would be you promised something to a client when you’re contracted by the funder of the services or the organisation you are working in to do something else. So, for example you promise your client total confidentiality but you’re required to report to the agency whether a client’s turned up or safeguarding requirements in order to protect a young person or a vulnerable adult from serious harm, or for example, that all confidentiality is with the agency, but that agency itself has funding arrangements which require its records to go to another body should something happen and that might vary from the agency closing to particular issues raised within the agency. So if you’re working in an organisational context that is often a chain of contracts and in order for your promises to be secure with your client, you need to know what those other complications are so you can adjust the relationship with the client and manage their expectations appropriately.
Q3: How do the new requirements under GDPR fit with our professional ethic of confidentiality?
They fit amazingly well, in terms of there’s a real emphasis in GDPR on openness and transparency with clients, in terms of how their data is, and the information about them is communicated to other people, and the basis of it is very often on the clients consent in the same way as we have had for a long time within our ethic. And the nature of our work is, that it’s very unlikely that we would want to freely communicate or to communicate information to third parties in the way that perhaps a market trader or a bank might want to do in the context of open banking. So some of the issues which are behind GDPR don’t really relate to our work, but nonetheless we do need to take GDPR seriously, and particularly when working in organisations, where you might have the risk of our information being intruded upon, or us accidentally communicating information about clients to third parties, the misdirected email is everybody’s nightmare.