The Shield of Confidentiality in Counselling
"Confidentiality." An important word. And one that, I've realised, means very different things to different people. It is something that informs and shapes my life. I think about it daily because the ethical framework that I work within places extreme importance on it, and for good reason. But there are times when situations arise that make me reflect on it more deeply and a couple of those have arisen recently.
What is confidentiality to you? If you have a spare couple of minutes, stop and have a think about what your confidentiality boundaries are. Maybe ask another couple of people what theirs are. You might be surprised at the differences.
For some people confidentiality means keeping a confidence from everyone, always. It's absolute. For some it's keeping a confidence within a certain group (family, a friendship group, a group of colleagues at work). Or sometimes people translate confidentiality as a time-limited thing: "It'll be ok to talk about this now. She doesn't work here anymore", "I said I wouldn't say anything, but that happened years ago so it won't matter now"; or a space-limited thing - "It'll be ok to mention that here. This is a different town.", "They've moved away so it's ok to talk about that now".
Maybe it's about thinking that confidentiality boundaries have to be laid out explicitly - "He didn't say I couldn't tell anyone so it must be ok". Or maybe it feels like attempts to be discreet mean confidentiality can be a bit 'elastic' - "If I don't tell her their name she won't know who I'm talking about".
Are these confidentiality boundaries you're comfortable with? I guess a good test is to consider how it might feel if your story was the one being shared in any of those circumstances. How personal or sensitive the information is will probably also have an impact on how you feel about those boundaries. In counselling, confidentiality boundaries are contracted, firm and explicit.
Confidentiality in counselling
When a client begins counselling, confidentiality is discussed and contracted at the start. The British Association for Counselling and Psychotherapy's (BACP) Ethical Framework lays out how members will protect and respect client confidentiality. It's not absolute, in the sense that there are times when it may need to be breached due to duty of care - "to protect a client or others from serious harm...and when legally required or authorised to disclose" (BACP, p21) but it is absolute in other ways.
I think the fundamental importance of client confidentiality in counselling is sometimes misunderstood by people who are not counsellors. Because of that I often get the sense that I'm seen as being 'precious' or 'defensive' about it so I'd like to explain some my 'absolutes' around client confidentiality.
The social world
I live and work in the same town and have an active online presence, which makes anonymity pretty impossible. The world is a small place. A friend/colleague/client of yours may be a client of mine and you may know that. You may even have recommended me to them. But if you mention them to me please be prepared for silence! Confirming I am working with them would be a huge confidentiality breach which would be disrespectful and potentially uncomfortable, traumatic or dangerous for them and could result in me losing my registration. If I'm pressed for a response it can feel really quite awkward for both of us. So please understand that my silence or my change of subject is not rudeness. It is part of my responsibility as a counsellor to hold client confidentiality both inside and outside the counselling room.
Word of mouth referrals
I am grateful for any recommendations people make on my behalf. It feels like high praise that someone trusts me enough to do that. But please understand that I can't thank you in person. That breaches the confidentiality of the person who has come to see me. Even if they've told you they are seeing me, I won't confirm or deny that I see them. They are at liberty to discuss their counselling with you if they want to. But I'm not. My professional ethics and my own integrity forbid this.
I won't discuss who I do or don't see with other counsellors/therapists/practitioners/health professionals unless I have explicit consent to do so from the client and even then I'd do it with extreme caution. Should a conversation like this ever happen it would be because a client wanted it to and for no other reason. It would happen in a safe, confidential space where it couldn't be overheard and it would be for a specific purpose. The client might even be there at the time. I wouldn't discuss my client's 'story' or have a casual conversation about them. I would have agreed with the client what they wanted me to pass on and that would be the limit of the conversation. I believe counselling works best when I know what the client wants me to know about them, and so other people's opinions on their situation or versions of a mutual client's 'back story' wouldn't be helpful.
I treat the confidentiality of past clients with as much respect as the confidentiality of present clients. I won't disclose who I may or may not have worked with in the past, even if you know that they have been a client of mine. Again, they can discuss their counselling with anyone they want to, but I can't and won't do that. This is the case even if a client is deceased. I still respect and protect their confidentiality. Their information is not mine to give away.
So these are the confidentiality boundaries that have sprung to my mind now. More scenarios may crop up for me to think about, and I'll ultimately come to the same conclusion. Silence. Confidentiality is not an 'ethical dilemma', it's a fundamental foundation of my work as a counsellor. Therapeutic relationships rely on confidentiality and trust to survive and flourish. So please understand why I - and other counsellors - protect it so fiercely.