Confidentiality

I have a pretty absolute view of confidentiality in a therapeutic relationship.  If someone is going to come to me, and share everything, then they need the assurance that nothing, absolutely nothing, is going to go any further without their consent.

THE CLIENT NEEDS TO EXPLORE IN PEACE

When I was in training, I disagreed with what I was taught.  The standard view was that, if there was a danger to the client or others, then it was OK to break confidentiality.  My problem with that was this: on that basis, putting myself in the position of the client, I wouldn’t share suicidal thoughts, I wouldn’t discuss self-harm, I wouldn’t discuss violent thoughts, and I wouldn’t discuss past abuse done to me.  At least, not without feeling that the world was somehow unsafe.

A therapist is a fellow explorer of the client’s world.  To perform that function properly, there needs to be a clear sense that what gets shared in the room goes no further.

SAMARITANS

I used to work with Samaritans.  Their view of confidentiality is very close to mine.  A person needs to be able to phone up and share anything.  If someone is suicidal, then it may be their last moment on this Earth, and I may be the very last person to hear them.  This can’t be interrupted by me trying to interfere with their choices.  That is not why they have phoned me.

This doesn’t mean that I don’t care about preserving life.  If there is an opportunity to discuss what it means to hope, to hang on, to turn life around and try again, then I’ll be there for that discussion.  But sometimes, working with depression, one has to sit with the client in the world they find themselves in, and be a good companion.  It’s good empathy, good listening.

BEING THE CLIENT’S SERVANT

Furthermore, there have been times when a client, once listened to, and given safe companionship, makes their own decision that life is worth living.  In therapy, the client relationship can be a vehicle for new understandings and attitudes.  If the client has to worry about where the information is going, it slows things down. How can we weigh things up, if one side of the scale is being artificially supported?

Don’t get me wrong: if a client says they want me to disclose aspects of risk to third parties, or work with their doctor, or work with their family, then I’ll do it.  But my primary duty is to the client themselves.  I am, in that sense, their servant, for better or for worse.

A RICH RELATIONSHIP

The big up-side is that, safe in the undertanding that nothing goes any further, a client can explore anything they like without fear of interference.  I’ll still be a real person in response.  I may well challenge the client if they seem to me to be hurting themselves or others unnecessarily.  A confidential relationship is rich, like deep, dark soil supporting a forest.  Dig it up to make a city, and you have lost the mystery and wealth of a natural environment for ever.

EXCEPTIONS

Only two exceptions, really.  Firstly, I take an emergency contact, if the client consents.  ‘In case we are talking on the phone one day, and I hear a skid and a crash.  I can call someone who can help you.’  And secondly, if a client shares that there is a fused bomb on platform 1 of Guildford station, I may share that with the police.

WE CAN BE BOTH OPEN AND CONFIDENTIAL

We could all do with confidential relationships.  We can still live open lives, and be sharing, friendly people.  But, if we have at least someone to share our most difficult, darkest thoughts, then we never have to be alone with them, and can always have help.  Carefully handled, it’s one of the big benefits of counselling and psychotherapy.