Confidentiality and Psychotherapy
In the business world, companies use non-disclosure agreements (NDA) or confidentiality agreements (CA), as well as confidential disclosure agreement forms (CDA) and proprietary information agreements (PIA). These are legal documents between companies: these documents list confidential material and information that that must not be shared with one another.
In psychotherapy, there are no such documents but there is a rule that is understood by both therapist and client that everything he says will not be passed on to any other person. In fact, I do say on my application form that all information is kept in the strictest of confidence. I explain to my clients that confidentiality is extremely important and that all their notes and personally details are kept under lock and key. This is of paramount importance because during therapy, many individuals give information about their unconscious desires and inner conflicts and of this information is given to a third party it could have a disastrous effect on an individual’s well being and trust of their therapist.
In 1996, the United States Supreme Court in Jaffe v. Redmond 518 U.S. 1 ruled against the disclosure of a psychotherapist’s notes. The court explained doctors treat physical ailments objectively. By contrast,
‘Effective psychotherapy depends upon an atmosphere of confidence in which the patient trusts the psychotherapist’s commitment and capacity to protect their frank and complete disclosure of facts, emotions, memories and fears’.
However, I do point out that on occasions, some material is helpful for other clinicians and that, from time to time, I publish information in academic journals. Clients still have anonymity. No names are mentioned—in fact, a pseudonym is always used—and names of places, and recognizable features of home life are not specified. For example, If a lady called Sophie went to the University of East London and met her boyfriend, Bill, who was also studying chemistry in year 3 of the degree course, and I needed to include this in the study because it was important to the case material, I would probably write something like the following:
‘ Sandra went to meet her boyfriend at the university: they were both doing the same course and were both in their final year’.
In the past, it used to be necessary to write to clients’ GPs after the first session; and, in many instances, clients would be referred by GPs in the first place. Nowadays, it is up to the client whether he wants his GP to know or not, and if this is the case, a signed consent form is needed.
There are exceptions to this confidentiality rule. If it becomes apparent that the client or a member of the family is being abused and that the appropriate steps have not been taken by the client to resolve this issue, therapists must explain to their clients that they have a moral and ethical obligation to pursue this. In these instances, I would explain that, now I am aware of this information, and know that nothing is being done to stop this abuse, I need to deal with this in the appropriate manner. Indeed, if legal proceedings occur, I might have to break confidentiality; however, again, I can only do this once the consent forms have been signed and dated. There are some other exceptional circumstances where confidentiality should be broken, and this refers to a situations in which the client or acquaintance is in mortal danger. In these instances, it is always advisable for therapist to speak to their professional body—specifically the ethics committee—and ask them for their advice in this situation.