Is Therapy Really Confidential?
You have probably noticed that many therapists will say something along the lines of, “I offer a safe and confidential space…” on their websites and in other promotional material.
But what does this actually mean, and is therapy really confidential? This is one of the most common questions I’m asked, so read on to learn more…
What is confidentiality?
When something is confidential, it means that it won’t be shared with anyone other than the person you’ve originally shared it with. This applies whether you’ve told them something verbally, or if it’s in the form of paperwork / recordings (including images, videos, and audio).
As a therapist, I work on the basis of assuming that what is discussed in sessions with clients is kept confidential, along with any other information I collect about them, such as contact details. This means that as part of my agreements with my clients, I will keep their details private, including their choice to attend sessions if they have not - and don’t wish to - share this with anyone else.
If I ever need to share information about a client for any reason, I always aim to discuss this with the client first so that I can explain why and answer any questions. Keep in mind, however, that it may not always be possible to do this, especially if I have reason to believe that someone is at immediate risk of harm.
It’s also important to understand that confidentiality in therapy is not absolute, and there are some important legal and ethical limits to keep in mind, which I’ll explain in more detail below.
What are the limits to confidentiality in therapy?
If you decide to contact me about therapy, I will make sure that I explain my policies around confidentiality and information sharing so that you can make an informed decision about what to share. No one else will be told that you’ve contacted me to enquire about therapy, or about whether or not we’ve decided to work together.
Some of the limits discussed here are legal ones, which means that therapists have to follow them or risk being prosecuted. Other limits are ethical ones, and this means that the law may not be clear about what a therapist has to do, so the therapist has to weigh up a number of factors when deciding whether or not to break confidentiality for an ethical reason.
Here are some of the limits to confidentiality in therapy that it’s important to understand and be aware of:
Supervision
As part of ensuring that I’m working safely and ethically with my clients, I have regular clinical supervision with another, more experienced therapist, and this is usually in the form of group supervision.
In supervision, I will talk about my clinical work and any issues that I’m having in it, including times when I think my own “stuff” might be affecting the work. This is important because I need to see and work with each client as they are, and not based on my own beliefs and experiences about other people and the world. I might not always realise that this has happened, and so having someone else available to explore what is happening is essential.
Supervision also gives me an opportunity to explore the process in the work, to understand the aims of the therapy, and to gain support and insights into how to move things forwards if I’m feeling stuck. The support from supervision is invaluable, and it’s important that clients know and understand that it helps me to do the best I can for them as well as myself.
If I need to discuss a client in supervision, I will make every effort to ensure that the client’s identity remains confidential. This means that I will only use a client’s first name when I’m talking about them, and that I will keep specific details that could identify them to a minimum.
Safeguarding Children & Vulnerable Adults
If the therapist you’re working with works for an organisation such as the NHS, there will be a specific Safeguarding policy in place, as well as a nominated person in the organisation who acts as the Safeguarding Lead.
This person will decide how to respond to any safeguarding concerns that are raised with them, including, for example, whether or not a referral needs to be made to Social Services or the Police. Your therapist should be able to outline the terms of the policy, and provide you with a copy of it if you request it.
For therapists like me who work in private practice, the terms aren’t necessarily as clear. If you work with a private therapist, they may choose to have a separate Safeguarding policy in place in addition to their confidentiality statement, but this isn’t compulsory.
If they do have a policy in place, they should explain what it applies to and when it would be used to clients. I don’t have a formal policy, but I have undertaken and update my Safeguarding training regularly and as I’m an accredited registrant of the National Counselling Society (NCS), I follow their policy, which can be found here.
Risk of harming self or others
Before going any further here, I’d like to dispel an old and enduring myth: that people with mental health issues are more violent and aggressive than the general population. This is absolutely not the case; in fact, those who struggle with mental health issues are far more likely to be the victims of crime, and therefore may need additional help and support.
If a client self-harms as a way of coping with their issues, generally speaking, this isn’t something a therapist would need to break confidentiality for and disclose to anyone else. We recognise that this might be the best - and only - coping strategy available to a client at the time, and telling someone to “just stop” is unhelpful, and risks the client taking more drastic steps to cope with things.
The key here is the word “risk”, which is difficult to measure and can vary hugely depending on the client and the situation. As a therapist, I might gauge this by considering something like, “How much of a risk is this client to themselves, e.g. might they harm themselves in a life-threatening way by mistake?”.
I would always endeavour to discuss any concerns I have with the client, and we can then work together to see if there are additional safety measures that can be put in place to help them. This might involve making a referral to another service or agency, or the client talking to someone they trust who can support them outside their therapy sessions.
I believe that as a therapist, it’s important that I don’t shy away from having these conversations with my clients. I usually find that being open and honest about any concerns I have helps the client to share more of what is going on for them, and I gain a better understanding of whether or not my concerns need to be actioned upon.
Disclosure of criminal offences or intent to commit a criminal offence
As I live and work in England, it’s important to note that this information is based on the law in England, and that the law can vary depending on your location, so please check this out for yourself if you are not in England.
Generally speaking, limits of confidentiality in relation to drugs don’t usually apply to a client’s personal drug use, but it would apply if the client told me that they intended to - or are - supplying drugs to other people. This is because the risk to the wider public would outweigh the client’s individual right to confidentiality because there is a risk of harm on a much bigger scale.
I would also have to disclose information to the authorities if it relates to terrorism, trafficking and modern slavery. Again, in these cases it’s because there is a wider risk to the public, and these types of offences usually involve a large network of people.
Pre-trial therapy
Occasionally, victims of a crime will be offered pre-trial therapy if their case is going to court. This is so that they can explore their feelings about what has happened in a general sense, and have a space to reflect on where they are now and where they hope to be.
A condition of pre-trial therapy is that clients and therapists can't discuss any specifics about the case in sessions because it could be argued that the client has been "coached" on what to say by the therapist when they're called upon to give evidence.
It's worth noting that any notes from sessions made by the therapist can potentially be requested by the police as part of their case, and if they are considered relevant to the investigation, they can be accessed by both the prosecution and defence solicitors. If the notes are considered relevant to the case, the client can choose to review their notes with their therapist before anything is handed over to the police.
Please note that I don’t offer pre-trial therapy, but can provide details of therapists who may be able to help upon request. More information about pre-trial therapy can be found on the Crown Prosecution Service’s (CPS) website here.
Court orders
Therapists may have to break confidentiality and disclose information about a client if they are ordered to by a Court (this is called a subpoena, and can be issued by any type of Court, including Coroner’s and Family courts). As part of this order, the therapist may only be required to release notes and other documentation to the Court, but occasionally, they may be called upon to give testimony as part of the proceedings.
If this happens, or a therapist is asked to provide a report to the Court, they would always aim to discuss this with the client concerned and obtain their consent (preferably in writing) to share details. They would still have to co-operate with the Court, or risk being in contempt, which could result in them being prosecuted themselves.
I know that some of these things might seem really scary and intimidating, but it’s important to know that it’s very unlikely that a therapist would need to break confidentiality in the ways I’ve described above. If you’re unsure of anything, I would urge you to talk it through with your therapist, and they should be able to clarify things.
And as ever, if you’re struggling with your mental health and think that I might be the therapist for you, please feel free to get in touch with me. You can contact me via Instagram and Facebook @emmapooleytherapy, via email at emma@emmapooleytherapy.com, or use the contact form below to book a free 30-minute consultation and we can see if we’d like to work together.