When isn't therapy confidential?

This is a concern that a lot of clients have. When will my therapist make a disclosure, and to whom?

Well, the answer to this question will depend.

If you have any questions then your therapist will be able to answer them, but here is some general information that may be useful.

The first thing to note is that your therapist can't just tell whoever they want about your sessions. For example, we can talk to mental health services about a specific challenge that they would need to support with such as suicidality. But we wouldn't tell them everything that you have spoken about if it wasn't relevant.

The police cannot force a therapist to break confidentiality when asking questions, they would have to produce a court order for the information. Then, typically, they may be allowed to question us for our information in court and have access to our notes if we have taken any. (There are some therapists who intentionally do not take notes becuase of this, particularly if they are working with sensitive topics or populations)

Notes

Our notes are confidential, and we have an obligation for a level of 'pseudonism'. In my practice, this means that they are all stored on a password-protected drive and using a 5-digit client code. Then, in the notes, I don't use specific pronouns and don't record names. If I need to make a disclosure, I get any information that I don't have access to from the client in the moment. If there is a specific reason to record a name, e.g., if I am asked to so that they have a record.

You can also request your notes, this is technically a disclosure, but you have a legal right to your notes. When I do this, I usually ask for the request to be verbal in session and in writing through an email. Sometimes, specific disclosures may take place, such as filing a police report with your therapist to support you or getting supporting documentation from a therapist. This can come at an extra cost as it is not part of our usually billed hours, however, that depends on the therapist.

Disclosures

The main caveats for disclosures will be a risk of harm. If your therapist is worried about a risk of harm to yourself or others, they may decide to take action. For the most part, if it's safe to do so, they will have that discussion with you. As mentioned above, we might need more information from you.

We take as much information as possible to determine how big of a risk is present, typically, suicidality is not reason enough on its own to make a disclosure. This is the one that people tend to worry about a lot. The first step is normally just a risk assessment, then a safety plan. If these steps don't seem to be working and the risk to your life is imminent, then we would consider disclosing to emergency services.

For almost every instance, this will be a conversation we have with you. The times it won't be are when it would present a greater risk to the general public and yourself if we would have made that disclosure.

The Exceptions

There are a few legal exceptions where we are bound to report. These include;

• Acts of Terrorism (The Terrorism Act, 2000)

• Drug trafficking and Money laundering. (Drug Trafficking Act 1994/Proceeds of Crime Act 2002/Money Laundering Regulations 2007)

• Safeguarding children or young people (especially if the child is missing or abducted). (Childrens Act 1989)

• If there is a Serious Crime Disclosure Order in place. (Serious Crime Act 2007)

• In cases of Female Genital Mutilation. (Female Genital Mutilation Act 2003/Serious Crime act 2015)

• In cases of a road traffic collision.

  (Road Traffic Act 1991)

  
  

  

What can my therapist say about me?

A good rule of thumb here is if anyone could identify you from what we say, then we have breached confidentiality. So, in my group supervision, we never say a name; we might use pseudonyms or client codes if there are a lot of individuals that are interacting. Then, we might say what was said in the session so that we can discuss any theory that would be helpful. Supervision is a professional group and as a result, has its own contract and confidentiality.

What can't my therapist say? I would say that if anything was personal, we wouldn't say it. For instance, I might tell someone in my life if my day was busy or not, and maybe if I would find it tiring. That's because it is about me and my response to the work. If anything was causing an issue that was personal to a client, then that would need to go to supervision.