Confidentiality is a cornerstone of the therapeutic relationship. In this article, we explore the need for confidentiality, the circumstances under which a therapist can break it, and whether or not they choose to inform the client.

In therapy, it is essential for clients to feel safe and comfortable sharing their thoughts and feelings without fear of judgement or disclosure. This feels especially true given the intimate nature of sex and relationship therapy. However, unless you're a therapist yourself, you may not know or understand the limits of confidentiality.

Why worry about confidentiality in therapy?

Therapists have a professional and ethical obligation to maintain confidentiality. Yet people often worry about it for several valid reasons:

• Fear of judgement or stigma: Concerns that the therapist will judge personal disclosures or share information with others.
• Privacy concerns: Worries that personal data will be disclosed without consent.
• Trust issues: Difficulty trusting others, especially when sharing deeply personal information.
• Fear of being misunderstood: Concerns that the therapist will not appreciate the nuance of their lived experience.

These concerns are precisely why many people prefer to find a therapist with shared lived experience or specialized expertise in their specific community. You can explore how to find your ideal match in this article.

What are the rules around confidentiality?

It is helpful to break the "rules" into two parts: Legal Requirements and Ethical Considerations.

[Image of the ethical decision-making model in psychotherapy]

1. Legally: My work falls under the law of England and Wales. I am legally obliged to break confidentiality if I believe a client is involved in money laundering or acts of terrorism. Additionally, if a court order is issued specifically requesting client notes (for example, in a criminal or family court case), I am required to hand them over. While court orders are rare in sex and relationship therapy, they represent a firm legal boundary.

2. Ethically: Beyond legal mandates, therapists have an ethical duty to protect client welfare. We may disclose information without consent if there is sufficient evidence of imminent harm—either by the client towards themselves or towards someone else. Deciding when to make this call is one of the most complex aspects of therapeutic practice.

Do you always tell a client if you're going to break confidentiality?

Short answer: it depends. My personal approach is rooted in social justice: nothing about us, without us. In private practice, my first choice is always to discuss the disclosure with the client—explaining what I am sharing, why, and to whom.

However, informing the client isn't always the safest route. If a disclosure involves illegal acts where informing the client might lead to the destruction of evidence (such as child pornography) or increase the risk to a vulnerable third party, the therapist may be required to report without prior notice. This ambiguity is why therapists work closely with Supervisors to navigate these "grey areas."

What do you disclose in supervision?

Supervisors are also bound by strict confidentiality. In these sessions, clients remain anonymous. We use initials, pseudonyms, or simply "the client" to ensure identity is protected.

Supervision focuses on the clinical process—the situations, patterns, and behaviours—rather than the person’s identity. Identifying factors (like skin colour or physical disability) are only discussed if they are relevant to the therapeutic work. A supervisor only holds the "perfect sufficiency" of information needed to support the therapist.

How does confidentiality work at Intimata?

At the start of our work, we sign a contract that explicitly details these boundaries. You can view the full documents here:

• The Intimata Contract (Clause 6)
• The Intimata Privacy Notice

Clinical Notes: These are encrypted and stored digitally. No one else has access to them.

Email & Admin: My assistant, Sophie, has access to Intimata email addresses for scheduling and billing. However, she does not access my clinical inbox ([email protected]) except in a genuine emergency. While I take every precaution, I advise clients that absolute privacy in email cannot be guaranteed to the same level as the therapy room.

Why is it important for you, the client, to know this?

I believe in transparency. Clarity builds trust, and trust facilitates healing. By understanding where the boundaries of the "relationship container" lie, you are on an equal footing with your therapist.

This knowledge empowers you to ask questions, advocate for your needs, and feel secure in the knowledge that your privacy is protected by rigorous ethical and legal standards.

Would you like me to create a "Confidentiality FAQ" PDF that you can send to prospective clients to help ease these common anxieties before their first session?