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 judgment 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?

Clearly, therapists have a professional and ethical obligation to maintain confidentiality. Yet people often worry about confidentiality in therapy for several reasons:

• Fear of judgment or stigma: people may be concerned that the therapist will judge them or share their personal information with others.
• Privacy concerns: people may worry that their personal information will be disclosed without their consent.
• Trust issues: people may have difficulty trusting others, especially when it comes to sharing personal information.
• Fear of being misunderstood: people may worry that the therapist will not understand or appreciate their experiences.

These are all super valid reasons to be concerned about confidentiality. This also partly explain why a lot of people prefer to find a therapist who has some shared lived experience as them, or at least has a lot of experience of working with people in similar situations or with the same conditions. (You can explore more about this idea in relation to finding your ideal therapist in this article.) 

What are the rules around confidentiality?

Let's break down the word 'rules' into 2 parts: legal requirements and ethical considerations. 

Legally, my work falls under the law of England and Wales. Consequently, I am legally obliged to break confidentiality if I believe that a client is involved in money laundering or acts of terrorism. (Hey, I didn't make these rules!) Similarly, if a court order is issued to specifically request my client notes, such as in a family, civil, or criminal case, I'm required to hand them over, therefore disclosing whatever is included in those notes. Court orders for therapist's notes are not a common occurrence in the UK (compared to, say, social worker's or psychiatrist's notes), and certainly not a regular experience for sex and relationship therapists. However, some divorce lawyers have been know to threaten and coerce relationship therapists into sharing their notes. 

It's worth noting that these are legal minimum requirements. I mention that because while we are required to report money laundering to the Police, we're not, legally speaking, required to report safeguarding issues such as child abuse to the Police, only to the Local Authority. (Make of that what you will in terms of the priorities of the lawmakers of England and Wales...). However, most therapists do care deeply about client welfare, and this is where the far tricker aspect of ethics comes into play.

Ethically, us therapists and counsellors cannot disclose any information about our clients without their explicit consent, except in certain limited circumstances, as outlined above. However, we do have some ethical considerations under which we may disclose information a client has shared with us with another professional or emergency service. Examples of this are when we believe there is sufficient evidence of imminent harm, either by the client towards themself or towards someone else. In reality, it's not always easy to know when to make that call, and hindsight can be bittersweet. 

One of the biggest challenges for the therapist around breaking confidentiality for ethical reasons, is deciding whether or not to inform the client.  

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

Short answer: it depends. It partly depends on the setting and set up of the therapy. Personally, I work in private practice, so my clients are choosing to attend by their own free will and paying with their money. Combined with my social justice approach to therapy (nothing about us, without us), my first choice would always be to discuss with the client what I was going to disclose, why, and to whom. This process could be very different if I worked as part of a clinical team, such as for the NHS or doing forensic work. 

However, informing the client isn't always the best route. For example, if a client were to share that they have images of child pornography on their phone, telling them I was going to report them to the Police would give them time to destroy the evidence. As you can see, the ethical aspect confidentiality can be intricate and ambigious for therapists to navigate, which is partly why we have supervisors, who help and support us through this challenging process. 

What do you disclose in supervision?

Let's start by saying that supervisors are also bound by confidentiality, which is contracted at the start of the supervision relationship. Different supervisors have different ways to ensure that the supervisee's clients remain anonymous. For example, some people use initials, numbers, or just first names. (And for those of us with more unique first names, don't worry, they use another name.)

Supervision focuses on the conditions, situations, and behaviours of the clients not what they look like or what they do. Physical or identifying factors are only discussed in supervision when relevant, such as when skin colour or a physical disability relates to the problem the client is facing. So, a supervisor should only hold the perfect sufficiency of information about the supervisee's client, just enough to give informed and appropriate support and no more.

How does confidentiality work at Intimata?

Good question, thank you for asking. Most therapists will have a contract that you will both sign prior to starting working together, including information about why and when they may break confidentiality. If you're thinking of starting therapy, and you want more detail, then you can see how I have chosen to navigate confidentiality in clause 6 of the Intimata Contract and Privacy Notice. 

My clinical notes are encrypted and stored digitally. Nobody else has access to these notes. 

In contrast, when it comes to email, Sophie, my amazing assistant, has access to all Intimata email addresses. However, she doesn't access my email inbox ([email protected]) unless she has to in an emergency. This means that clients can share personal updates, experiences, photos and such in emails to me and they are almost certainly only going to only be seen by me, but that can't be guaranteed. 

Client personal data, similarly, is only available to Sophie on a need-to-know basis, such as accessing a client's email address to send scheduling or billing emails. To give you an idea of the benchmark for this, we would need to be able to justify every single access of client data to the ICO, should we be audited. So, we take data protection pretty seriously, even if it isn't something that most people think about.

Why is it important for me, a client, to know this?

Personally, I'm a big fan of knowing where you stand in any interpersonal relationship. This includes knowing and understanding where the boundaries are and what elements make up the boundaries of the relationship container. I'll take clarity over confusion any day of the week!

Importantly, confidentiality helps build trust, facilitates honest discussion, promotes growth and healing, protects privacy, and meets ethical and legal standards. But, in order to protect both the therapist and the clients, there are limitations to this confidentiality.

This article has been written to help you understand these boundaries and limitations, so you, as a client, are on a more equal footing with your therapist in terms of understanding confidentiality. The aim is to help you feel sufficiently empowered to ask any questions you have and to advocate for yourself in therapy. I hope it helps you to feel better equipped to raise any concerns around therapeutic confidentiality.