Confidentiality and psychotherapy

When you start counselling or psychotherapy it’s of the utmost importance that everything you communicate with your psychologist stays confidential. Even more so than a visit to a medical doctor, because instead of a broken arm, a flu or gastritis you re typically talking about very personal potential shameful sensitive issues like traumatic experiences, sexuality, relationships with family, partner or friends.

In the Sri Lankan context confidentiality appears to be a rare commodity. According to many of my clients it doesn’t seem to be a priority among mental health workers. A psychologist should be responsible, respectful, professional, ethical and have integrity. The guidelines and rules of conduct in the professional code are derived from these five basic principles.

In the contact with their clients, psychologists have a confidential relationship. Psychologists must understand that people ought to feel comfortable talking about personal information. They need to be able to communicate without fear that this information will leak from the room and be assured that their psychologist takes their privacy very seriously. No written, telephonic or electronic information about the client should be communicated to third parties without written permission of the client.

You can speak about anything with your psychologist: your life, your feelings, your thoughts, your fears, your study, work, home situation, your parents, friends, relationship, and family. Because you need trust and safety to be vulnerable, confidentiality is imperative.

There are four situations where the duty of confidentiality might be broken. If it’s foreseeable that such a situation might occur, the psychologist will inform the client that he is obliged to break the confidentiality unless such a statement will endanger himself or third parties.

1. If the client might be a danger to himself or to others. In these cases, the psychologist s duty of confidentiality can be broken but the psychologist must make a thorough assessment to ensure if there is an actual danger.
2. To share diagnosis information with an insurance company or a relevant medical doctor. The psychologist must explain this to the client and a written permission of the client is mandatory.
3. If there are reasons to believe that there is for example child abuse or abuse of the elderly.
4. If there are legal provisions. These are exceptional situations like an unnatural death of the client or a compulsory psychiatric treatment.

The psychologist must make a well-considered decision. He can’t just breach the duty of confidentiality; this only happens when there is no alternative. He has to assess if it could be damaging for the client or others if the duty of confidentiality would not be broken. And he has to reflect if his decision gives him moral doubt. Only if he is convinced that the breach of confidentiality is the only option, then it’s permissible.