Reading D

For counselling to be maximally effective, the person seeking help must feel secure in the knowledge that what they tell the counsellor is to be treated with a high degree of confidentiality. In an ideal world they would be offered total confidentiality so that they would feel free to openly explore with the counsellor the darkest recesses of their mind, and to discuss the most intimate details of their thoughts. As new counsellors we naively believed that we could at all times give those who sought our help an assurance that what was said in a counselling session was between them and us and would not be discussed with others. We very soon learnt that this was an idealistic belief and found that in practice it is generally not possible, advisable or ethical to offer total confidentiality.

As a counsellor you may at times be troubled by some personal difficulties regarding confidentiality and may need to talk with your supervisor about these. Counsellors are faced with a dilemma with regard to confidentiality. Unless we give a person who seeks our help an assurance that what they tell confidence, they are unlikely to be open with us. However, there are limits to the level of confidentiality that we can offer, and we need to be clear with the people who seek our help about these limits. Most importantly, as counsellors we need to be aware of the limits to the confidentiality that we are offering.

Absolute confidentiality is often not possible.

Many experienced counsellors would agree that promising total confidentiality is unethical (Shillito-Clarke, 2009). It is certainly true that confidentiality is compromised by the following:

• the need to keep records
• the requirements of the counsellor’s own supervision
• the need to protect others
• working in conjunction with other professionals
• participation in educational training programs, conferences, workshops and seminars
• cases where the law requires disclosure of information.

The above list will now be discussed in detail.

The Need to Keep Records

As explained in Chapter 38, there are compelling reasons for keeping good records. Counsellors who work in agencies frequently use computerised systems or centralised filing systems for such records. This may make it possible for other counsellors and non-counselling staff such as receptionists and filing clerks to have access to confidential records. Some counsellors omit to note certain categories of sensitive material on their record cards as a way of protecting those who seek counselling help. However, there are obvious consequences if this policy is adopted, as important information may be overlooked or forgotten during subsequent counselling sessions. Clearly, for the protection of those who seek help, computerised records need to be protected by adequate security systems. Similarly, hard-copy records should not be left lying around in places where they can be read by unauthorised people, and should be stored in lockable filing cabinets or in a secure filing room.

Requirements of the Counsellor’s Own Supervision

1 he requirements of professional supervision, as described in Chapter 41, demand that counsellors be free to fully disclose to their supervisors material relating to people who are seeking help. This is essential if the best possible service is to be provided, and is also necessary for the wellbeing of counsellors themselves. Some counsellors openly talk with the people who seek their help about the requirements of professional supervision and sometimes it can be reassuring for a person to know that their counsellor is receiving supervision.

Counsellor supervision is in the best interests of the people who seek help.

The Need to Protect Others

Experienced counsellors sometimes work with people who are contemplating suicide, with people who can be dangerous, and with those who have committed serious offences against other people and may possibly repeat such behaviour. Counsellors have responsibilities to those who seek help and also to the community’. Consequently, there may be instances where a counsellor needs to divulge information to protect the person who is seeking help from self-harm, or to protect a third party. For example, if a counsellor knows that the person who is seeking their help possesses a gun and intends to kill someone, then it would be unethical and irresponsible if the person at risk, the police and the psychiatric authorities were not informed. Consultation with a supervisor or experienced practitioner is strongly recommended, whenever this would not cause undue delay. The aim should be to ensure that the person seeking help receives a high level of care that is as respectful of their capacity for self-determination as circumstances permit, while also ensuring the safety of others who may be at risk.

Working in Conjunction with Other Professionals

Professionals such as psychiatrists, medical practitioners, psychologists, social workers, clergy and welfare workers frequently phone counsellors to talk with them about people who are seeking their help, and also seeking the counsellor’s help. It is sometimes in the interests of such people for other professionals to be appropriately informed about their situations. It is also desirable for counsellors to maintain good working relationships with other helping professionals. Sensible judgements need to be made about what information can be, and is, disclosed, and what is withheld. It is important to try to avoid compromising a person’s trust in you as a counsellor and to respect their lights as a person.

If as a counsellor you believe that it is desirable that sensitive material relating to a person seeking help be disclosed to another professional, then, unless there are unusual and compelling reasons for not doing so, the permission of the person concerned should be obtained. Obtaining their permission involves informing them about what you wish to do and why. They are then able to give informed consent. Preferably, this informed consent should be verified in writing so there can be no misunderstanding. Many agencies have a standard consent form which can be used when information is to be shared. The general practice is for this form to be discussed with the person concerned and then signed by both the person and the counsellor. Where two or more members of a family require counselling help, family therapy may be useful. However, if family therapy is not possible, or is considered inappropriate, then the helping professionals involved with individual members of the family are likely to achieve more successful outcomes if they consult with each other, have case conferences and work together as a team. If such cooperation and teamwork is to occur, the process needs to be made transparent to all family members involved, and their consent for the sharing of information needs to be obtained.

It may be advantageous for the person seeking help if the counsellor works in collaboration with other professionals.

Sometimes you may discover that a person who is seeking counselling help from you is also consulting another counsellor. There is rarely justification for two counsellors to work with the same person, so after discussion with the person it is sensible to contact the other counsellor to decide who will take over the case. However, as with most situations, there can be exceptions. In a small number of cases, if good contact is maintained between two counsellors, it may be possible for them to both remain involved provided that they agree in setting clear boundaries and goals for the work that each of them will undertake.

Educational Training Programs, Conferences, Workshops and Seminars

Another problem area regarding confidentiality concerns ongoing training, upgrading of skills and sharing of new techniques. Counsellors need to grow and develop as people and as counsellors. This can partly be done through personal supervision and partly through large group sharing at conferences, seminars, workshops and case conferences. Material presented at such events to people who sought or are seeking help can sometimes be disguised by changing names and other details, but often this is not possible, particularly when DVD recordings of counselling sessions are used. However, we should stress that it would be unethical to use material in this way without the prior written consent of the people involved who sought or are seeking help. Moreover, there could be legal as well as ethical problems if consent is not obtained.

Where The Law Requires Disclosure of Information

Confidentiality may be limited by legal intervention. Sometimes counsellors are subpoenaed to give evidence in court and in such cases withholding information may be in contempt of court. Additionally, mandatory reporting is required by counsellors from certain professions in some countries or states with regard to issues such as child abuse.

Clearly, from the preceding discussion, there are many reasons why confidentiality in the counselling situation is limited. However, it is the counsellor’s task to ensure that confidentiality is preserved as far as is sensibly, legally and ethically possible. Assure the people who seek your help that you will do this to the best of your ability, because they need to feel that whatever they share with you is protected information, which will not be carelessly or unnecessarily divulged to others. It is quite unethical to talk about a person who is seeking help, or material related to them, to any person whatsoever, except in the circumstances previously described in this chapter. What a person shares with you is personal property and must not be shared around, so if you do have a need to talk about a person seeking help or their issues, talk with your supervisor.

We all like to have our privacy respected.

You will need to make your own decisions, m consultation with your supervisor, about how best to deal with the confidentiality issue. Our policy is to be up-front with the people who seek our help and to explain the limits of confidentiality as they apply. For example, when we worked for an agency that had a particular confidentiality policy, we were careful to inform the people seeking help of the policy from that agency. As private practitioners, if we believe that it would be useful or sensible to divulge information for an ethically acceptable and professional reason, then we obtain the informed consent of the person involved.