The Beech Group

“Confidentiality” how important is it and when should it be broken?
Unlike Priests the maintaining of confidentiality is not absolute for counsellors and therapists. However, it is an element of our work that is crucial if our clients are going to feel comfortable talking to us about things that they have never spoken about before and which they would not like anyone else to know.
Therapists frequently face ethical dilemmas in their work and they have to weigh disclosure against the trusting relationship they have with their client. This dilemma is even more frequently apparent when working with couples.
If one partner discloses that they are having an affair and that they do not want their partner to know. How is it possible not to bring this to the session with the other partner and not mention it when it is absolutely essential to be even handed?
Even more difficult would be when one partner discloses that they have had an HIV test and it has proved positive but they have no intention of telling their partner.
When I begin my work with a new client or a couple I always tell them that our work is confidential with the proviso that if I believed that someone was going to be physically hurt, either themselves or someone else I may need to talk to someone.
This statement may seem a little vague, but I believe that it has to be so, because it would be impossible to list every occasion which would require me to break their confidence. So “may” allows me to consult my Supervisor and consider whether it is necessary to talk to “someone”. That “someone” would vary according to the circumstances, it might be a partner, GP, Social Worker or the Police according to the nature of the harm.
At the end of the day it comes down to the judgement of the person holding the confidence and that judgement is very subjective and depends on the beliefs and life experiences of the therapist.
For some people this may seem very unsatisfactory, but I would maintain that most clients have a good instinct about who to trust and the system does seem to work pretty well, considering I have been a therapist for 30 years and have only had to break a confidence on one occasion without the client’s permission.