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Counselling Ethics FAQ

Will my Counselling be Confidential?

I abide by and adhere to the British Association of Counsellors and Psychotherapy’s Ethical Framework.

As part of that framework, I practice confidentiality with all of my clinical work.  This means that you can speak with me knowing that your friends, your family, your work colleagues and so on will not get to learn what you have said in a counselling session – and neither will my friends, family, work colleagues and so on.

But … what confidentiality also means is that I will discuss your case with a strictly limited number of other professionals for sound ethical reasons.  All clients and patients of therapists should be made aware of this (as you will be during our initial meeting), but unfortunately this is not the case with some other professional therapists.  I make it a particular point to discuss what confidentiality means – and what are its boundaries – with all of my clients at the start of counselling.  During our initial meeting I will also give you a printed copy of our counselling agreement.  After all, there’s a lot to remember during our first sessions.

Because confidentiality is not just about not talking about our therapy work, our written agreement explains what confidentiality means.

For example, in addition to the ‘not discussing what we say in the room’ part of confidentiality, I will have made you aware that:

  • I meet with my choice of clinical supervisor one a month to discuss my cases and my work.
  • During my yearly quota of continued professional development (eg training courses), I may refer to certain casework in order to review of reflect upon the case  (you details will be anonymised, meaning I won’t use your name nor other identifying information).
  • UK law may require of me to break our confidentiality if I learn of something that is unlawful.

The rest of this article expands upon these matters.

Confidentiality & Supervision.

As a private practising therapist who is a member of – and accredited by – the British Association for Counselling & Psychotherapy, I meet with a qualified supervising counsellor once a month for a minimum of 90 minutes. This is to discuss my practice and my case load and to check that I’m working to my best, keeping with ethical principals, and dealing with dilemmas that come up in most every case.

I will, from time to time discuss your case and our work together with my supervisor – but I will have first made sure that my supervisor does not know you, or is likely to come in contact with you (say, for example, though the workplace).  I will refer to you only by your first name (or another name if you prefer).  If I cannot assure your confidentiality in this manner – for example if my supervisor knows you in the work place or socially – then I will seek supervision from another supervisor for the duration of our work together.

Confidentiality & Continued Professional Development (CPD).

In seeking additional knowledge to keep me up to date with therapeutic thinking, it is sometimes useful to refer to an aspect of a case whilst attending a training course.  If, when we discuss our agreement, you request that I do not refer to you during my CPD then I will respect this.  Even so, it’s rare to-the-point-of-never-happens nowadays for me to bring up casework willy nilly, and I make sure that anything I discuss within the confines of other therapists in the context of CPD still keeps your identity anonymous and our casework vague enough to never identify you.

Confidentiality & UK Law.

Confidentiality sometimes has to be broken if I am required to do so by law (for example if you disclose to me your intent of harming yourself or others (including children) or if you disclose intent of committing a serious criminal offence or terrorism).  This may also apply if I learn of someone else who may be being harmed or in danger, or is planning to harm others.

This does not mean that I will go running to the police the moment that I hear about something illegal, but it is part of my ethical commitments to you to inform you that the law may not protect your confidentiality.

I will intend to discuss with you of my (admittedly very rare) intent to break confidentiality of our work before I do so, but you need to be aware that the law may require that I take action first and without your consent or knowledge.

Declining your request to break confidentiality.

I have been discussing where confidentiality is maintained but expanded in the form of supervision and CPD, and have discussed UK Law where I may not be able to keep knowledge confidential.

There is another aspect: your request to reveal information about our counselling work.

Confidentiality is very important – even to ensure it is not broken in situations where you request it (for example, giving your permission to a solicitor to request that I give a report about our case work).

If we are still working together it is best for us to have a sufficiently detailed discussion of the consequences of such events before I decide how I will respond – and I will not automatically respond with a ‘yes’.  What has been, up until this moment, vital to protect needs a serious conversation about why this need has now changed.

Should our counselling work have been completed, and we are no longer in contact, if I receive a request to reveal the contents of our counselling work with a third party… even having received your permission (eg written) to do so … I may decline [if I am unable to discuss the request and its consequences with you directly].

Confidentiality – In conclusion.

Counselling is not to be taken lightly – neither by therapist nor clients.  Clinical work such as counselling and psychotherapy requires ethics, respect and the highest form of protecting both the therapist and the client’s right to feel safe during the work.

I take a particularly thoughtful approach to protecting confidentiality – and this may surprise a number of clients who may assume that (a) nothing is ever revealed about the case to anyone … or conversely (b) I will summarise our casework to anyone when the client wants me to.

Confidentiality is vital.

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B2B Ethics

Did your client read that Tweet?

Over on Facebook, the Business & Marketing Skills for Therapist Group (here) are helpfully discussing how they can get their message about their practices (etc) out into a wider world.  Some members of the group are professional marketeers, some members are professional therapists.  Something happened to me today that made me notice something that’s essential to therapists as we learn to market our services using public social networks. 

Let me share with you a story…

Tweeting? Twittering? Tweeping?

Over the past month or so I’ve been posting information about counselling on Twitter. I have only 90-or-so followers (compare this with Stephen Fry who has nearly 4 million followers). It’s good fun, it strengthens my reflective practice, it gets me known a little more and brings some new folk to my website.

One might think that 90 people – some of whom are porn stars, one of whom I’m sure is not really a hedgehog, and some of whom seem to hope I’ll be buying their obscure products any moment now – are all who are reading my posts. Maybe not even 10% of the 90 are really reading what I haven’t say.  So little feedback, you see.  So, what might it matter if I might casually slip in a small case example to demonstrate a point in a Tweet?  What harm could 140 characters cause?  It’s only 9-ish people that’ll ever read what I tweeted.

The issue, though, isn’t how few people are reading me (or you, dear fellow therapist, once you hit that Tipping Point).  The issue is that once my post goes into the world, anyone can get at it. 

Any.

One.

Do you know who reads your tweets?

Today, I was surprised (though delighted) to find that some of my Tweets have begun appearing in online newspapers recently. Surprised because these are online resources that I do not follow, they don’t follow me, and I haven’t sent them any of my tweets.  But they’ve still gotten hold of them (“public”, remember!). 

By some mathem-agical power of the InterWeb, my little tweets have somehow spread out into the big, scary world and, by chance more than design, have gotten included in publications that I’ve never heard of.  My words are circulating around (at least for 24 hours until the next publications go out tomorrow, at least).

How thrilling!!

But, can we return back to that little case example I might have Tweeted about?

I put to you – dear ethical reader – the query…

…what if one of the readers of these online papers happened to be the client that I referred to in my Tweet?

What if he recognised himself?

What damage would I have done by, perhaps imagining that non of my followers had anything to do with my client; that they were the only ones who would have read my misplaced comment* ?

Ethics & Marketing.

In the Facebook group earlier discussed, therapists and skilled marketers are passing around valuable information on how a therapist might get their message out there into the world.  I would suggest to you that sometimes it happens – and when it happens BOY does it get far and wide out there.

Marketing experts will teach us therapists these things… but the ethics in what we, as therapists, put out there are entirely our responsibility … and ours alone. 

Anonymising a case is not the same as protecting its confidentiality.

And anything you write on the Internet is not private :p

I’ll leave you with that thought.

Comments are welcome, below, but preferably back on the Facebook group if this is where you found this post.

Just to clarify – I don’t discuss online/in public forums any current case work at all.  When demonstrating a point, I tend to make references to generalised examples or to casework that is already in public circulation (eg a case discussed by Patrick Casement in one of his books) .