How Confidential Is Psychotherapy?

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Therapy is confidential, right? What is said in the room, stays in the room? Your therapist won’t share the stuff you tell them with anyone else? You’d hope so, but if social media is anything to go by, the reality of protecting client confidentiality is falling miserably short of professional standards.

At its most basic level, confidentiality is an ethical requirement, which means that what clients say and do in the therapy room remains private; with three exceptions:

• Sharing information in supervision with a (usually) more senior professional, with the aim of better understanding the therapeutic process
• Sharing information in response to a legal request, which isn’t as straightforward as it might seem, and is only mandatory in the UK if a subpoena has been issued
• Sharing information in relation to a safeguarding concern; because safeguarding always trumps confidentiality.

Counsellors' and psychotherapists' responsibility to maintain confidentiality includes sharing information verbally and in writing, anywhere and in any context. I would argue that the same right to confidentiality should extend not just to our clients, but to anyone we know, including family, friends and colleagues, and that we shouldn’t share anything about them in any format or context either, without their consent.

Social media is a great tool for personal and professional networking and development. But, like all tools, it needs to be handled with care, and if it isn’t, it can be dangerous. It also provides an additional context where client information can – and is – being shared without consent. I see posts almost daily from counsellors and psychotherapists breaching their clients' confidentiality.

They might say things like: “I’ve just had this amazing feedback from my client who said they felt really held and heard in a way they haven’t before.” The therapist thinks this is okay because it’s what the client said about them, not about themself.

Or they might say: “My client’s been really struggling with her boundaries, and she’s just had this incredible breakthrough.” The therapist thinks this is okay because it’s sharing something positive about their client, whom they haven’t named.

Or they might say: “I’m worried about the number of Year 9 boys in my daughter’s school who are viewing porn.” The therapist thinks this is okay because they’re showing concern for the boys and they don’t think they’re breaching confidentiality because they haven’t named the individual Year 9 boys, their daughter or the school.

What these therapists don’t seem to realise is that by identifying themselves, they have made the clients they work with and the school their daughter attends and the Year 9 boys identifiable too.

Confidentiality applies to all forms of technology, including social media, WhatsApp groups, webinars, podcasts and vlogs. It’s worth noting that many CPD (Continuing Professional Development) webinars and live training events are now recorded, meaning that whatever is shared in those contexts could potentially find its way into the public domain. So, if a therapist talks about a client in those spaces, they are breaking confidentiality and breaching professional ethics.

Some therapists are also failing to maintain confidentiality in written publications, including blogs and journals. No-one should be sharing anything in print that a client, colleague, friend or family member said without their consent. Journal editors, of which I am one, are responsible for checking contributions and making sure that informed consent is in place, and double- and triple-checking prior to publication. My personal belief is to apply caution in sharing information about real clients in print, even with their consent, although many publications allow this. I have written hundreds of publications about my work, and I have never written about a real client or shared any real dialogue anywhere. Everything I write, including the examples in this post, is fictional; only the themes are real.

My observations have led me to wonder about the extent to which therapists understand confidentiality. I actually think that lack of understanding is the best-case scenario, because the alternative is that they do understand and don’t care; I can see no other reason why confidentiality is being breached so frequently and so blatantly. As a profession, we have a collective responsibility to do better.