Therapy and Confidentiality

What are the expectations of confidentiality in therapy?

Confidentiality plays a key role in building a therapeutic relationship. Clients, whether they are new to a particular therapist or to therapy altogether, often feel a sense of comfort in knowing that they can be honest in their sessions without having their privacy leaked to a third party. Therapist confidentiality lays the foundation for trust, which can allow the therapy to become more individualised and effective.

For their part, therapists are trained to protect their clients’ privacy. In South Africa, confidentiality is governed primarily by the Protection of Personal Information Act (POPIA), which regulates how personal information, including health data, may be collected, stored, used, and shared. POPIA requires therapists to have a specific purpose for holding client information and to safeguard it. In most cases, a therapist may not disclose client information to others without the client’s informed consent, except where disclosure is required or permitted by law, such as in cases involving serious risk of harm or mandatory reporting obligations.

Confidentiality also shapes many day-to-day decisions therapists make. For example, therapists are often thoughtful about what they include in official session notes, sometimes leaving out very personal details that could be misunderstood or cause harm to the client if viewed outside the therapeutic context. Therapists also take care to protect clients’ privacy if they encounter their client in “real life”. Most therapists will not acknowledge a client in public to protect privacy, unless the client initiates contact first.

When might a therapist have to break confidentiality?

There are a few specific and clear instances when therapists are required to report personal information about their clients:

• If the client poses a danger to themselves or others
• If the therapist suspects the abuse of a child or an elderly or otherwise dependent adult
• If they are legally forced to by court order

Most therapists will include a detailed explanation of these exceptions in their privacy policy, which the client reviews and signs before their first session. Therapists may also mention confidentiality in early sessions with a new client in case the client has any concerns about confidentiality that could prevent them from fully engaging in therapy.

Even when a therapist is compelled to break confidentiality, they are generally careful about only disclosing what is necessary to protect their client or others, and they only tell third parties who urgently need to have that information.

What are the rules around confidentiality in the context of supervision?

Many therapists, whether in a group or private practice, will have a supervisor who helps ensure that a therapist is on track with their clients, not getting burned out, and that they are not breaching any ethical standards. To do their job, supervisors need to have some understanding of a therapist’s current clients and any problems they may be experiencing in therapy.

However, therapists err on the side of caution and reveal only as much information as they need to during supervision. They are also careful to conceal any identifying details about their clients (such as their name, age, or profession) so that supervision can still be helpful without breaking confidentiality.

How do therapists present research without breaking confidentiality?

Therapists may sometimes write, teach, or speak publicly about their work to advance understanding of mental health. In these cases, therapists will not use any identifying clues of specific clients, including the client’s name, age, profession, or other specifics. They often use generalised descriptions to illustrate common experiences rather than recount a single client’s story. Different therapists’ approaches to research and writing can vary hugely, however, and if this is a key concern, it should be brought up with a therapist early on in the process.

Do therapists talk about clients with their partners or family members?

Therapists, like people in any profession, may talk in general terms about their work with partners or family members. However, ethical standards prohibit them from sharing identifying or personal details about clients. Conversations, when they occur, tend to focus on the therapist’s emotional experience or workload – not on who their clients are or what they have shared.

Overall, being able to trust in client-therapist confidentiality can make a meaningful difference in whether someone’s therapy is successful or not. If a client has any concerns, they should feel encouraged to discuss them with their therapist. Gaining a better understanding of a therapist’s perspective and approach to privacy can only benefit the therapeutic relationship.