Broadly speaking, it is no doubt true that clinical psychologists come across the complexity of human nature through their practice every day (Forman, 2010). Human thinking and behavior are not something fixed. Biological, psychological, and social factors are combined together and interact with each other leading to unique results in clients’ lives. When people enter into therapy, regardless of their mental health issues, oftentimes their common aim is to eliminate their discomfort and distress and learn how to cope better with their current difficulties. Most times achieving those goals is highly related to the quality of the working alliance between the therapist and the client (Lambert & Barley, 2002). Additionally, it is common sense that the development of the therapeutic relationship depends on the client’s willingness to trust the therapist and confide their deepest thoughts, fears, and emotions to them (Younggren & Harris2008). Revealing sensitive topics can make the client feel vulnerable and emotionally exposed. Thus, clinical psychologists have the ethical and legal duty to protect client’s privacy and ensure that the shared information will remain confidential.
At first sight, confidentiality may seem a simple, clear, and defined issue. However, in real-life settings, it can be a complex concept to apply to a therapeutic context and it is often limited due to a variety of reasons, such as safeguarding the client or others. Some people support the idea that confidentiality is essential to the therapeutic process and the client’s privacy should always be protected, while others argue that confidentiality should be breached under certain circumstances. The purpose of this essay is to review these two different perspectives critically. Stepping back and observing the whole picture will enable us to formulate a deeper understanding of this controversial issue.
In order to be able to understand and evaluate the importance of confidentiality in clinical psychological practice, it is crucial to explore the meaning of its definition as well as the responsibilities with which it is accompanied with. Confidentiality is a moral and legal obligation of psychologists and it is included in the practice guidelines of the British Psychological Society (BPS) and other regulatory documents. The term refers to the therapists’ duty to refrain from sharing clients’ information and keep all the records in a safe place in accordance with legislation and national policies (British Psychological Society, 2017).
According to Woody (1999), confidentiality is “the cornerstone of professionalism” (p.607). It is an essential part of the therapy and it should be discussed at the beginning of the therapeutic process. It is necessary for clients to be aware that the information they will bring to the therapy will remain confidential and secure. Additionally, at the initial session clinical psychologists should inform them about the limits of confidentiality explaining to them in which situations their information may be shared (BPS, 2017). After having all the information, clients can decide if they will consent orally or in written form. Another important issue to be mentioned is that many times clients’ views on issues regarding confidentiality may differ from the therapist’s perspective. It is important for therapists to notice the difference in the way of thinking, discuss it with them about it, listen to their opinion, and review this ethical contract whenever it is necessary during the therapeutic sessions.
Considering all the above information, it becomes clear the ethical imperative of confidentiality, which can lead someone to wonder why it is such an essential part of the therapeutic context. In order to address this issue, it is really important to construe confidentiality as a part of the therapeutic process rather than just as a discrete and “one-time” procedure.
Firstly, it is reasonable to assume that confidentiality could lead to higher levels of self-disclose. In the cortex of clinical practice, this term refers to the ability of someone to freely reveal their hidden thoughts, fears, or shameful experiences and it is considered a fundamental element of therapy. People who seek support from a clinical psychology practitioner may experience a variety of symptoms or situations that are not comfortable with. As a result, they can frequently feel embarrassed to express their thoughts and feelings (Younggren & Harris, 2008). To put it in other words, without confidentiality, clients may be unwilling to communicate their secrets and deepest beliefs with the therapist or even lie about them to avoid feeling ashamed or humiliated. In a recent survey, ninety-three percent of participants admitted that they had lied to their therapist (Blanchard &Farber, 2016). Among other reasons for lying, the main one was feeling uncomfortable about the discussed topic. Being dishonest or hiding information can easily lead to poor quality of service and eliminate the positive outcome of the therapy. In contrast, ensuring their privacy and keeping that promise can help them feel safe enabling them to reveal more information. Indeed, there is some evidence that supports this point of view. According to Woods and McNamara (1980), who work with undergraduate students, receiving from the therapist the promise of confidentiality can affect the client’s level of disclosure. In more recent work, in which researchers tried to explore the factors that are related to self-disclosure, they conclude that confidentiality is a main factor and can contribute to the client’s willingness to be open and share personal and sensitive information (Ignatius & Kokkonen, 2007).
A lot of academic discussion has been done in regard to how confidentiality related to the effectiveness of clinical practice, with many professionals arguing that confidentiality is a fundamental element of effective therapy (Kobocow McGuire & Blau, 1983; Martindale, Chambers & Thompson, 2009). Discussing confidentiality and giving consent is the first step in building a trusting relationship. In a qualitative analysis, that aimed to explore clinical psychology service users’ perspectives on confidentiality and informed consent, it was shown that all participants related their experience of these issues to the quality of the relationship they had developed with their therapist (Martindale, Chambers & Thompson, 2009). Reassuring clients that therapy is a safe environment where they can make their confessions without fear will lead to a strong therapeutic alliance probably. A good therapeutic alliance in turn can affect the outcome of the therapy. The good quality of the therapist-client alliance can predict the positive results of the psychotherapy, regardless of the psychotherapy approach that will be used (Ardito & Rabellino, 2011). With all the above in mind, it is relatively easy to address the question of why confidentiality is considered an ethical duty and a fundamental part of the therapeutic process.
Discussing clients’ records, outside the therapeutic context and without their consent, may harm them in multiple ways and provoke a big trust “rift” between the therapist and the client. In their work, Donner, VanderCreek, Gonsiorek, and Fisher (2008), conclude that breaching confidentiality “should be a last resort” (p.369) and that it is necessary to minimize the reasons leading to disclosure. On the other hand, under certain circumstances sharing clients’ information is the οonly possible solution.