Learning from complaints: confidentiality

An essential part of the therapeutic relationship is the confidence that is shared between therapist and client. That confidence and trust is essential in creating a safe space where therapy can take place and breakthroughs can be made.

However, there are occasions where you may be asked to break that confidentiality. This can pose a significant dilemma for a therapist juggling pressure from different people and agencies.

In recent years the UKCP complaints team has dealt with a number of queries and complaints about confidentiality. There are some themes and common scenarios that have emerged which we have discussed below providing some talking points and tips about how you might want to respond if you are faced with a similar situation.

Police request for client notes

If you work with a client who may have committed a criminal offence, or someone who has been the victim of an offence, you might be contacted by the police asking for copies of their client notes. This is a difficult situation to face as you may feel pressure to provide the information to help with a criminal investigation. You may want to consider the following when making your decision about sharing information:

  • Would this be in your client’s best interests?
  • Has your client provided their consent?
  • Do they fully understand the implications of giving their consent?
  • Will the information be used in unexpected ways?
  • Will sharing the information leave the client vulnerable (as it may be shared with a large number of people)?
  • You may be required to provide evidence in court?
  • Will it affect your therapeutic relationship?

It is important to remember that unless you receive a court order you can refuse to share your client’s notes if you feel it would be appropriate to do so.

If you suspect that this may be an issue you will face with one of your clients, you should discuss the potential limits of your confidentiality with them at the outset of therapy.

Subject Access Requests

Subject Access requests or SARs give individuals the right to request a copy of their personal data. The comes from the General Data Protection Regulation (GDPR) – a piece of legislation designed to protect privacy and give people more rights over how their information is used.

The most common kind of SAR request you’re likely to receive is a client or former client asking for the information that you have about them.

How do you know if you have received a subject access request?

It can sometimes be difficult to spot a SAR:

  • It doesn’t have to be in writing.
  • It doesn’t have to reference any laws or use legal terms.

Someone saying I want everything you’ve got on me could be a subject access request.

What to do if you receive one?

  • Acknowledge it.
  • You have 30 days to respond.

You can’t charge a fee for responding unless you have large amounts of documents, which as a therapist is unlikely.

Things to think about

  • Do you actually have the information they’re asking for? If you don’t take notes during therapy sessions you might not have anything written down.
  • Could it have an effect on the therapeutic relationship?
  • Have you written something about them that they may not appreciate? Even if this is the case you may still have to share the information but you may want to think about how to manage this.
  • What is the person intending to do with the information?
  • The information you have might not just be client notes but could be financial information or information from others (eg- GP referrals).
  • Does the information they’ve asked for also contain personal information about someone else? If it does, you may need to remove this or ask consent to share it.

Providing reports for use in legal proceedings

You may be dealing with clients who are receiving therapy at the request of a court or on the instruction of lawyers. In which case you may be asked to provide reports about their therapy. The two most common complaints that we receive about reports are:

  • That they are written on behalf of one family member without the consent or knowledge of the other.
  • The report includes hearsay evidence about another person who the therapist has not seen.

If you are writing a report here are some useful tips you may wish to take into account:

  • Don’t make judgements or evaluations about someone you haven’t met.
  • Relate facts clearly in a chronological order.
  • Don’t elaborate, exaggerate or speculate.
  • Be aware of your own personal biases.
  • You are not an advocate of your client, your role is to provide your expert opinion.
  • When giving your expert opinion, base it on facts and reasoned analysis.
  • Review the report for accuracy, succinctness and clarity.
  • Contact your professional indemnity insurers, supervisor, or college for assistance.

With all of the above scenarios please remember that you should treat each request for information individually and exercise your professional judgement. Because the decision is a judgement call it’s important that you document your decision making process, including who you spoke to for advice, how you considered the request (what factors you took into consideration) and why you made your decision.

Useful sources of information

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