Is counselling confidential?

everything you say to your counsellor kept completely private between you, or are there limits to confidentiality?

In this instalment of "Counselling Basics", I'm talking about all things confidential in private practice counselling. I'll explain:

what and how counsellors typically record information about their clients
who has access to this information, why they might have access, and under what circumstances
the legal and ethical limits to confidentiality

Confidentiality in counselling

When seeking counselling, we need to feel safe in speaking openly and honestly about often challenging experiences that we might not have discussed with anyone else before. Key to this feeling of safety is being able to trust that what you say to your counsellor will not be repeated to anyone else.

Your counsellor should never speak about you or the content of your sessions with anyone else or in a public forum (including social media) even if they believe they have anonymised the information, or feel it's suitably "general". A counsellor might mean well if they tweet "had a great session today - client made breakthrough in building relationships with their family!" - it's quite general, anonymous - but it's a public forum. If you see the tweet, you might recognise it as you. If you've told friends or family that you're working with that counsellor, they might decide they're talking about you, too. It's a breach of confidentiality, and therefore a breach of trust.

Breaches in confidentiality can feel like a serious breach of trust - and it can make it hard to trust in the same way in future. So it's important to know what information your counsellor stores about you, how they store it, and under what circumstances they might need to pass certain information on to other people.

What information do counsellors keep about their clients?

As with all aspects of counselling in private practice, different counsellors may have different policies and procedures when it comes to storing or processing information about you - but these policies should be clear and they should be able to explain them to you if you ask. I have a full privacy notice available on my website that explains what data I hold about clients I work with, and how that data is kept.

Most counsellors hold the following information:

Personal contact information (including an emergency contact) - to arrange sessions, invoicing, and in case of emergencies or unforeseen circumstances. This information would only be shared with someone else (such as emergency services) in the case of a serious emergency. Limited information (such as a list of client names and contact information) might be shared with a counsellor's supervisor or executor, should the counsellor be incapacitated or otherwise unable to attend session. This information should be kept separately from any session notes. Generally, this information is destroyed after you have concluded your work together.
Brief, anonymised session notes - these are used as a record of attendance and as a memory aid for the counsellor between sessions. They are kept anonymously (often using a client code that only the counsellor can identify) and should contain no specific identifying information. You can request your session notes, or provide explicit written permission for them to be released to someone else. If a judge (by court order) or a coroner requests the release of session notes, your counsellor is legally obliged to provide them. Otherwise, your counsellor should be the only person with access to these notes. Session notes are generally kept for up to seven years after you have concluded your work together (in case you recommence work, or the notes are required in a court of law, or to support an ethics board if a complaint is raised). Whilst other people or officials can request notes, your counsellor is not obliged to release them unless you provide written consent.
Information about certain medical conditions (such as asthma, allergies, etc.) - this information may be shared with medical professionals in serious circumstances where not doing so might put your health/wellbeing at risk. As with the session notes, this information may be stored for up to seven years, after which it should be securely destroyed.

How does my counsellor store this information?

This again will vary between counsellors - they might keep paper notes, electronic notes, or a combination of the two. But it should all be kept with security in mind - password-protected and encrypted files, securely locked cabinets (in a space separate from the counselling room), anonymised where possible/appropriate. Session notes (which should be anonymous) should be stored separately from identifiable information. As most counsellors communicate with clients via email, this still constitutes electronic client data, so they should be registered with the Information Commissioner's Office (even if they store the rest of your data in paper files).

If you're unsure about how your counsellor stores information about you - ask! They should be able to provide clear reassurance about their processes.

So other than that, everything I say to my counsellor is kept strictly confidential?

Yes - up to a point. There are certain legal limitations to confidentiality, which all counsellors (whether in private practice or not) are bound by. Your counsellor is legally obliged to inform the relevant authorities, without telling you they are doing so, if you disclose the following:

information about, or involvement in, acts of terrorism
information about, or involvement in, money laundering
information about, or involvement in, drug trafficking

Beyond this, limits to confidentiality may vary depending on the counsellor's own policies (or the policies of the company they are employed by - for example, if they are seeing you via an Employee Assistance Programme or insurance company). Some counsellors may have a policy to break confidentiality if they feel you are at serious risk of harm to yourself (for example, if you are expressing suicidal thoughts or intent), or feel that someone else is at risk of harm. Some organisations may have policies around the disclosure of historical abuse, or drug and alcohol use.

To make informed decisions about what you choose to disclose to your counsellor, it's important that you fully understand their specific policies around limits to confidentiality. Your counsellor should go through this clearly when you first meet (when they cover a verbal or written contract) - and they should be able to provide specific policy information on request.

What about supervision or peer groups?

You may be aware that counsellors are required to undertake regular supervision as part of their terms of registration. Whilst this does count as a limitation of confidentiality (counsellors may discuss your sessions with their supervisor), the content of these discussions should be anonymous (i.e. you will not be named, and no identifiable information should be shared or recorded). Professional supervisors are held to the same legal and ethical standards as their supervisees - what is discussed in supervision should be held confidentially, except in very specific circumstances (such as those listed above). The focus of supervision is the counsellor's professional practice and conduct, and not about client-specific material.

Some counsellors may also engage in peer supervision or peer support groups (where several counsellors meet to support each other in private practice), but the same rules regarding confidentiality and anonymity apply here, too - whilst counsellors might discuss aspects of their practice, they should not be sharing client-specific information.

Take home thoughts

Your counsellor should never discuss you (or what you say) publicly, in any forum, even if they "anonymise" it or think it is innocuous (such as posting "I had a client today who..." type posts on social media)
Your counsellor will hold certain personal data about you, and this should be kept separately from brief, anonymised session notes
The only people who can request to see your notes are you, a coroner or a judge (by court order). If anyone else (even the police) requests to see your notes, your counsellor is not obligated to release them unless you provide written consent.
Your counsellor may be legally obligated to breach confidentiality in specific circumstances (acts of terrorism, money laundering, drug trafficking)
Your counsellor may be ethically obligated to breach confidentiality, but the circumstances of this should be made clear in your counselling contract and policies (commonly where there is serious risk of harm)
Counsellors should receive regular supervision, but this is for their professional development - material they discuss is anonymous, and supervisors adhere to the same ethical and legal standards as their supervisees

If you are ever unsure of the limits to confidentiality - ask your counsellor! They should be open and up-front about specific terms and policies, and be able to confirm this in writing should you request it.

If you are ever concerned about a possible breach of confidentiality, you can contact your counsellor's membership body.

Did you enjoy this post? Did you find it helpful? Want to know something about counselling I haven't talked about yet? Please leave me a comment below, or email me at dr.astridcoxon@gmail.com