Patient Confidentiality and the Stigma of Seeing a Psychologist

Confidentiality may contribute to reducing the stigma of seeking psychological assistance. Unfortunately and sadly, the reality is that most individuals still feel ashamed to tell family, friends or people at work that they are seeing a psychologist. This post will try to allay your concerns. It will also provide you with insights that may make it easier to seek help.

As a clinical psychologist confidentiality was emphasised repeatedly during our training. Unless I treat the work I do with my clients with the utmost integrity, there is every chance I could lose them as well as seriously harm my reputation.

Let us consider the law. By law clinical psychologists in our country need to have their clients sign a Consent Form when they enroll for therapy. This form clearly states how the client’s information could be used. The wording may differ but the overall message includes the following:

  • The client has the right to confidential treatment. The client needs to know confidentiality will be maintained.
  • Information regarding the client’s treatment and management will be released only to qualified professionals that the client has provided.
  • Confidentiality can and will be broken in situations where maintaining confidentiality would result in imminent danger to either the client (e.g. self-harm) or other people. The Clinical Psychologist will endeavor to resolve these situations before breaking confidentiality.
  • Confidentiality cannot be guaranteed with regards to Forensic and Medico-Legal assessments or consultations.
  • The Clinical Psychologist is required by law to report any suspected child abuse, elder abuse or abuse of people with disabilities to the appropriate authorities.
  • Information obtained in sessions may be used for research purposes, presented anonymously at professional meetings and/or published in journals/textbooks. Under no circumstances will any information be provided that can identify the client.
  • The client also needs to understand that if they choose to communicate with the Clinical Psychologist via email, that email is not completely confidential, due to hackers and system administrators. The Clinical Psychologist will endeavor to ensure the confidentiality of client communication.

In my experience confidentiality mostly becomes an issue when management requests some kind of feedback on an individual who has been referred for therapy.

Let us consider a practical case. I was contacted by a client who was facing changes in her working conditions. Her work hours were to be extended and include a night shift. At the time she had a 5 year old daughter who was on a 12 month treatment plan for leukaemia. My client had followed all the correct procedures in informing the company of her situation. They raised no concerns at the time. The company had in the meantime been taken over by another group. The management of the new group was inflexible in their decision despite my client having spoken to her seniors as well as someone in the Human Resources Department. She decided to take the case to the Commission for Conciliation, Mediation and Arbitration (CCMA).

With her consent I wrote several reports to her management. These reports did not go into her history at all. The reports covered her circumstances with her daughter in detail (treatment regime, her need to be with her daughter for treatment), practical logistics at home, the processes she had followed at work to inform management, etc. In the report I provided a brief assessment of my client. Based on my corporate and private practice experience, I made recommendations: what was reasonable as well as the potential implications of their continued lack of support. The client gained the impression that the company wanted to force her to resign to cut on staff. She was unwilling to sacrifice the benefits she had built up over years of loyal service.

The client read every report I wrote. She approved the content before she personally submitted them to her senior.  As I had been very careful with what I included about her, she saw no need for the content to be changed.

I did once have an abusive husband who requested a report on his wife saying she was unstable. This was clearly not the case. He became threatening in his approach when I indicated I would only submit a report to another professional person such as their general practitioner. Needless to say their doctor never requested information from me.

I am very aware that psychologists who are appointed within a company often fail to negotiate parameters with management. Just recently again I heard of a young Industrial Psychologist who shares information with management that she should not be divulging. Needless to say, the employees no longer trust her.

Management on the other hand appears to be very satisfied with her. She is taking on a very risky role. It will be a matter of time before her effectiveness and role will be reduced. This is a common problem where there are internal consultants within a company. Is their allegiance with management or the employees? Hopefully she will learn over time that she needs to manage her internal role with greater discretion.

As a psychologist I am here to serve my primary client and ensure their emotional well-being. It is crucial therefore for you to make your wishes clear on confidentiality if you are concerned about it. As in every other profession: do your homework well in deciding on your therapist of choice.

Posted in Self mastery, Therapy.