The watchword of therapy is confidentiality. Treatment success relies on the client’s trust. But, is it wise for mental health professionals to put themselves in a situation where keeping one person’s confidence can be used against others in the room?
Imagine the following. A couple comes to marriage counseling. They have a young daughter.*
Among the concerns expressed by the pair is the woman’s father, the child’s grandfather. He has accused his son-in-law of sexually abusing the little girl.
The woman tells the therapist her dad is unreliable, prone to irrational and outrageous statements. Moreover, he holds a long-standing grudge against the person she married.
The woman dismisses the idea of abuse by her mate, supporting his denial.
Several challenging weeks into the process, the man notifies the doctor he can’t attend the next meeting. He adds that it will be fine if his spouse comes for a solo session. She wants to.
On this occasion, she utters something never said to anyone: her father molested her when she was young. Indeed, her daughter is never permitted to be alone with the grandad for this reason.
Nonetheless, she doesn’t want the husband to know. The specialist affirms his intention to keep the confession secret.
The marital sessions remain on a downward trajectory, leading to separation and a divorce filing. The estranged woman now thinks her partner did touch the daughter inappropriately, consistent with her dad’s contention. Her earlier dismissal of this possibility, she claims, was part of an attempt to save the relationship.
Adding to the dilemma, the mother now aims for sole custody of the six-year-old. She also reminds the psychologist of his promise not to discuss or report the historical violation by her father. Legal action will follow if he breaches her trust, she threatens.
In hindsight, should the counselor have agreed to the individual appointment with the wife?
The doctor is in a box. If he reveals the mother’s history of molestation by the little girl’s gramps, she will bring suit. If he does not uncover this fact, his lack of reporting what he knows permits the woman’s demonization of her spouse to appear more convincing than it otherwise would.
The law, depending on the state in question, might yet offer a remedy.
In the event the therapist’s records of the unaccompanied session are subpoenaed by the husband’s attorney, a judge might overrule the wife’s desire to maintain the information as privileged and, therefore, outside of consideration by the court in a trial.
Nonetheless, this is a cautionary tale for all marriage and family counselors. A somewhat similar problem can occur in the absence of the child custody issue.
Within couples therapy, one party might tell the therapist of an ongoing extramarital affair in an unaccompanied interview. A different conundrum would be created thereby.
If the psychotherapist informs the naive partner of the infidelity, he has breached the confidence of the adulterer. If he continues the therapy, he is violating his responsibility only to provide care if he believes it can be potentially useful.
More examples might be offered.
An unseasoned health professional can find himself in a predicament with both ethical and clinical implications
Precise guidance to prevent such difficulties is not commonly found in the ethical guidelines of the various helping professions.
Therapists, one hopes, obtain enough supervision in the practicalities of their work to avoid horror stories of the kind described above.
Most of us achieve a measure of wisdom with hard experience and training. Of course, the truth of such a statement applies to much more than what happens in the clinic.
*This essay is based in part on “Legal and Ethical Issues for Mental Health Professionals: Revised 2020″ by Psychotherapy.net Academy.”
The second image is Der wilde Mann (the wild man) by Paul Klee.