Chana* was clearly shaken when she came into session. After a childhood of abuse and significant trauma, she has been painstakingly working to become the best mother she could be. As a mother of five and approaching middle-age, Chana and I had spent months exploring her hopes and fears of having another baby. In addition to her therapy, Chana sees a chiropractor who gives her “corrections.”
Recently her chiropractor, a mother of eight, has become insistent that Chana has an obligation as a frum woman to have more children. The chiropractor had discussed Chana's reluctance at length with Chana’s sister, sharing intimate details about Chana that she knows from working with her – information that Chana had purposely not shared with her sister herself. Chana is now being pressured by her sister, brother-in-law, and mother-in-law to have another baby.
Raizy* was sitting in the office of a prominent Rav to whom she had gone to seek personal advice. During the meeting, the Rav answered a phone call and began to discuss, in detail, a “problematic family” who had experienced horrific domestic violence some years before. “I feel so uncomfortable around my neighbor now,” Raizy says. “I wish I didn’t know these things about her.” Just hearing the information was upsetting for Raizy, and then the Rav went ahead and clearly used the names of the family members involved.
“I’m so embarrassed, but I found out that Suri Kohn* is your client," Sara* says. "My brother insisted on a ‘shalom bayis expert’ to try to help my husband and I. We both come from such dysfunctional families, and it's affecting our marriage. The ‘expert’ boasted to us about all the other ‘cases’ he has ‘cured.’ He used their names and told us about their problems with a lot of very personal, very embarrassing information, including that one person was in therapy with you. I’m really afraid of what he might have told other people about us.”
Expectations of confidentiality are a familiar concept when seeking out a mental health professional, but confidentiality is also a right and an expectation when seeking the help or advice of others in many arenas. I generally explain the right to confidentiality in the first session with every client, saying that although our meetings will be held in private, clients may repeat anything I have said. I encourage them to feel free to consult with other professionals in the field if they feel that something I have said or done does not feel right. Conversely, it is my professional obligation to keep completely private anything that they may tell me. The exception is that I may discuss certain issues with a supervisor if I am in need of guidance. In this situation, names and identifying information are not used.
At some time, many of us will seek services, not just from therapists, but from all types of healers, religious figures, lawyers, employers, teachers, principals, physical therapists, professionals and paraprofessionals in many others fields. In all of these situations, privacy is an assumption; unfortunately, it is not always honored. As such, it is important for clients to be familiar with their right to discretion. It is even more important for professionals and paraprofessionals to be familiar with the ethical guidelines for their respective fields. Most organizations that provide trainings or certifications of any kind, even brief "courses" in a particular area, also publish guidelines for proper rules of conduct and ethical practice. Generally included in this is a statement regarding a Client’s Bill of Rights, which pledges to do no harm, to provide the best possible services, and to establish rules of confidentiality. Practitioners, even in our cozy, heimish world, have a responsibility to familiarize themselves with these guidelines to ensure that they are practicing responsibly, ethically, and within their scope of practice (i.e., they only do what they are specifically trained and licensed to do).
As a client, be aware that if your provider has spoken to you about other clients, that person is breaching his or her moral, professional, and ethical tenets. You may rightly assume that such an individual may be speaking about you to others as well. If you learn that you are being discussed with other clients, friends, or relatives of that service provider, you may want to seriously consider finding another option. A practitioner who violates your boundaries and right to confidentiality may be committing malpractice in other ways as well.
So why is confidentiality important? For starters, breaking confidentiality is simple lashon hora, and it can cause significant harm to the emotional well-being of the person involved, if not more so. Most of us would be horrified to learn that our accountants shared our personal financial information with others. How much more so our deepest, most intimate, personal details of our lives and health?
Most of us hold deep within us feelings and experiences, rational or otherwise, which we believe to be shameful or humiliating. If we do not feel comfortable that we can trust a therapist, doctor, or other professional to respect our privacy and keep us safe, we will never reach out for the help we need. And exposing a client’s secrets does, in reality, make them more vulnerable to actual shaming, humiliation, and manipulation, and even intimidation and extortion.
Trust is the foundation of any important relationship, personal or professional. When a practitioner in a service or helping field violates the trust of a client, it casts doubt on the trustworthiness of the entire field. On an interpersonal level, when trust is violated in one relationship, it can spill into others. A person whose trust has been violated by a professional or non-professional helper, may then go on to distrust their spouse, family members, or healthy authority or helping figures. The depth of betrayal and damage that can be done may make it nearly impossible to trust again. And if there is one thing we need as humans, it is to know that we can rely on each other in times of need.
*The stories above are all true, with names and information changed to protect the identity of the individuals involved.
SIDEBAR
Some Guidelines for Confidentiality:
- Never sharing a client's name, date of birth, address, phone number or any other identifying information.
- Keeping files and records locked or encoded.
- Never sharing information about a client, even with another professional, without signed consent. For adult clients, this includes friends and family. For minors, this may mean very limited sharing of information.
- Keeping confidential financial, medical or other information, progress notes, assessments or reports, as well as any written correspondence (including emails and texts).
- It should be noted, however, that disclosure of information is legally and morally required when the health or welfare of a child is at risk, or when a client is a danger to himself or others (suicidal, homicidal).
Ilana Rosen LCSW Is a psychotherapist practicing for 18 years and specializing in the treatment of complex trauma and bereavement. She is trained in the Internal Family Systems (IFS), and EMDR modalities. She maintains a practice in Monsey, New York.