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Monday 1 September 2014

Our Lips Are Sealed: Why counsellors and psychotherapists maintain (or try to maintain) Confidentiality

by Stephen B.Chadwick, MA Counselling Psychology.

Of course I would have to start off this post with the classic Gogo’s song and a video insert from the same. However, I think I will leave that towards the end of the post.  This is kind of, sort of, a heavy “intellectual” post so it might be nice to finish off with something light and silly or carefree.

Okay, the other day someone mentioned to me that they had read on another blog somewhere that counsellors and psychotherapists/psychiatrists/psychologists/psychoanalysts are generally considered to be (gasp!) a bit aloof and ridiculous. And mainly this is because they are perceived as being very secretive, in other words they don’t reveal (or shouldn’t) very much about themselves when clients come in for therapy sessions. As a result, there is a belief within the larger (non-mental health) world that counsellors are a bit buffoonish. So ultra-concerned about confidentiality. They have reason to be. And there is reason for it.

 Hi, my name is ________ and I am a _______

I mean, think about it, ordinarily if you were to meet a strange person, at a cocktail party or whatever (fill-in-the-blank) social venue you would probably start out with social niceties and then after awhile you would get to know the person.You would typically introduce yourself, say "Hi, my name is Steve and I am a "fill-in-the-blank" --- see my post on identification, link here:

You would start out very superficially and as time went on, you would start to reveal yourself to the person and they would start to reveal themselves to you. This is like any relationship: friendship, love relationship, etc., etc. and of course the longer you know the person, usually the more details you would reveal and they would reveal and your relationship would deepen. Like, Duh! This makes sense. Again, see my post on trust and trust-building process, link here:

I’m sure that everyone understands this. It’s like going swimming in cold water. MOST people don’t go jumping in – although of course some do – most people go in bit by bit as they get accustomed to the water.

So you start revealing yourself, even the very intimate details that you are afraid to reveal to most others for fear of rejection. But as you trust the person, as I say the relationship deepens, solidifies and you are able to trust more and more. Now here is the word: TRUST.

The word “CONFIDENTIALITY” come from the Latin, meaning:
Meaning to “thoroughly trust” in other words, when you hold confidentiality, you are holding something such that one party “thoroughly trusts” the other party not to reveal anything.

So why and how do counsellors and therapists keep or retain confidentiality about clients? What is the point?

Once it was thought that counsellor and therapists keep themselves quiet about themselves and their own activities in order to preserve their privacy.

And to a certain extent this is true. 

If you are a client coming to see a counsellor, would you feel comfortable if the counsellor started telling you about THEIR childhood? -- My guess is probably not.
You are there after all to see the counsellor for YOUR problems not theirs.

However, when you initially go into see a counsellor, if you don't know anything about the counsellor, how can you trust him or her?

Unfortunately the point is... you can't.

And it's a gamble.

Nobody wants their public life put out on display

It's kind of like going in to see a doctor. When you go in for an examination, he or she may ask you to undress and sometimes (gulp!) ride down to your underwear or even no underwear!

The point is you are going to feel naked and somewhat vulnerable, perhaps immediately with the counsellor or psychotherapist. You may have to tell him or her things that you have kept hidden or unhappy memories that have left emotional scars that you have not felt confident --- there's that word again -- to tell anyone else. It's scary!

So, what the therapist does, by modelling a no-tell situation about his or her own history is showing that he or she is the type of person who can hold confidences.

Think about it, if you meet up with someone who is very talkative and gabby, would you think that that person could keep a secret? Or would you much rather tell a secret to someone who is rather reserved and not forthcoming about their own life?

You would probably be more likely to trust the person who was somewhat reticent to discuss their own private life with you than someone who was talkative.

Think of it also this way: Nobody wants their public life put out on display... and we're not talking about celebrities.
But do you remember this fellow?

And Monica Lewinsky?

And this fellow's wife?

When the media (and the various political groups) got ahold of what had happened to them, it had a field day! And really, it was a private affair (literally) between Bill Clinton, Monica Lewinsky and Hillary Clinton.

Think of it this way, should it have been your marriage or relationship (or your parents) or someone else close to you, would you have wanted that to be made public?

Of course not. And that is exactly why therapists try to keep identifying details out of discussions.

(Self)disclosure can make the client/patient feel less isolated.

Now.... that having been said... there are times when a therapist will talk (a little) about their life or someone else's. However this is usually to help the patient or client feel less alone with their problem. They use it as an illustration.

So, for example you have a client who is tremendously distressed with X..... whatever X may be: a personal tragedy... a learning disability.... a past history of abuse (either sexual or physical) or some other issue.  If and only if the client is feeling isolated then the counsellor may say..... "Well, I have struggled with addiction in the past"... and this may help the client to feel less alone with their problem.

Think of it another way.

When concentration camp survivors came back to regular society after the war, whether in Europe or North America, it was reported that a number of them had tremendous difficulty telling people about what they had seen and what they had witnessed. It was so horrific and so barbaric.

Many of them experienced HUGE relief when they finally were able to connect with someone else -- anyone else who had experienced similar situations to what they had endured. Hence the birth of the support group. For them it was a reassurance that "No, I am NOT crazy" there are other people out there who understand what I have experienced.

Now, you can substitute in any type of situation for "concentration camp", for example, prisoners of war, sexual assault/rape victims, etc. etc.

However, you don't even have to go that far or that extreme.

For some people, for example people who struggle with addictions, or depression or fill-in-the-blank, just knowing that someone else has experienced something close to what you have experienced can create a bond. Especially when the emotional pain you have been struggling with has been hidden for so long.

But I am digressing again.

I am talking about confidentiality.

SO, confidentiality -- the keeping of secrets is a good thing. However sometimes, revealing information (or personal disclosure) on the part of the therapist to the client is a good thing, because it may help to put the client at ease.

However there is also another school of thought which says that when the client comes in to see a therapist, they are already struggling with X -- whatever X may be.


The psychotherapist is a screen reflecting back to the patient.

So when the therapist is a stony wall of silence about his or her own life -- which usually happens especially so in psychoanalysis (see my post on All About Psychos)  link here:

Then what happens is the client sees everything in terms related to what they are struggling with.

So, I will give an example.

A young woman comes in who is having trouble with her marriage or job or whatever it is... Fill-in-the-blank.

She doesn't tell the therapist(male) that she has some sexual abuse in her background whether by her father or brother or a previous partner. However, this past trauma keeps affecting her and in her relationships with others. However, she hasn't been able to recognize this.

The therapist is mostly silent and blank in the session, like screen or wall that just simply reflects back to her what she says, like a silent movie screen. Now, if you look at my other post on Narcissism, see link 
Remember the image from the painting by Waterhouse?  Narcissus is totally and utterly consumed by his image and that is all he sees in the water, while he meanwhile ignores Echo.

This is the same as the woman who comes to the therapist. The therapist, by being silent and verbally reflecting back to the woman what she tells him, begins to take on traits of what the woman sees in front of her and all around her.
At some point the woman in therapy will begin to start talking about her past trauma and may very well even start to see reflected back to her in the therapist elements of her own dysfunctional behaviour. So she may begin to hate the therapist or resent the therapist or play out her past trauma with the therapist....... OR.... if the therapist and she have a good working therapeutic relationship.....

The therapist will point out to her how she may be using the therapist to work through her past issues of trauma, sexual or otherwise.

In that process, the woman now "works out" what she has been struggling with in terms of relating to other people, in particular perhaps men, and what she may have been holding onto for ten, twenty or even thirty years.

And that dear friends, is kind of, the essence of therapy.... Not completely of course!

And it is also why, for a number of reasons, therapists and counsellors are all so concerned about confidentiality.

This is why we keep our lips sealed! Precisely because (private) details of other peoples lives can often ruin them if made public.

And remember, in the immortal words of the Gogo's: Our lips are sealed.

Take Care,


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