Keeping secrets: Trust and confidentiality in counselling and psychotherapy

A/Prof. Andrew Crowden1, Janet Crowden2

1University of Queensland, Brisbane, Australia, 2University of Southern Queensland, Brisbane, Australia

Uncertainty surrounding confidentiality and disclosure in therapeutic relationships remains a problem. Breaches of confidentiality are not rare. The Royal Australian and New Zealand College of Psychiatrists (RANZCP) has recently expressed increasing concern about the use of subpoenas to gain access to clinical records. The RANZCP reaffirmed the commitment of the psychiatric profession to confidentiality in clinical practice advocating law reform that recognises the therapeutic value of confidentiality and respects the privacy of patients (PS86PP, RANZCP 2016). Consumers too are concerned. The Psychotherapy and Counselling Federation of Australia’s records reveal that breaches of ethics, accounts for the largest number of client complaints at 39.34%. Matters concerning confidentiality account for approximately 11.4% of all complaints made by clients (PACFA, 2018).

How do professionals determine when to keep information confidential or disclose to a third party in challenging situations? In this paper we consider if virtue ethics can capture the nature of trust and confidentiality within complex psychotherapy relationships.  The difference between confidentiality obligations in everyday life and within distinct professional psychotherapy relationships is described. How key sources of Australian law account for professional obligations in relation to privately disclosed health information is identified. A neo-Aristotelian virtue ethics approach that recognises the intrinsic nature of distinct psychotherapeutic relationships is examined. If a disposition to act from respectful positive regard, compassionate empathy, congruence and trustworthiness are combined with technical skills (techne), distinct knowledge (episteme), intellect (nous), theoretical wisdom (sophia) and a well-developed sense of the governing virtue practical wisdom (phronesis) is a psychotherapist then able to act with discretion, sagacity (insight) and professional integrity at the right time in the right way? Seminal psychotherapy cases are used to determine if virtue ethics can increase our understanding about the complexities surrounding professional confidentiality in counselling and psychotherapy.


Biography:

Andrew Crowden is Associate Professor in Philosophy at the University of Queensland’s School of Historical and Philosophical Inquiry. He has Ph.D. and Master degrees from the Bioethics Centre at Monash University. Andrew is Chairperson of the University of the Sunshine Coast Human Research Ethics Committee, a member of the Australian Institute of Aboriginal and Torres Strait Islander Studies Research Ethics Committee and Research Ethics stream leader for the Australasian Association of Bioethics and Health Law. Andrew is an active researcher and is a chief investigator for several interdisciplinary genomics/bioethics projects in collaboration with a range of industry and university partners.

Janet Crowden is currently completing a Juris Doctorate at University Southern Queensland. She holds a M. Education, Grad Dip Education and B.A in Communications.  She is interested in human rights, animal rights and ethics. Employed as a senior educator for many years Janet has strong interests in curriculum, literature and student wellbeing. She is an experienced Family Mediator and is a partner at Crowden Consultants. Janet currently serves on the Animal Ethics Committee at the University of the Sunshine Coast.