Zest Counselling views confidentiality as a means of providing the client with safety and privacy. However, Zest does not hold that it is an absolute principle as in certain circumstances, confidentiality may need to be broken, e.g. causing self-harm to self or others.
Counsellors will communicate Zest’s confidentiality policy and it’s limitations to the client during initial assessment and contracting before counselling commences regardless if it is face-to-face or via the telephone. The counsellor will inform the client of the need to discuss and consult in clinical supervision, line management and the internal clinical consultation process. However in most instances they will remain anonymous with the exception of child protection, suicide and vulnerable adult situations. Client material will be presented for supervision and consultation anonymously. Discussion of client issues will be strictly limited to relevant information and personnel only and must be purposeful. When discussions cannot be anonymous every effort will be made to achieve client consent.
Confidentiality agreements may be reviewed and changed by joint negotiation. Any changes to the contract will be logged in clients notes.
Confidentiality contracts pertain unless there are overriding legal or ethical considerations.
Exceptional circumstances may arise which give the counsellor good grounds for believing that the client will cause serious physical harm to others or themselves. In such circumstances the client’s consent to a change in the confidentiality agreement will be sought when possible, unless there are also good grounds for believing the client is no longer able to take responsibility for his/her own actions. The decision to break confidentiality should be made only after appropriate clinical consultation within the line management and consultation system.
Counsellors must familiarise themselves with Zest’s procedures document on confidentiality and its limitations and our child protection policy. Counsellors must consult on any issue of ambiguity and presenting issues of suicide, self-harm, domestic violence, murder, traumatic events and impacted suicide within immediate family. Decisions to breech confidentiality are made on a case-by-case basis.
Ethical considerations central to breaking confidentiality involve a balance between acting in the best interest of the client and acting in ways which enable client resumption of full responsibility for their actions.
If a third party is involved with a client (parent or referral source) and requests information regarding the client, the counsellor will follow Zest procedure “Confidentiality and its Limitations”. Where previously agreed as part of the contract with the referrer we may share client attendance record.
When invited to take part in case conferences, counsellors will attend with the agreement of the client and Clinical Director and will only raise issues previously agreed and documented with the client.
In the event of a client being referred to another organisation by Zest, the information forwarded will be clarified and agreed with the client by the counsellor, having first consulted with the management. Where the counsellor needs to explore the relevance of a referral organisation’s service provision (e.g. how they deal with confidentiality) this will be explored anonymously, protecting client anonymity.
Requests for information from third parties must be referred to line management. All requests for information from The Justice System & Media must be referred to the Strategic Team. (Fergus Cumiskey, Norma Patterson and Denise Andrews)
Zest counselling have specific policies on confidentiality in relation to Data Protection, Court Proceedings, Domestic Violence and Risk Assessment. Information in relation to these sub categories is contained in our procedures document.
Confidentiality and its Limitations
It is our policy to treat all personal information about young people whether obtained directly, indirectly or by inference confidentially. Such information includes name, address, biological details and other descriptions about the young person’s life and circumstances that might result in identification.
At this point the client needs to be aware that they are within the assessment stage and the offer of counselling may be dependent upon clarification and discussion with other health professionals e.g. GP, CPN, Psychiatry and CAMHS. The purpose of any third party discussion needs to be agreed with the client and authorised either verbally or in writing on the proforma to share information.
Disclosure of Information by Consent
When the counselling relationship is ongoing, the counsellor will seek the client’s consent in advance of any disclosure of information, which could be construed as a breach in confidentiality. The rationale for disclosure of information and the implications of the process for the young person will be explained. This sustains our commitment to support the young person’s autonomy and capacity for informed consent at every stage of the counselling process. Any disclosure of information will be made in the young person’s best interest.
Disclosure of Information
The counsellor will only disclose information obtained from the counselling relationship in the following exceptional circumstances:
- The young person requests, and both therapist and client believe disclosure is in the young person’s best interest, that certain, limited information may be passed on.
- Circumstances where the counsellor has sufficient grounds to believe that the client is suffering or is likely to suffer significant harm.
- If the client discloses that they are aware of significant harm of another young person under the age of 18 or over 18 and defined as a vulnerable adult.
- In the event that the young person is under a car order, or when child protection issues arise, the counsellor may attend case conferences and continue to honour Zest’s confidentiality contract.
Signed permission detailing the terms upon which the counsellor may disclose and to whom, will be logged in all instances of disclosure by consent. Line managers and/or clinical consultations will be consulted about all decisions to disclose information with client consent.
Breach of Confidentiality
Whenever possible, a counsellor’s decision to breach confidentiality (without client’s concent), will be made after consultation with their line manager and/or clinical consultant who will decide if the Strategic Team need to be made aware. Any breach of confidentiality will only relate to the immediate situation and will only be relayed to those services that can provide appropriate support required by the young person. The counsellor will log all revisions to individual confidentiality contracts, tracking actions taken, outcomes and implications, reporting on this process, step by step to their line manager and/or clinical consultant.
Exceptional Circumstances – Breach in Confidentiality
This clause pertains in circumstances whereby the young person withdraws or refuses consent for disclosure or whereby the need to consult the young person or seek their consent to disclose is superseded by statute and or child/vulnerable adult protection considerations, including:
- Circumstances where the counsellor has sufficient grounds to believe the client will cause serious harm to themselves or to others.
- Circumstances where the counsellor has sufficient grounds to believe that the client is suffering or is likely to suffer significant harm, for example through neglect, physical abuse, sexual abuse, emotional abuse or drug abuse.
- There are significant grounds to believe that doing so could put the young person at further risk. For example age, maturity, and magnitude of the risk.
- When client records are required for the purpose of internal Zest investigation, or subpoenaed for court proceedings.
Client records and counselling notes are kept for the purpose of the counsellor tracking their work process with clients. Counselling notes are brief and factual reflecting only to the information and language used by the client and summarising the main issues of each session. All counselling notes are kept are kept under an anonymous client ID number and stored securely. These are the property of Zest Counselling. A client may request to see counselling notes relating to their therapy. A client may request to see counselling notes relating to their therapy. A detailed discussion must be had with the client about the possible therapeutic issues around viewing their notes. All requests of this nature must be discussed with your line manager and the clinical director, who will make a decision about what is in the best therapeutic interests of the client. Counselling notes cannot be copied or given to clients.
If the counsellor receives any information e.g.. letters showing any identifiable information about the client, these need to be stored separately with the referral form so as to protect the clients identity. Zest Counselling records statistical information on client gender, age, ethnicity and other issues. This statistical data will be made available on an annual basis for evaluation and reporting purposes. As part of the NI Drugs & Alcohol Strategy, we also collate information on patterns of substance misuse. Clients will be offered an informed choice whether to participate in this data gathering or not. Individual client identification will not be possible.
Third Party Involvement & Client Safety
Outside of the exceptions outlined in the confidentiality policy above, Zest staff will not engage in third party discussions about any matter arising from our counselling contract which may in any way risk client identification, client safety or a breach in confidentiality, this includes clinical supervision. This commitment represents the ethical cornerstone of our practice, differentiating the independent professional counselling service we offer from many conventional configurations of how adults engage with young people. Clients may request that a third party be present during the assessment and/or counselling session. This has a number of ethical implication for our work with the young person, especially when this is another young person. Confidentiality from this third party cannot be guaranteed. Although a client may not see this as important at the time they may regret sharing personal information in front of the third party at a later date. Also discussing difficulty and sensitive material in front of another person can impact on that person who has not had training or support to deal with.
To address this, counsellors should not permit a client to be accompanied by another young person during counselling. If a client feels that they are unable to enter counselling without a friend present for support then this would suggest that perhaps the young person is not ready for counselling to commence at this time. This should be explained to the young person, emphasising that they can take up the offer of counselling at a later date. There may be occasions that the young person, adult/parent/referrer, or both make a request for the other or themselves to be present in a session and this needs to be managed in a sensitive and professional manner.
Alternatively a parent, referrer or key contact may ask or ring to speak to you about a client It is important in these instances that you highlight that you relationship with the young person is confidential and if you spoke with them it could compromise your relationship with them and it would be unethical. If the young person specifically requests that the parent accompany them it nay be that you use this as an opportunity to outline the service, confidentiality and if the parent has support needs of their own that they are signposted to an appropriate service. The parent or referrer needs to be aware that you will not engage in third party discussion about the young person.