Confidentiality debate

Discussing and resolving differences is always an interesting aspect of Child and Youth Care work. (Strictly between you and me, how do you feel about this month's subject?)

Viewpoint 1 : Absolute confidentiality
I am always irritated when people within the Youth Service talk about confidentiality as 'an issue'. What they mean by this is that they are prepared to consider betraying the trust of a young person for the sake of professional practice. For me, confidentiality has to be the cornerstone of youth counselling; we must take young people seriously and respect them as individuals in their own right.

Listen
To do this effectively we need to be able to listen properly to what they are saying. Too often we hear young people, but do not listen to them. We really hear only ourselves, complete with our own prejudices and experiences. We are all urged to develop our listening skills, but this often involves simply giving the young person the impression that we are listening. Schools, social services and youth agencies all seem to operate standard procedures for dealing with problems rather than listening to young peeple. The result is that they get shunted from one agency to another, which can be quite disturbing for someone who is already worried or upset.

Once workers get past the hurdle of proper listening, the importance of confidentiality becomes more obvious. I work at Open Door, a counselling and support service for people under 25. Like the Samaritans, we operate a policy of complete confidence. Our publicity states: “Under no circumstances may we inform parents, schools, police, social services, probation officers or any other agency or individual about what we have discussed, unless you ask us to." The last part of that sentence is not a loophole; we genuinely believe we have no right to betray the trust of young people, or to twist their arms because of what we feel is right for them.

Controversy
Because of this policy Open Door has caused a considerable amount of controversy. Many's the time we have had to sit at meetings with representatives of other agencies who are up in arms about our total confidentiality. Their attitude is that if young people are at risk, then the professionals ought to be involved. They do not seem to consider that some young people are uncertain whether or not to tell anyone at all about a particular problem, and ifwe did not exist then they probably would keep silent. For those people we are the bottom line. They may eventually choose to go to the police or to social services, but that is their choice. The important thing about agencies like ours is that we act as a catch net for young people who are so distressed and confused that they don't know what to do. For this reason, the ability to listen rather than just hear is paramount; as, of course, is full confidentiality. It is up to the young per son to choose what kind of action to take, and it may be that the chosen action is to do nothing. Where this is the case, we support it as a positive decision and are available if the young person wants to consider other possibilities at a later date. Without proper listening, and without total confidentiality, we feel that it is impossible to show true respect for young people.

(From a contributor to Youth in Society)

Viewpoint 2: “Need to know" basis
Confidentiality is not a principle in itself; it is part of a set of wider principles which guide the process of helping a person in difficulties through a trusting relationship. Confidentiality should serve this relationship and the helping process. A counsellor in a trusting relationship would never wish to hurt, prejudice, betray or harm a youngster in any way “would never put the young person at unnecessary risk, would never propose or implement a treatment programme which was inappropriate “either developmentally or clinically, would never 'take over' the youngster's life by making all of the choices and decisions. The counsellor would respect the young person's preferences, strengths and cultural values “and certainly respect the youngster's right to privacy regarding the problems which gave rise to the relationship, the family, progress of treatment, etc. These things are all part of a professional relationship. But ... when it comes to the helping process itself, there are some considerations which demand further thought.

The team
Where there is a multidisciplinary team in a helping agency, there is added value in sharing information with those who are working directly with the youngster. In such a case, applying confidentiality too literally, for example by restricting its definition to include only counsellor and client, may render information useless. This is not to say that information should be shared automatically with all members of a team, or even with the head of the agency. Hoghughi (1992: 16) suggests that “need to know" is a good principle for determining the extent of confidentiality.

Supervision
It is usually the agency itself which is accountable for the helping services offered, and the agency builds certain “safety nets" into its staff system. One of these is supervision, whereby line workers consult regularly with another staff member. In such a case the supervisor is seen as an extension of the line worker's own skills, resources and responsibility. When a worker does not have the precise training or experience to handle a problem presented by a particular youngster, it is in nobody's interests for that worker to carry a responsibility alone. The agency shares this responsibility.

Grave danger
Another widely accepted condition under which confidential information may be shared is when a worker has reason to believe that a youngster or someone related is in palpable danger “the young person threatened seriously to harm another or to commit suicide. Awareness and vigilance on the part of others at such a time is the least responsibility an agency can demonstrate. (Not the same as the “excuses" some staff offer for their indiscretions, such as that information was shared “for the youngster's own good".)

Permission
A counsellor is often well advised to admit to a client any inadequacy in skill or information about a problem area, and to ask permission to consult more widely. “I will need to get more information about this. Is it OK with you if I ask Mrs Smith about it?" We should understand the young person's own expectations of confidentiality: he or she may really want us to keep certain information from a certain authority figure or a parent, but would have no hesitation about “in-house" consultation.

Basic ethic
These exceptions apply to specific circumstances, and do not in any way undermine the basic ethic of confidentiality as stated elsewhere by Hoghughi (1988:13): “A central plank of the orthodoxy of all helping professions is that the relationship between the therapist and the child (and his parents) is confidential and that information gained through it is sacrosanct and may not be freely communicated to other professionals.” However, blanket ideas of confidentiality applied too dogmatically, can simply prove a point at the ultimate expense of the youngster.

References

Hoghughi, M. (1988) Treating Problem Children: Issues, Methods and Practice. London: Sage

Hoghughi, M. (1992) Assessing Child and Adolescent Disorders. London: Sage