No. 1966
Confidentiality at all costs?
VIEWPOINT 1
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 people. 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 if we 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 person 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 we feel that it is impossible to show true respect for young people. (Alvin Goodwin, writing in Youth in Society)
VIEWPOINT 2
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 multi-disciplinary 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 the primary 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 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.
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 has 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 indiscretion. that information was shared "for the youngster's own good".)
Permission: A counsellor is often well advised to admit inadequate 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 an authority figure or a parent, and might 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.
ALVIN GOODWIN and BRIAN GANNON
Readings in Child and Youth Care for South African Students Vol.2.
(1999).Cape Town:
NACCW And Pretext Publishers, pp.178-180
References
Hoghughi, M. (1988) Treating Problem Children: Issues, Methods and
Practice. London: Sage
Hoghughi. M. (1992) Assessing Child and Adolescent Disorders. London: Sage
