What is Confidentiality?

According to the B.C. College of Social Workers it is the duty of social workers to “hold in strict confidence all information about clients. Social workers disclose such information only when required or authorized by law to do so or when clients have consented to disclosure.” The legality of this is based on British Columbia’s Privacy Act. As explained by the BC Association of Clinical Counsellors, this act gives legal recourse to any one who has had their privacy violated, unless permitted by law.

Confidential information includes but is not limited to:

Client name, identity and status as the counsellor’s client (or not)
Client attendance at counselling appointments
Information disclosed by the counselling client during a therapy session
Information about a client obtained through other means, such as via a physician, teacher, hospital, family member or other third party
Verbal or written information – for example, information imparted in conversations or clinical notes

Release of Information

Sometimes clients request or agree for their information to be disclosed to a third party. Counsellors will then ask the client to sign a release using specific guidelines, such as what information is to be disclosed, to whom, for what purpose, when this release of information expires and how this permission can be revoked.

A formal release of information may be initiated to:

Coordinate and organize care with another health care practitioner, particularly if the counsellor and the third party need to work together to help the client.
Obtain background information/health and treatment records from another provider to support the client’s treatment plan.
Assist in the counsellor’s understanding of the client’s situation, particularly when specialized help was offered elsewhere.

Limits to Confidentiality

HARM TO A CHILD

A counsellor practicing in B.C., as stipulated in the Child, Family and Community Services Act has a duty to report to child protective services if they have reason to believe that a child, 18 years of age or younger, has been or may be at risk of being harmed physically, sexually or is experiencing serious emotional harm (defined as severe: anxiety, depression, withdrawal, self-destructive behaviour or aggressive behaviour), or if the child is experiencing physical neglect by a caregiver.

There is no legal requirement that the counsellor have proof, but rather only if the abuse is known or suspected. Investigation of facts is done by trained child protection workers.

In addition to the obvious risk to children of not reporting, counsellors who choose not to obey the law could face expulsion from practicing their profession, fines of up to $10,000 or 6 months imprisonment, according to B.C. law.

HARM TO OTHERS

When a counsellor believes that a client poses an imminent risk of serious physical harm or death to an identifiable person or generally identifiable group of people, Canadian common law would then trigger a duty for the counsellor to warn the intended victim, contact the local authorities (i.e. police), or both; this duty to warn is for the purpose of protecting the intended victim or allowing the victim to take steps to protect themselves.

HARM TO SELF

Most counsellors also have a stipulation in their client service agreements that should clients express the intent to cause significant harm to themselves, or take their own life through suicide, that emergency personnel will be summoned and details about the client (name, date of birth, address and relevant details about their current situation) will be released for their protection.

If the client is under 19, child protection (or emergency) authorities would need to be contacted. If the individual is 19 years of age or older, counsellors are authorized to inform the authorities about the situation as per the Personal Information and Personal Privacy Act, which states that an individual or organization can disclose personal information if “there are reasonable grounds to believe that compelling circumstances exist that affect the health or safety of any individual.” If you live in B.C. and are experiencing suicidal thoughts, please call 911 or 1-800-SUICIDE for 24/7 help. Outside of B.C., contact 911 or your local distress centre.

VULNERABLE ADULT

There may be circumstances where a counsellor receives information indicating that a vulnerable adult is being abused or neglected and unable to seek support or assistance. In such situation, the counsellor is authorized under the Adult Guardianship Act to make a report.

In this act, abuse refers to “the deliberate mistreatment of an adult that causes the adult (a) physical, mental or emotional harm, or (b) damage to or loss of assets; and includes intimidation, humiliation, physical assault, sexual assault, overmedication, withholding needed medication, censoring mail, invasion or denial of privacy or denial of access to visitors.”

Neglect, refers to “any failure to provide necessary care, assistance, guidance or attention to an adult that causes, or is reasonably likely to cause within a short period of time, the adult serious physical, mental or emotional harm or substantial damage to or loss of assets, and includes self neglect.”

Such a report would typically be made to a “designated responder,” usually the appropriate regional health authority or the B.C. Public Guardian and Trustee.

COURT ORDER

In some cases a counsellor may be subject to a court order or subpoena to release clinical information, such as clinical notes or to testify in court.

This can be a very challenging situation for both counsellor and client, particularly if the counsellor perceives that such information will be harmful to the client or cause damage to their therapy or the therapeutic relationship. In cases like these, Registered Social Workers are encouraged by the BC College of Social Workers’ Standards of Practice to advocate against the release of such information, keeping in mind that such efforts may not be successful.

Sometimes a client will request notes or testimony with the aim of strengthening their case.

EMAIL

It is important to note that email, while an efficient mode of communication, is generally not considered secure and if used, should be limited to basic communication with your counsellor about practical matters such as scheduling issues. Google (the email provider used by Strength in Heart) claims that when both parties are using their email service, Gmail, transmission of emails is encrypted. Google also offers an online tool to look up domains to see how email exchanged with Gmail is encrypted in transit.

CLINICAL SUPERVISION

Your counsellor may seek clinical supervision to assist them in maintaining an ethical and accountable practice, which could involve, but is not limited to, generating new counselling strategies or problem solving client situations, to help deliver optimal care to clients. That being said, there is usually no reason for any identifying information to be shared.