Confidentiality

Means exactly what it says!

Details #

Confidentiality will be a key issue except in a fairly small subset of therapies for problems associated with near zero shame and with clients who are completely willing to be identified. For all other work there is a tension between a wish to share information so that therapy can improve and others benefit from what is learned pulling against protection of clients’ confidentiality. One of the appeals of quantitative change data is that it carries essentially zero risk of breaching confidentiality: it is hard to see how any particular score on the PHQ-9, or the CORE-10, or any other purely quantitative measure can identify someone.

The problem comes from the other data that is so important to provide context to scores: gender, age, perhaps ethnicity, disability status, social situation. The number of Tudor males whose job was king and who had a hunchback narrows things to one person. (Well it does if you have been exposed to a fair bit of Shakespeare or of UK history.) The more variables we have the more important it becomes to consider the danger of “de-anonymisation”, of identifying someone.

The problem becomes more challenging still for qualitative data and that introduces the complexity of who might be able to identify whom: in principle if a client can recognise him/herself and didn’t give permission for that then there has been a breach of confidentiality even if it is implausible that anyone else could identify that person. However, generally we can assume that the therapist(s) could. Then there are the complexities of group, couple and family therapies where others may be able to identify someone just from a short quote from a personal questionnaire. (“A horse, a horse, my kingdom for a horse” … well, OK, perhaps that never appeared in a PQ or PSYCHLOPS but some very specific things sometimes do.)

There are no magic answers to protection of confidentiality but it should be considered carefully and the issue there in any “informed consent” briefing or form.