It is important to be clear
EARLY in your work with the young person about what can be kept confidential and what cannot.
Most workers in Child and Adolescent Mental Health will be used to explaining the limits of their confidentiality to clients early on in their therapeutic relationship. It is important for a therapist, at the earliest appropriate opportunity, to offer a prepared explanation of:
- The meaning of confidentiality in a therapeutic relationship
- The limits of confidentiality in this relationship.
Child Protection
The therapist's duty of confidentiality is always "trumped" by
Child Protection concerns if these imply that a
failure to act upon this information would mean that significant harm is likely to occur.
Serious crime
Other examples where confidentiality is limited would be hearing about a serious crime such as murder, etc. For example, simple theft would be unlikely to fulfil this criterion. The keyworker always reserves the right to consult with colleagues within the team (and should be explicit about this in discussing this with their patient) about whether
breaking confidence is the most appropriate course of action or not.)
Mentalization and Confidentiality
Mentalizing interventions often involve an explicit effort to reduce the "opacity" of one's own mind - "thinking out loud".
It is important to try to explain this process:
- The nature of one's CURIOSITY about the young person's experience
"It is important for me to try really hard to get an ACCURATE picture in my mind of what it is like to be in your shoes - the one thing I know is that I definitely CAN'T do mind-reading, so I have to use kind of nosey questions, but nosey in a good way, I hope!"t
- Its PURPOSE of this curiosity
"...that way there is a better chance that I can help find ways of really being helpful to you - rather than just play-acting at being helpful..."
- Explain EARLY ON the limits to what my curiosity can cover (i.e. this is not a PRURIENT process.)
"of course there are limits to what I am prepared to be curious about. It is really important that you feel that some things CAN be private for you; so if you feel I am ever asking about things you don't want to talk about, I would like to have a really clear way of finding that out ASAP - how could you let me know that?..."