CONFIDENCE IN CONFIDENTIALITY

by Dr. Winnie Waiyaki.

The question always is, “Will I be understood? Will I be judged?” Most people who come to therapy will struggle with these two questions. Oh, and a third one: ‘’Will the therapist tell my story to others?’’ This is a valid concern I agree, as we live in a small society where the likelihood of someone knowing your story is high. It is with regard to this concern that I want to share my experience with one of my clients.

When Wambui Solite came for therapy, she was very nervous. She is the daughter of a Kenyan multi-billionaire. Her family is always in the news and she did not want her issues “advertised” in the Daily Times the very next day. Did I know who she was? I apologized for being so misinformed that I did not recognize her beautiful face. My attempt at giving an encouraging remark fell flat on its face!

My constant assurance that my ethical code does not allow me to share her story did not assuage her fears. I wondered whether I should have omitted telling her the exceptions to confidentiality! A therapist is committed to keeping a client’s information confidential, however, there are times they are obliged to breach confidentiality.

“You are allowed to give me away?” she almost shouted with a sneer. “That is what is wrong with Kenyans”, she added in her heavy British accent, obviously giving away the fact that she had studied abroad. Honestly, in such situations I am tempted to put on my own rendition of the British accent, which I gained for watching endless episodes of “Yes, Prime Minister”, an acclaimed satire on British politics.

However, it is in my own Kenyan public-school voice that I calmly assured her that this is the rule the world over, the developed world included. “If your client threatens to commit suicide, or harm another person or violate the rights of vulnerable people, a therapist is obliged to report these things.” With a near vulgar laugh she inquired, “vulnerable people?”

“Yes, this includes children and old people who would be defenseless against a client’s assault,” I responded, still keeping calm.

With a roll of her eyes she retorted, “As if! What could possibly possess me to harm little ones? On the other hand, my father I would gladly kill, I dare you to report that!” She added gloatingly, her eyes full of fire!

Unshockable as therapists are supposed to be, an alarm bell rang through me, when I imagined a headline “Daughter Spears her Billionaire Father to Death.” At a primal level within me, I imagined her wielding a spear, and not a smooth pistol as besuited her glamorous self.

“Well, we can talk more about that”, I heard my therapeutic self respond, with a tone that suggested to her that everything that you say in therapy will be soon brought up but not necessarily against you. Therapists actually hear everything; it is all noted and applied somewhere. I desperately hope I also conveyed a sense of compassion, for she who wants her father dead, needs lots of empathy.

After my detailed explanations, including that therapists also do seek supervision for their cases and consult as well, I asked her whether she had any questions. In a rather subdued voice, yet with a fire, she said grudgingly, “Can you promise never to tell without first asking me?”

“Of course!” I replied in my most assuring and enthusiastic voice. “One, even in supervision and consultation, I do not get to disclose your identity. Two, my supervisor is also trained not to be curious about my clients’ identity”, I added, hoping to elicit a smile. I was rewarded with a faint smile, and somewhat a reduction of the fire.

I felt like we had jumped over a certain hurdle even as I informed her that sometimes Clinical Psychologists seek collaborative information from other people that may know the client. This I said with a hasty assurance that I could never go behind her back.

We went on to have therapy for a year in which she was always vigilant. As we terminated, she was most grateful that her issues never made it to the press. I felt my gain was that she gained confidence in confidentiality.

Confidentiality is an essential for the therapist and an indispensable assurance for the client.

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