NUMBER 1005 • 18 JULY • confidentiality
A central plank of the orthodoxy of all the helping professions is that the relationship between the therapist and the child (and his parents) is confidential and that the information gained through it is sacrosanct and may not be freely communicated to other professionals. The context of this book is not appropriate for a discussion of the concept of confidentiality and the complications surrounding it. It is, however, helpful to distinguish between, on the one hand, the sensitive and responsible use of information in order not to hurt a child or his parents or to damage the therapists and, on the other hand, not disclosing information at all, simply because it has been given in confidence by the child or the parents to a particular treatment agent. We take it as axiomatic that no action should be taken which hurts the child and the parents through insensitivity. Broadcasting damaging information is one clear instance of this and should never be practised. If a treatment agent lacks the sensitivity to communicate information in an unhurting and undamaging way, it is most unlikely that he will be a good therapeutic agent in the first place, and he should therefore be prevented from engaging in such an activity.
However, it is also a central contention of this book that the treatment of problem children is a means of achieving social order and enforcing social values, employed by a group of people who, whether they act in a statutory or a voluntary capacity, are empowered and warranted to intervene in the life of a less powerful citizen. As such, all treatment agents are of equal standing although they may vary in the organisational or (preferably) the professional/intellectual authority they carry, by virtue of their (ascribed or acquired) expertise in a particular field. The relationship between the child and one particular therapist, such as a psychiatrist, is no more confidential or sacred than that between the child and a teacher, the child and a social worker or the child and a nurse. The logical conclusion of treating information acquired from, by or through a child as confidential is that each parry would refuse to communicate with the others lest the canons of confidentiality be breached. This is as counter-productive of treatment as it is unnecessary.
We believe that the notion of confidentiality in the treatment of children and their families as practised among and between professionals is vastly overplayed, to the detriment of children and of the interests of minimal intervention aimed at maximum benefit. One element of such maximum benefit is that all therapeutic agents should know what the others are doing so as to regulate their own actions accordingly. In any case, public accountability for all actions, which we regard as the chief ethical safeguard for the children and their care-givers, demands the sharing of information. If we do not believe in the integrity of other people involved in the treatment of the child, we should not allow them to participate in treatment in the first place.
Hoghughi, M., Lyons, J., Muckley, A., & Swainston, M. (1988). Treating problem children: issues, methods and practice. London: Sage Publications, pp. 13-14