First appointment with Psychotherapist. Confidentiality question.

[onedayallthiswillbeyours]

I have finally managed to make an appointment after years and years of needing help and am determined to attend this time. I'm pretty certain I have avoidant personality disorder (totally self diagnosed because I have been unable to seek help ).

I'm just wondering, will everything I say be kept in strict confidence? If I were to divulge suicidal thoughts, is the therapist under obligation to pass this on to GP or other HCP? I'm just wondering how much I can safely say.

Yes, it is usual to share broad treatment information and risk information with your GP. If you are an adult, then it will be confidential apart from GP unless you disclose something which suggests you are an immediate risk to yourself or someone else, or you disclose something that might indicate someone else is at risk, in which case social services or police might need to be contacted (unusual of course and they will always tell you first what they are going to do). I hope it doesn’t put you off having an honest dialogue with your therapist, the rules are just there to keep you safe and to help the therapist not take undue risks with public safety or have too many sleepless nights. They should explain the limits of confidentiality to you at the first appointment.

How would a psychotherapist know who a client's GP is? Surely that would only be if the appointment was as a result of a referral?

Thank you so much Eva, I really appreciate your informative reply. This is such a massive step for me, I'm trying to mentally prepare myself as much as possible as it is the fear of the unknown/imagining the worst that I often find most difficult to cope with.

I think it might depend if it's in the NHS or private whether they inform your GP? They should explain confidentiality at the start of your first appointment though and they will be happy for you to ask any questions about this to ensure that you understand where the limits of confidentiality lie.

Watcher I imagine they will ask me to fill in a form with those details. I'm not sure what would happen if I left that part blank though... Different (but sort of the same) is when I have a physio come to treat my horse she is under professional obligation to inform my vet of her visit and treatment given.

Really? I'm surprised. I thought the whole point of psychotherapy and counselling was that it provided a safe, non-judgemental space to explore all sorts of feelings and thoughts without the fear of them being disseminated (other than in the case of criminal activity, of course).

Watcher, counsellors and psychotherapists have a safeguarding role in a client's treatment. They're obliged to explore levels of risk and intention with a client who mentions suicidal ideation, and if they conclude that the client is a present danger to themselves then they have to consider liaising with other agencies. This could be GP, social services or even the police. However, individual practitioners will view the limits of their duty of care in different ways. OP could ask at the first session how her therapist deals with mention of suicidal thoughts and/or plans. This will help her decide if she feels comfortable discussing such material with that particular therapist.

My therapist set out her terms very clearly for me to agree to. I have opted not to have my GP made aware that I am seeing a therapist. However, for her to treat me, I had to agree that if she believes that I may be at serious risk of harming myself or another person or people that she will let the appropriate health professionals know.

Everything we discuss is confidential.

I was very happy with those terms and was glad they were really clear for me to understand.

IME this will be discussed at the beginning of your first session - counsellors have always said to me something along the lines of "anything we discuss is confidential unless i assess that you may pose a risk to yourself or others"

Good luck I really hope it goes well - be kind to yourself afterwards, counselling is invaluable but draining and I feel physically exhausted sometimes afterwards!

Thinking of you

Thanks so much BeautifulDay. You are so right! I am absolutely shattered, and feel totally drained, but I feel so relieved - I have done it! Taken the first step up the mountain... I hope I don't always feel this exhausted afterwards, or my Thursdays are going to be very unproductive from now on!

I'm so glad you made it OP - it will be worth it in the end so well done!

The other unexpected thing to be aware is totally normally is that you start talking about all kinds of stuff in there no matter how much you think you're going there to talk about a specific topic!

Doesn't matter which huge life event has triggered me, I always end up talking about family dynamics and my bloody dad 😂