This is hard to write, because it’s upsetting for me, but I think it’s important to share. I want to talk about confidentiality during NHS Therapy. I’ve already spoken about some specific issues with confidentiality in the NHS, but today I’ll be focusing on Therapy. A thread

When I was referred for an assessment appt with a psychologist at IAPT, confidentiality was explained to me. I was told that everything would be kept confidential, unless there was a risk of harm to myself or others, but that I’d be told first about them breaking confidentiality.

In that appointment, once we’d established that we would be going ahead with Cognitive Analytic Therapy, the psychologist asked for my permission to share anything she deemed relevant with my CPN. I agreed to that arrangement.

She later explained that a Formulation would be written in therapy, & that it would be shared with CPN, psychiatrist and GP. I was reluctant about this, & was unaware of exactly how much info would be shared, so I didn’t give my full informed consent, but I did reluctantly agree.

Towards the end of therapy, I had to have a CPA meeting with psych, CPN & psychiatrist. However, what I wasn’t aware of is that they had already met up two weeks prior to this CPA, without me there, in what they called a “professionals meeting”. I recently read this in my notes.

During this “meeting” about me, without me, the psychologist shared something that I had shared with her, something deeply personal - something that I wouldn’t ever even share privately with a friend, never mind share it here with you now. I found this out from reading the notes.

The notes of this meeting were handwritten by the psychiatrist. I don’t know the full context for why this deeply personal thing was brought up for discussion, or exactly how they spoke about it, but the fact is, they spoke about it, and it is now in my permanent medical record.

Now, this being shared with CPN, I have to accept, because in my utter naivety at the beginning, I *did* consent to the psychologist sharing things with CPN. But I did NOT agree to things being shared with whichever psychiatrist happened to be seeing me at any given appointment.

Nor did I agree to it being recorded in the psychiatrist’s notes about me. I was extremely vulnerable when I shared this with the psychologist. & when I say it was deeply personal, you’re just gonna have to trust me that it is, because I can’t share it here with you & never will.

It was written in such a matter of fact way. & to see it there in the psychiatrist’s notes & to then realise it was spoken about in a meeting between these 3, just made me feel physically sick. There was no need for details to be spoken about like this. It did not need to happen.

The manner in which is was written (the psychiatrist wrote the notes, and it was together with all her other notes) and also the timing of it being written - near to me being discharged, means that it is highly likely the psychiatrist from perinatal team would’ve also seen this.

It also means that during a crisis, after my medication was stopped, the psychiatrist from the crisis team would have also likely read this about me too - a male psychiatrist (which, trust me, if you knew what has been written, you would be disgusted).

I shared this deeply personal thing with the psychologist without really thinking who else would end up knowing about it. CPN, I have to accept. But had I known this would’ve been discussed with a psychiatrist, & then recorded permanently in my notes, I would’ve NEVER shared.

The fact is, my confidentiality was broken during that meeting, without good cause. But I doubt the psychologist has ever given it a second thought or ever even thought of it as breaking my confidentiality. And so I wonder how many other people this kind of thing happens to.

I have no real idea of exactly how many people have read this deeply personal thing that I shared, whilst glancing at my notes. It makes me feel physically sick. It frustrates me how many professionals seem to think it’s OK to break confidentiality in this way.

There are some real moral and ethical issues at play here. I only found out about this breach in confidentiality because I requested my medical records. By the way, I had to fight HARD to get them. I had professionals continually trying to get me to change my mind.

Another breach of confidentiality also happened when my Formulation was accidentally posted to a different patient/different GP Surgery due to an admin error. Again, I wasn’t informed of this. I only found out, to my horror, when I accessed my notes.

As an abuse survivor, control is important, especially with regards to my trauma history and who gets to know about it. To find out something so personal I shared, in what I assumed was a confidential therapy session, is now permanently recorded in my notes has deeply upset me.

I find it nauseating that me not being referred back for more therapy (despite knowing I could after a year) is probably seen as a success. I’m probably a statistic somewhere proving that CAT works. When the truth is, trust has so deeply been broken, I’d never risk going back.

It also greatly frustrates me that this kind of dangerous disregard for our confidentiality is probably happening all across the UK and so many patients are actually unaware of it, because we don’t all request access to our medical records. So this behaviour goes unchallenged.

The power imbalance is huge. I could never make a complaint about this confidentiality breach because it would mean that more people would be made aware of the deeply personal info I shared with the psychologist in that session. It is humiliating.

When you say at the beginning of therapy that confidentiality will only be broken if there’s a risk to us or anyone else, you’re not really telling us the full truth are you? It is way past time now for you to reflect on this.

It makes me wonder how many psychologists out there are breaking confidentiality during Therapy on a daily basis and not even seeing it as a big deal. Anyway, I just wanted to try write about this in the hopes it gets some profs to reflect on their practice. Thanks for reading