Confiding in therapists: Watch what you’re saying

What stops a therapist from divulging a patient’s deepest secrets?

Ali Suffayan* decided to visit a therapist after relations with his fiancée soured. At one session, the therapist urged him to discuss what he felt was pushing the relationship into rocky waters. “I did not know that my fiancée had been called in and was sitting behind a curtain at the therapist’s office,” he recounts.

During the session, Suffayan confided in the therapist, discussing aspects of the relationship that he was hesitant to bring up with his fiancée. His fiancée was furious. “Our relationship was hanging on by a thread and the therapist just pushed it over the edge,” Suffayan says, adding that he know realises that his issues stemmed from miscommunication. “The experiment only made things worse.”



Suffayan was not aware of any means of redress in his case. Had there been any provision to sue for medical malpractice or invasion of privacy, he feels the damage had already been done. “Its useless crying over spilled milk,” he muses. He blames the deficiencies in his therapist’s education and training, saying there was a total lack of patient-doctor confidentiality in his case.

The notion of patient-doctor confidentiality ensures that a person seeking medical or psychological help will be comfortable in sharing all aspects of his or her condition as he or she is guaranteed privacy. The confidentiality helps professionals in their diagnosis, as it encourages patients to be as forthcoming and honest as possible, with no fear of the information being misused or divulged. However, patient-doctor confidentiality is a concept many psychologists in Pakistan do not understand well, says Ravale Mohydin, who worked as a counsellor in Pakistan before pursuing higher education. She recalls that her patients’ parents, spouses and in-laws would routinely inquire about their progress. “I had to remind them that I had signed a contact guaranteeing my client’s privacy.”

There are some exceptions to the confidentiality clause. “If I think a patient has suicidal tendencies or is going to harm someone, I discuss it with someone close to them,” explains Mohydin. “Anything else, according to international standards, cannot be disclosed to anyone, no matter what.”



In some cases, psychologists think it is okay to discuss a patient’s condition with their family. When her brother was sent to a counsellor for behavioural issues after not doing well in high school, communications designer Shehla Waheed says she received a call from his therapist. “She told me everything about his case, including his feelings toward various family members and his resentment toward us,” Waheed says. “After some reflection, I realised that my brother’s case was quite complicated and had to be dealt in a different way.”

Asked why some therapists share information in such a manner, Mohydin says that in many cases, relatives use ‘family unity’ as an excuse to probe therapists about sessions. “They want to know how well the patient is doing,” she explains. And in legal terms, these therapists are not breaking any laws. “There is no law in Pakistan that protects patients against a breach of privacy — there is just a confidentiality contract that some therapists sign,” Mohydin emphasises.

Many psychologists don’t sign contracts listing the terms of privacy. “I have heard horror stories where therapists have shared sensitive information with the wrong person at the wrong time, thereby worsening the patient’s condition,” Mohydin confirms. Former head of the Psychiatry Department at Jinnah Postgraduate Medical Center in Karachi, Professor Saad Bashir Malik concurs. “I have come across many psychiatrists and therapists who are very unprofessional when it comes to maintaining their clients’ confidentiality,” he says, adding that many therapists and psychiatrists with celebrity clients openly discuss details of the case and diagnosis. In some cases, these professionals utilise details of a case for teaching purposes. “Medical teachers need to use case studies for teaching purposes, but even in that case, a client’s identity must never be revealed,” Malik says.

Professor Malik reiterates that even in cases where the doctor and patient do not sign a confidentiality contract, the right to privacy must be ensured. “It should be implicit,” he says, with the exception of cases wherein doctors must divulge information on court orders or if the patient could harm someone.

Dr Tariq Attique, a psychiatrist at Lahore’s Sheikh Zayed Hospital, points out that while psychiatrists must hold a licence to practice from the Pakistan Medical and Dental Council, there is no body governing psychotherapists’ practice. “Anyone who has a university degree in psychology is free to practice as a psychotherapist here,” he says. “There should be a council to regulate who gets to practice as counsellor.”

“In Pakistan, we are not aware of our right to privacy,” Advocate Tipu Sultan Makhdoom says, explaining that cases of breaches are usually dealt with by the licence-issuing authorities. He has never come across a lawsuit wherein a therapist has divulged confidential information.

So, how can you ensure your safety and privacy? Firstly, check out a counsellor’s credentials. “Make sure they’re from well-reputed universities and inquire about their professional methods and philosophy,” Mohydin advises. Additionally, demand a contract listing the terms of confidentiality that both the therapist and the patient must sign.

*Names have been changed to protect privacy.

Saleha Rauf works for the Lahore bureau of The Express Tribune and tweets @SalehaRauf

Published in The Express Tribune, Sunday Magazine, November 1^st, 2015.