Issues around confidentiality for people with intellectual disability can be complex in counselling practice. It is important to work with your client to find an appropriate balance between the client’s right to privacy of their personal information, and the need to share information with others to promote understanding and safety, or to work together to achieve the client’s goals (including family members, carers or other service providers).
Due to general difficulties in verbal communication and specific issues such as confabulation (exotic story telling), it can be difficult for counsellors to assess the need to disclose client information to third parties. Each situation needs to be assessed on a case-by-case basis, taking time to explore matters without assumption about the level of seriousness.
Compliance is a common issue in navigating confidentiality with clients who have an intellectual disability. For example, sometimes clients agree to the sharing of their personal information with third party people or organisations that they would prefer to keep the information from, but they comply with requests due to fear of the third party or fear of getting into trouble. This is most prominent in instances of ‘powerful carers’, who have a high level of influence over the person with disability (Upton, 2009).
It is useful to approach confidentiality issues as areas for negotiation. This means discussing confidentiality on a regular basis, talking about and exploring what it means, and discussing what kinds of circumstances would break it. This also means being aware of the people and relationships in the client’s life, both professional and personal – this awareness may help with the negotiation process and ethical decision making. Discussing confidentiality directly with family members, carers and supporters will help to develop a shared understanding of confidentiality, reiterate the client’s right to confidentiality, and reduce the level of acquiescence on the part of the client.
Asking a client to read a confidentiality policy or giving them a flyer about confidentiality is not sufficient. Confidentiality needs attention on a regular basis, and should not be a static agreement with the client but a moving agreement depending on the issues that come to light.