The essential ingredient of a trusting therapeutic relationship

Trust is the foundation of the therapeutic relationship. It’s what all good healthcare professionals strive for. And there’s one essential ingredient to that happening - maintaining privacy and confidentiality. Without it, everything falls apart.

I’m sharing something different this week. It’s not an expert TED talk or inspiring podcast, it’s just me, giving a talk on privacy and confidentiality. It’s not super polished or particularly well delivered, but it makes a point. And it’s only five minutes.

The point is this. As a healthcare provider, a key part of our job is making clinical decisions. We hope these decisions result in outcomes that make people’s lives better. But it doesn’t always happen that way. And one of the reasons it doesn’t always happen is because we’re not always working with good information.

Quality decisions require us to have access to quality information at the time of decision making. And a key (you might even say seminal) source of that information is the person in front of us. But how open they are with sharing that information with us is another thing. If they decide to censor the information they provide, the quality takes a rapid nosedive that we might not even realise.

One approach to this is to go around them and try and find another “more reliable” source to confirm or disprove the information they provide. And sure, there’s a place for that. But I think we also need to focus on building a quality relationship with that person. Create an environment where they are comfortable with disclosing information openly and honestly.

There are different techniques to help achieve this. Empathising, using active listening, withholding judgement, things like that. All are valuable. But the one absolutely essential, non-negotiable element to building a trusting therapeutic relationship that you cannot do without is providing them assurance that you are maintaining their privacy and confidentiality.

There are the obvious things like not talking loudly on the phone about sensitive information on the bus, or keeping paperwork and computer screens outside the view of bystanders. There’s also the boring stuff, like maintaining responsibility for any artefacts of the information they disclose to you (i.e. anything that you store in physical or digital form) for the entire lifecycle of the information, from the point of it’s creation, through to destruction. And then there’s the sucky things about assuring privacy and confidentiality, that you get judged by the person’s perception of your whole professional group. Reputation carries beyond the individual, so if there’s a healthcare professional saying things out of turn on Facebook or Twitter, they risk bringing us all down with them to some degree. Not good.

So there endeth the first lesson in privacy and confidentiality- not an exciting topic, not just a legal responsibility, but an ethical cornerstone of quality professional practice.