When Is It OK to Violate Confidentiality?
Gossiping with or about clients is always unethical. But there are limited scenarios where it is legally OK to violate confidentiality.
Boundaries—defining them, communicating them, and guarding them—can be tricky. All humans have a right to choose their boundaries. Sometimes this is easier said than done, especially when it comes to intellectual boundaries in the therapeutic relationship.
Intellectual boundaries relate directly to a person's thoughts, beliefs, values, and opinions. In school, we are taught to respect the thoughts, beliefs, values, and opinions of others. We are also taught to keep our personal thoughts, beliefs, values, and opinions to ourselves. In other words, professionalism involves leaving one's personal life at the door.

But what happens when a client stirs a reaction within you that promotes a feeling that an intellectual boundary is being violated? Or, what if you unintentionally stir a client with something you say, do, or display? We all carry past experiences that shape our perspectives. Added to this, our culture is hot right now with opinion, expression, offense, and defense. What happens when these perspectives and emotions, be it ours or our clients', filter into the treatment room?
Here, we will explore how perspectives might collide, how to avoid this occurrence, and how to respond when a boundary is crossed.
Our profession is unique. We spend a significant amount of time with our clients and often get to know them well. Our role is to provide a client-centered, safe, and competent bodywork experience. Sometimes that means our clients will express themselves, including their social frustrations.
Client expressions might include personal opinions about politics, social or cultural groups, social movements, people who are different than they are, or someone whose opinion they strongly disagree with. Unfortunately, sometimes you might hold opinions they disagree with.
It is highly likely you will have clients who are significantly different from you. It is important that these differences do not affect the therapeutic relationship. That responsibility lies in your hands.
The most effective way to avoid this type of relational friction is to create a respectful, neutral environment. To do this:
If a client makes a comment about something that is not in alignment with your perspectives, leave it be. Don't comment or respond. Simply roll right past it and redirect the conversation to the therapeutic goal.
These suggestions are not meant to create a stale, cold, or impersonal environment. You can offer a peaceful and nurturing environment in which clients feel your warmth and care without imposing belief systems.
Intellectual boundary violations can be genuinely unintentional. If a client is expressing an opinion, even one that you agree with, you can simply not respond and continue to do your work. If a client is really pushy or aggressive even after you have attempted to dial down the situation, you have every right to terminate the session. Following are examples of minor and major boundary violations and how you might handle them.
If a client is expressing a strong opinion, you might say, "It sounds like that's really important to you. Where do you feel that experience in your body? Can you take some deep breaths into that space and release or disperse it just for this time so you can allow yourself to retreat from it?"
If they continue or ask you if they have offended you, simply say, "My opinions, both those that are similar and different from yours, aren't part of the session. It's best if we stay focused on [insert the therapeutic goal] and really allow your nervous system some space to shift into healing mode."
Likewise, if a client reacts to something you say, you can respond with, "I genuinely did not intend to upset you. I apologize. Are you comfortable continuing the session?" However, the likelihood of upsetting a client is greatly reduced if you follow the previously stated recommendations.
Your safety is as important as your clients' safety, so if you feel threatened you can say, "I'm not comfortable with the tone of this conversation. It is not supportive to our therapeutic goals, so I'm going to end the session now."
You also have a right to not work with that client further. If they try to rebook at any time, you can say you do not feel you can offer the quality of care they need or that you are not comfortable with the interpersonal dynamics, but you will gladly offer them contact information for two or three other therapists they might choose from. Keep it simple. There is no need for argument from either side.
We all have varying histories, experiences, triggers, and valid reasons for responding to stimulus in the ways we do. Ultimately, our boundaries are ours to determine and maintain. The most important part is for this to be done with purpose and professionalism, which involves always respectfully honoring boundaries—our clients' as well as our own—and remembering that the treatment room is not the place for social commentary. It is, instead, a refuge.
Gossiping with or about clients is always unethical. But there are limited scenarios where it is legally OK to violate confidentiality.
When we use the term emotional release, we create an agenda where none should exist.
What does acting and staying within your scope of practice look like, and when is a referral more appropriate?
Clients and therapists alike have the right of refusal. Don't be afraid to use it.