By Karla Cloete (HPCSA Registered Counsellor)

Disclaimer: The content of this blog is not intended to diagnose or treat, and all information is intended to promote psycho-education in the community. Please consult with a relevant healthcare provider before taking any mental health advice.

The simple answer is yes- your sessions with a psychologist or registered counsellor are confidential, but there is a big asterisk. 

What is confidentiality in counselling?

According to The National Health Act No. 61 of 2003, which governs all mental health professionals, you have the right to confidentiality as well as a right to privacy as covered by the South African Constitution (Act No. 108 of 1996).

This covers information such as the information and content of your counselling sessions and identifying information (name, address, postal code, etc.). 

What are the exceptions to confidentiality?

There are quite a few asterisks to your right to confidentiality

With express consent

Before your practitioners discuss you or your sessions with anyone, they will ask you for express consent, which will usually be documented in some way. For example, in my practice, clients sign a release of information form.

To refer you to a doctor, psychiatrist or occupational therapist, etc. or even in discussion with your family members, your psychologist or registered counsellor will need to get your express consent to do so. When having this conversation, you can also let them know what information you would and would not be comfortable with them sharing

Parents or guardians’ consent 

Practitioners often triangulate with teachers, co-parents, grandparents, au pairs, etc., who may be able to provide important insights into the child’s functioning and well-being. 

If a client is under the age of 12, the psychologist or registered counsellor needs written consent to discuss the particulars of their client with other professionals or to gather information from important persons in the child’s life. 

When they are court-ordered

In cases where the law is involved, your mental health practitioner may be subpoenaed to testify in court. Most practitioners will only then appear and testify ‘under protest’. They will only share the absolutely necessary information with the court to protect your privacy to the extent they are able to. 

This is different from when you are mandated to see a professional for evaluation due to divorce proceedings, criminal investigation or other legal processes. In this case, the relationship with that professional is evaluatory from the onset. In this case, the limitations and exceptions of confidentiality will be thoroughly explained to you before the process begins. 

Mandated reporting

Psychologists and registered counsellors are mandated reporters. This means that if they have a reasonable suspicion or have confirmed cases of child abuse or neglect as per Section 110(1) of the Children’s Act. In cases of abuse or neglect of vulnerable persons, such as the elderly or those with intellectual disabilities, HPCSA professionals must also report according to the Older Persons Act and the National Health Act No. 61 of 2003.

Being a harm to yourself or others

In cases where your psychologist or registered counsellor is concerned that you are a safety risk to yourself or to those around you, they may break confidentiality. 

Supervision and peer-consultation

All HPCSA professionals are encouraged to seek out supervision from more experienced practitioners to provide the most ethical, highest-quality services possible. Your psychologist or registered counsellor may discuss your case with a supervisor. In doing so, they will not share any identifying information about you and will only share the minimum necessary details to receive guidance from their peer. 

Other frequently asked questions

–Will my counsellor tell my parents everything I say?

No, they won’t. The psychologist or registered counsellor will give parents or caregivers feedback about the sessions to make recommendations, gather information or help practise certain skills at home. But the content of the session will remain between you and the counsellor. If you have concerns about this, you can let your practitioner know if there are specific things you want them not to discuss with your parents. 

-What about medical aid? Will they have access to my records?

To claim from your medical aid to cover your session fee, your psychologist will have to provide them with certain information. This is usually covered in the consent forms you sign before the session. This information includes your name, address, the date and length of your sessions and medical aid information. Your practitioner will also need to list an ICD-10 or Z-code with your claim to let your medical aid know what kind of counselling you are receiving or what mental health condition is being treated. The content of your sessions cannot be accessed by your medical aid. 

-My workplace or employer is paying for my sessions. Will they have access to my records?

In cases where a third party is footing the bill, your psychologist or registered counsellor will let you know before the sessions start what the exceptions and limitations of confidentiality are. The employer may want a report or an update on sessions. Your practitioner will safeguard your private information, and if a report has to be made, they will share the bare minimum information. This might include how many sessions you have had, whether it is ongoing or if more are need etc. If you have been mandated to see a practitioner due to legal or performance issues at work, the practitioner will let you know what is and is not confidential. This can only happen if you have given consent.

-How is confidentiality different from POPIA?

Your psychologist or registered counsellor is bound by both confidentiality and POPIA. POPIA applies to any practitioner, health care facility, business or organisation that deals with your private information. While all businesses must respect POPIA, they are not all bound by the HPCSA rules on confidentiality.

Sources: 

The Older Persons Act 13 of 2006

The National Health Act No. 61 of 2003

Section 110(1) of the Children’s Act

South African Constitution (Act No. 108 of 1996).

HPCSA Booklet 5 (CONFIDENTIALITY: PROTECTING AND PROVIDING INFORMATION)

If you are interested, I offer a 20-minute free consultation call to individuals who are considering starting counselling in Pretoria or online. You can book here. 

Check out this blog if you’re wondering if your child needs counselling.