Habitual, and prosaic, my partner and I greet each other at the end of our days with, ‘…And how was work?’ We still do this, even though for fifteen years now I have only ever answered with a ‘good/bad/middling’ type response that always serves to close down any further enquiry. In return, I’ll dig into the more detailed narrative I hear about his daily office life – the varying landscape of tension amongst colleagues, their unfolding life stories, the banter. But as tempting as it may be at times to share my own work anecdotes, I’m duty bound to remain schtum.

Confidentiality is the lynchpin of therapy. It simply wouldn’t work without it. Therapy involves a number of helpful elements – a professional expertise, compassion, a committed relationship, a consistency (sessions taking place each week at the same time under the same rules) and a therapist’s attention to the detail of an inner life often not matched elsewhere. But it also offers a safety that (generally speaking) everything revealed won’t leave the consulting room. This allows things to be said that may need to be said that may never be said to anyone else. Would you say to your best friend, ‘I’m in love with your wife?’ or ‘I can’t bear your daughter?’ Probably not, and probably not to anyone who knows your friend either. Would you say to anyone, ‘I feel like killing my mother? I feel like killing myself?’ Maybe, but my guess is not easily.

Confidentiality applies not only to the content of conversations that go on in the therapy room, but also to the fact you may be therapy. So as tempting as it may be to reveal to my friends that I’m seeing one of the Queen’s corgis every Monday morning, I can’t leak that fact out, nor his desire for a longer daily walk. When I began my own therapy, I failed to understand this, and took umbrage when my therapist ignored me when I waved at her on a bus. She wasn’t being ‘po-faced’ (I think I felt at the time), she was protecting me from revealing myself as a client to her companion sitting beside her.

Of course there are exceptions to these rules. It may well be in some therapy services, confidentiality extends to a ‘team’ – ie beyond the therapy room to others who may be caring for you (a psychiatrist or nurse or social worker for example). You may also want your therapist to support you in a claim of some sort, by writing a letter, in which case you would give written permission allowing him or her to do so. Some limits are imposed on us by law – such as anti-terrorism legislation or when subpoenaed to court. Other limits are less clear, and rely upon our discretion – such as where there is a risk of suicide or child protection. So, we may well breach confidentiality if we suspect our client may cause serious harm to self or others – I do. This doesn’t mean I go running to the local police station if I fear a client is suicidal, but I always agree at the outset of work who it may be I’ll contact if feelings get too unbearable, and a client goes missing on me.

Generally speaking, we have an ethical responsibility to act in ways which balance our client’s right to confidentiality against a need to communicate with others and protect other interests. But whatever we decide, we need to be ethically accountable for any breach of confidentiality. Part of this means confidentiality boundaries should always be spelt out at the beginning of any work – and they shouldn’t ever include the right to chat about it at a dinner party.

I’d be lying if I said all of this was easy. Ironically, one cost of a great job that involves talking, means not talking about it.

This originally appeared as a blog on welldoing.org.