Managing Secrets in Family Therapy

While seeking a request is central to Bower(note) the protocols developed at Bower Place to manage any episode of care, there are occasions where meeting the request is not helpful or appropriate. An example was a mother and her 16-year daughter who had been consulting a practitioner individually. They had spoken about including the mother who knew the young woman was attending therapy and had agreed that it was time to invite the mother to a joint session to discuss their relationship. Before this could be arranged the practitioner was met by the mother in the waiting room who had rung and arranged an individual session so she could ’Fill you in about what is happening with my daughter’. The practitioner felt ambushed and compromised, particularly when the mother told her that she should not tell her daughter the conversation had taken place. This was particularly difficult given the joint session that was planned. What do I do now, she asked me?

This is a challenging and critical issue which focusses attention on the question ‘Who is the client?’ Traditionally we would imagine the client is the person who has been attending sessions but for those of us who work systemically and relationally our answer is that the client is the relationships which impact the wellbeing of those with whom we have been working. In this case it is the mother and daughter. It also focusses us on confidentiality and how this is practiced.

The situation is both informative and an opportunity to make a difference. It tells us something about how this relationship works and suggests secrecy and deceit may well be central to the difficulties between these two and perhaps others in the system. It may allow us to think differently.

So, what to do now the conversation has occurred between the mother and the practitioner? A distinction needs to be drawn between the fact of the meeting and its content. The mother has a right to privacy in terms of what she has shared, unless it contains information that we cannot keep private in any context, just as her daughter has a right to privacy. Given this, it is important that the daughter know of the meeting and the practitioner is not forced into a position where she feels she must lie in a joint session and act as if she and the mother have never met.

The advice to the practitioner was to call the mother, apologise for not having explained the position at the time of meeting and let her know that the daughter needed to know the meeting had taken place. This could be done either by the mother or the practitioner would take responsibility to explain this. She was to make clear that just as the daughter had a right to confidentiality about the content of the discussion so did her mother and this would not be shared to either. Only the fact of the meeting would be disclosed. She was to explain that keeping the secret would render her ineffective in future work either with the daughter individually or in joint sessions because of the inherent dishonesty involved and that she knew this was not the mother’s wish. In doing so she risked either mother or daughter deciding they no longer wished to continue to work with her.

If this were to happen again, I recommended the practitioner address this issue before speaking to a family member about the situation and give them the choice to proceed on the understanding that relevant others would be informed or choose not to proceed. If she chose this the others would still need to know a time had been made with the intention of speaking to the practitioner.

This issue focusses on boundaries and managing situations where a client attempts to create a rigid boundary between them and the practitioner which will shut out others. Opening the boundary may create possibilities for more honest and productive dialogue, address an inherent inequality and allow new patterns to evolve. Alternately it may result in a decision by the client that they do not wish to have transparency introduced into their relationships or their lives.