Privacy and discretion in therapy for high-profile clients: what to expect and what to ask
Confidentiality in therapy is a professional obligation, set out in each therapist's code of ethics, and it covers what you say and the records kept about you. It has limits, usually including serious risk of harm to you or someone else and some legal requirements, and a therapist should explain those at the start. For people with public profiles, practical privacy matters as much: how you book and pay, where and how sessions happen, who in your world knows, and how records are stored.
What confidentiality covers
Confidentiality is part of the foundation of therapy, and professional codes of ethics set it out as an obligation. The Australian Counselling Association's code, for example, describes confidentiality as a means of providing the client with safety and privacy, and says that any limit on it is likely to reduce the effectiveness of counselling.
Confidentiality usually covers:
- What you say in sessions
- The fact that you are a client, in most settings
- Your records, which should be kept securely, with your identity stored separately from case notes
- Arrangements after the therapy ends, including what happens to records if the therapist can no longer practise
Where the limits are
Confidentiality is not absolute, and a good therapist will explain the limits at the start, as part of agreeing how you will work together. Common limits include:
- Serious risk of harm. If a therapist has good grounds to believe someone may be seriously harmed, including you, they may need to share information. Codes of ethics usually ask them to seek your consent first where possible and to share only what is necessary.
- Legal requirements. Some laws, such as those about safeguarding children, can require disclosure. Courts can sometimes require records.
- Supervision. Therapists normally have clinical supervision, and codes of ethics expect them to consult a supervisor before any decision to break confidentiality. It is reasonable to ask how they protect your identity when they discuss their work.
- The setting. Where a therapist works inside an organisation, there may be extra limits, which should be explained.
These limits apply to everyone, however prominent. It is better to understand them clearly at the start than to discover them later.
Practical privacy
For people with public profiles, family wealth or sensitive roles, confidentiality is only part of privacy. The practical arrangements often matter just as much.
| Area | Questions worth thinking about |
|---|---|
| Booking | Who contacts the therapist? Do you want an assistant involved, or not? |
| Payment | Whose account pays, and what will appear on statements? Is a company or family office involved? |
| Location | Online, at the therapist's practice, or somewhere private? Could you be recognised arriving or leaving? |
| Communication | Which email address or phone number will be used? Is it shared with staff? |
| Calendar | What will appear in shared calendars? |
| Records | Where are notes kept, how are they secured, and how long are they held? |
| Other people | Who in your household or business needs to know, if anyone? |
Privacy in couples work
Couples work adds another layer. In couples therapy, what one partner says is usually heard by the other. In discernment counselling, much of the work happens in separate conversations, and the counsellor does not repeat what each partner says in private, although they may share general impressions. If you are considering couples work, ask how the therapist handles information shared by one partner alone, and what would happen if one of you told them something the other does not know.
Non-disclosure agreements
Some clients ask a therapist to sign a non-disclosure agreement. Some therapists will. An NDA can make expectations explicit, but it does not override the therapist's professional code or the law, including the limits of confidentiality described above. If you want one, it is worth asking the therapist how they approach it and, if needed, taking legal advice on what it can and cannot do.
Questions to ask before you start
- How do you explain the limits of confidentiality to new clients?
- Who else might know that I am your client, including supervisors, administrators or anyone who handles payments?
- Where and how are your notes stored, and for how long?
- Which platform do you use for online sessions, and do you ever record them?
- How would you handle meeting me in a public or social setting?
- Have you worked with people whose position or visibility makes privacy a particular concern?
- Which professional body are you registered with, and how would I raise a concern?
A therapist who answers these clearly, without making you feel unusual for asking, is giving you useful information about how they work.
Common questions
Can I ask my therapist to sign a non-disclosure agreement?
You can ask, and some therapists will agree. An NDA does not replace or override the therapist's professional and legal duties, including the limits of confidentiality in their code of ethics. It is worth asking how any agreement would sit alongside those duties.
Will my therapist ever tell anyone what I said?
Only within the limits explained at the start, which normally include a serious risk of harm to you or someone else and certain legal requirements. Therapists also have clinical supervision. Ask how they protect your identity in it.
What if I meet my therapist socially?
It is worth agreeing in advance how you would both handle that. Many therapists will not acknowledge a client in public unless the client does so first.
Is online therapy secure?
It can be, but security depends on the platform and on both people's devices and surroundings. Ask which platform the therapist uses, whether sessions are recorded (they should not be without your consent), and where notes are kept.
Lucy Orton works with people whose visibility or position makes privacy a particular concern, and sets out how confidentiality works at the start of any intensive.
References
- Australian Counselling Association. Code of Ethics and Practice, version 16, sections 9 to 12 (confidentiality, settings, exceptional circumstances, management of records). theaca.net.au
This page is general information about intensive therapy. It is not a substitute for individual assessment or advice, and reading it does not create a therapeutic relationship. If you are in crisis or at risk of harm, contact local emergency services or a crisis line now. How these articles are written and checked: our editorial standards.