Abstract: Standing on a Knife Edge: Managing Confidentiality in Forensic Psychotherapy

This talk addresses the theme of "confidentiality in forensic psychotherapy". First the author will address the tension between statutory regulations imposing a duty to disclose and a duty of confidentiality to the patient. A comprehensive description of the legal differences between countries in relation to confidentiality is outside the scope of the presentation, but an account of the relevant legal issues within the Federal Republic of Germany will be described in brief. In Germany, for example, the rules governing the extent to which confidentiality is affected differs between forensic outpatient (e.g. probation) and inpatient/detention settings (e.g. prisons or forensic inpatient clinics). This discussion will focus on the identity and the practices of psychotherapists within these settings. Within the psychotherapy community, there is marked variation, ranging from a complete rejection of the obligation to confidentiality ("victim protection takes precedence over data protection", as claimed by the Zurich victim protection charter) to the other extreme – the opinion that therapists are not to communicate with anybody other than their patients regarding treatment (Bollas and Sundelson 1996). The lecture will examine the respective standpoints based on psychoanalytical theories and challenges the radical views on the subject. In inpatient settings, a degree of sharing of information appears necessary on the one hand, since external requirements usually apply and have to be fulfilled under institutional conditions for enabling communication with legal authorities and to facilitate multidisciplinary work between professions. However, this view stands in contrast to outpatient conditions, in which confidentiality is usually more rigidly maintained, the treatment boundary tending to be characterised by a more classical approach in relation to confidentiality. The author will argue that a theoretical evaluation of the various relevant issues is essential, primarily for the reason that, to the author’s knowledge, today there is no empirical research to evaluate whether limitations of confidentiality affects treatment outcome.

Markus G. Feil is a psychologist, psychotherapist and psychoanalyst. From 2001 to 2008 he worked in a forensic clinic in Hamburg/Germany. There he introduced principles of a therapeutic community as well as special treatment programmes as SOTP on a high security ward for patients with severe personality disorders. Since 2008 he is Head of the Psychotherapeutic Outpatient Clinic for Sexual Offenders in Munich/Germany.