The American Journal of Family Therapy, 37:351–354, 2009
Copyright © Taylor & Francis Group, LLC
ISSN: 0192-6187 print / 1521-0383 online
DOI: 10.1080/01926180701862970
Secrets or No Secrets: Confidentiality
in Couple Therapy
FAN-CHI KUO
University of San Francisco, San Francisco, California, USA
This paper discusses secrecy in couple therapy from ethical and clin-
ical perspectives. The author explains what secrets mean in terms
of therapy and then moves to what controversies are raised by re-
vealing or withholding secrets. The author reviews and evaluates
current approaches to handling secrets in couple therapy regarding
the use of informed consent. Additionally, the manner of implemen-
tation serves as another variable. In this paper, the author presents
several scenarios which are widely used. The article ends with a
call for further research on how the change of formats in therapy
affects confidentiality.
BACKGROUND
It is not uncommon that a therapist offers couple therapy to a couple with
some conjoint and individual sessions. Based on system theories, seeing a
couple together paints a better picture of their interactions and relationships.
On the other hand, separate individual sessions function in gathering more
personal information and relational histories. In general, no matter what
type of format a therapist applies, the major goal of couple therapy is to
facilitate relationships for a couple. However, the problem occurs when
“secrets” are revealed in separate sessions. From the client’s perspective,
secrets are often best kept unknown to the other partner. From the therapist’s
perspective, secrets have profound clinical implications. They are actually
the key factor interfering with the couple’s relationship. Considering the
meaning of secrets, should the therapist bring them up in the following
conjoint session?
Address correspondence to Fan-Chi Kuo, School of Education, Counseling Psychology
with an Emphasis in Marriage and Family Therapy, 4130 Fulton Street, University of San
Francisco, San Francisco, California, 94117 USA. E-mail:
[email protected] 351
352 F.-C. Kuo
CONTROVERSY
According to American Association for Marriage and Family Therapy
(AAMFT) Codes of Ethics section 2.2, a therapist is not allowed to reveal
any individual’s confidence in the systems-oriented therapy setting without
the prior written permission of that individual (2001). The Board of Behav-
ioral Sciences also emphasizes how important it is to maintain confidentiality.
A therapist can only break confidentiality when it is required or permitted
by law (2007). As a consequence, the first challenge a therapist faces is
whether the disclosure of secrets violates confidentiality. This is the second
challenge; “A therapist continues therapeutic relationships only so long as it
is reasonably clear that clients are benefiting from the relationship” (AAMFT
1.9, 2001). However, withholding a secret is not helping therapy move for-
ward. It is obvious that this action fails to live up to beneficence in terms
of aspirational ethics: Therapists are dedicated to promoting the best inter-
ests of the clients (as cited in Corey, 2007). Additionally, some secrets are
related to illegal activities, such as adultery in some states (Bass & Quimby,
2006). Disclosing them may trap the unfaithful partner into unwanted legal
disputes.
DISCUSSION
Informed Consent
Gottlieb, Cooper, Margolin, Vangelisti, Caughlin, and Timmerman suggest
establishing clear policies concerning confidential communication in deal-
ing with secrets in the systems-oriented therapy setting (Gottlieb & Cooper,
1993; as cited in Bass & Quimby, 2006). Karpel (as cited in Weeks, Odell,
& Methven, 2005), Gottlieb, and Cooper (1993) further propose several ap-
proaches regarding making the policy of secrets in informed consent.
1. No information is confidential within a couple
The therapist will not keep any secrets and will share all information
received. This policy stresses openness and honesty within the couple.
On the other hand, it compromises security and trust in the therapeutic
relationship.
2. Individually revealed information can be disclosed only with a separate
waiver
This policy grants the highest degree of confidentiality and promises
a safe environment for each individual to share her or his secrets. The
position allows the therapist access to the greatest amount of information.
However, without the individual’s permission, the therapist cannot trans-
mit critical information to the partner. This makes couple therapy look
more like two persons in a relationship who happen to share the same
Confidentiality in Couple Therapy 353
therapist. This rule makes the effectiveness of couple therapy question-
able.
3. Some individually revealed information is confidential within a couple
The therapist will list the exceptions of confidentiality, such as dis-
closures related to extramarital affairs, contagious diseases, unsafe sexual
behaviors, physical conditions, active substance addiction, severe mental
disorders, etc. This rule strives to minimize the disadvantages of the no-
secret policy and maximize the quality of confidentiality. Unfortunately,
there is great difficulty in its implementation. It is impossible to include
all information in advance which would interfere with therapy and be
divulged.
4. The degree of confidentiality within a couple relies on the therapist’s
discretion
The therapist will inform the couple that the information will be kept
confidential unless the therapist believes any individually revealed infor-
mation is critical or detrimental to treatment. This policy is designed to pro-
mote the efficacy of couple therapy. In some cases, clients feel confused
and uncertain about the therapist’s position. From feminist perspectives,
the therapist discretion carries an inherent power imbalance.
Implementation
The manner of the therapist in divulging confidentiality acts as another vari-
able. Here are some common practices:
1. The therapist will suggest to the individual that certain information be
shared to the partner in the following conjoint session, such as the pres-
ence of sexually transmitted diseases. Before that, the therapist will pro-
vide few individual sessions that work towards the client’s fear of disclo-
sure and coaches her or him how to express the secret.
2. Before suggesting the individual confide to the partner, the therapist will
give the individual a limited time period for stopping certain behaviors,
such as active extramarital affairs, or will help the individual stop the
problems, such as excessive spending (Weeks, Odell, & Methven, 2005).
3. If the individual refuses to confide to the partner, the therapist will share
the information and may refer the couple to other alternatives (Bass &
Quimby, 2006).
4. In the situation that the individual refuses to share the information, the
therapist will not share the specific information. The therapist will inform
the couple that “she or he is aware of information obtained from one
partner that makes it impossible to do couple therapy (Weeks, Odell, &
Methven, 2005).”
354 F.-C. Kuo
SUMMARY AND CONCLUSION
The most well-known way to deal with confidential communications within
a couple is to provide a good therapeutic structure; that is, informed consent.
No matter what policy a couple therapist applies, it always comes with its
pros and cons, and none is a guarantee against a potential legal action. For
further research, confidentiality in changes of format is a highly relevant
topic. The four models I mentioned here are applicable to the presence of a
couple in the first session. However, in some cases, the client requests to see
the therapist individually and then followed by conjoint sessions. In other
cases, during the course of individual therapy, the client wants to bring her or
his partner into therapy. How does a therapist process the prior information
the client revealed? The transference of confidentiality presents another legal
and ethical challenge.
REFERENCES
American Association of Marriage and Family. (2001). Code of ethics. Retrieved April
11, 2007, from http://www.aamft.org/resources/LRMPlan/Ethics/ethicscode
2001.asp
Board of Behavioral Sciences. (2007). States and Regulations. Retrieved April 11,
2007, from http://www.bbs.ca.gov/law-reg.htm
Bass, B. A., & Quimby, J. L. (2006). Addressing secrets in couples counseling: An
alternative approach to informed consent. The Family Journal: Counseling and
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