One of the lesser known aspects of psychotherapy is the rule of confidentiality. This rule (which by the way is not a binding part of Thai law yet, but handled very strictly in most Western countries) basically says that everything a client tells in the context of an ongoing psychotherapy has to remain between the therapist and the client/patient. In my home country Austria, psychotherapists are not even allowed to inform married partners about the diagnosis or whether the spouse or wife has been attending a therapy session or not. Clients can release the therapist from this constraint, but only to a certain extent. In court, psychotherapists are not allowed to reveal details of the therapeutic conversations as well. Exceptions to the rule of confidentiality are usually only allowed in cases where there is imminent danger.

While this regulation might sound awkward to some, it makes perfect sense. it guarantees a safe place for patients where they can trustfully express their deepest feelings and weakest points without having to fear that anyone else will ever hear about them. In times where more and more slices of our ‘privacy’ are taken away from us by governments and electronic means, and where society has developed some very tight models of ‘politically correct’ thinking, it can be very important to be able to have at least one place where you can express your thoughts, concerns, or your most delicate problems, being sure that they will remain inside the 4 walls of the therapist’s practice. It has happened more than just a few times, for instance, where men told me about pedophile or violent fantasies or where women told about certain sex-related issues or problems trying to find a partner; only if such thoughts can be expressed and openly talked about without having to fear being looked down upon it is possible to put these very delicate issues into perspective and to develop strategies on how to deal with them better than before, or maybe even to resolve the situation by applying new ideas and approaches.

The rule of confidentiality alone is a good reason why someone seeing a psychotherapist or counselor doesn’t have to consider thenselves as ‘weak’ or ‘mental’. Having an atmosphere where one can openly talk about their problems with someone who will take a neutral position and just tries to support as effectively as possible can be reason enough. If you are not sure how your therapist or counselor handles the rule of confidentiality, just ask. It’s a sign of professionalism if you receive a straight answer on it.

(This short article is part of a weekly series dealing with psychological expat problems and general mental health issues and was published in various newspapers and magazines in Thailand, 2011)