The Conundrum of Confidentiality, Part 2

BCC executive director Dr. Tim Allchin tackles questions on confidentiality in counseling. His article appeared first here and is used with permission.

Part One of this article describes the difficulty for biblical counselors in simply embracing the professional counseling ethic of complete confidentiality. Part Two proposes suggestions that biblical counselors should embrace regarding confidentiality.

While the assumption within the ethical standards of professional counseling is that confidentiality must be upheld, this standard is not based on a moral argument. The argument is utilitarian based upon the premise that complete confidentiality does the most good for the most people in most situations.

Even the ethical standards recognize there is a greater good that comes when confidentiality is broken such as in reporting abuse or seeking help for someone with suicidal intent.[1] Is it fair to ask whether there are other situations that benefit from more limited confidentiality? Could confidentiality harm as well as help?

How Might Blanket Confidentiality Do Harm?  

Consider a few potential scenarios:

• Is a pastor who practices biblical counseling really loving the young wife whose husband is visiting prostitutes at massage parlors if he doesn’t disclose his knowledge to her?
• A church-based biblical counseling mentor is counseling a college student who admits he is “doctor shopping” and has developed an addiction to prescription drugs but is afraid to tell his parents, do we just sit on our hands until either he decides to disclose this or an overdose makes it plainly clear?
• If an 18-year-old male confesses sexual involvement with three different 18-year-old females on past youth group trips, do we have any obligation to warn the youth leaders or his parents to keep a better eye out? What about the newest relationship that appears to be forming between him and an elder’s daughter?
• A 50-year-old man confesses that recently and secretly he has stopped taking his psychiatric medications and has been fantasizing about crashing his delivery truck into his ex-employer’s office. He routinely and unnecessarily drives past his old workplace on his delivery route, fueling these fantasies. He maintains he is only joking and would never harm himself or others.

Varying Standards of Confidentiality 

The standards of confidentiality often vary, depending on the context of counseling and the relationship between the counselor and counselee.

One of the difficulties in applying mental health ethical standards to biblical counselors is that it can be difficult to define who is a “biblical counselor.” Simply enforcing professional counseling ethics of confidentiality and mandating that anyone who offers any type of biblical counseling in any context does not work. We need to differentiate between a trained biblical counselor and someone just providing biblical wisdom and counsel one-on-one.

Virtually every biblical counselor agrees that the responsibility to “counsel one another” is a responsibility given to the whole church. However, we would also agree that complex cases require wisdom and humility that often necessitate a referral to someone who may be more qualified to provide biblical help and hope due to their experience and training level.

Varying Contexts

It would be wise for us to discuss more fully how confidentiality should be applied in many different contexts and how assurances of confidentiality should be explained and practiced, depending on who is providing the biblical counseling and the context in which they are serving. Consider the following contexts where someone might consider themselves to be providing biblical counseling:

• Biblical counselors can be pastors.
• Biblical counselors can be friends.
• Biblical counselors can be elders, trustees, or deacons.
• Biblical counselors can be youth workers.
• Biblical counselors can be Resident Assistants.
• Biblical counselors can be denomination representatives.
• Biblical counselors can be Christian camp staff.
• Biblical counselors can be lay volunteers in a church ministry.
• Biblical counselors can be paid, professional counselors.

The reality is that there are millions of biblical counselors in these categories with the fewest being in the “paid, professional counselors” category.

Biblical counselors do not believe that professional counselors should be the only ones providing biblical counseling. The Word of God, the Spirit of God, the power of God, the guardrails of church history, and the authority of the local church are all crucial elements to effective biblical counseling. Our hope is that counseling of every persuasion would be impacted by these elements. We know that many godly and wise individuals with no formal counseling credentials or licensure are able to counsel wisely because these elements are given by God to His Church.

A Proposal: 7 Principles Biblical Counselors Should Practice and Commit to Regarding Confidentiality

1. Biblical counselors believe that confidential counseling benefits the effectiveness of counseling and should be the norm. Therefore, we prioritize guarding the counseling relationship through practicing confidentiality, refraining from carelessly discussing cases and only discussing with those whom consent has been given (Eph. 4:29; Ps. 101:5; Prov. 26:20).
2. Biblical counselors should embrace the principle of “do no harm” and should seek to honor confidentiality while also actively protecting the vulnerable and confronting offenders (Prov. 25:9-13; Matt. 7:12; Rom. 12:9-13; 1 Pet. 2:16-17).
3. Biblical counselors should unapologetically break confidentiality to report child abuse to the full extent required by law, no matter what level of counseling they provide, paid or not (Mark 12:17; 1 Tim. 2:1-2; Rom. 13:1-7).
4. Biblical counselors should commit to breaking confidentiality when suicidal, homicidal, or other violent intent is discovered in counseling because of our commitment to do no harm (Rom. 15:1-2; 1 Thess. 5:14).
5. Biblical counselors should have a means of keeping both paper and digital files safe and secure. Furthermore, biblical counselors should not let any church leaders, including the pastors, read files without the authorization of the counselee. Any supervising pastors should be detailed in the informed consent (1 Cor. 14:40; 2 Cor. 12:20).
6. Biblical counselors should seek the authorization of counselees to cooperate with legitimate and official court requests and to “do no harm” in compliance (Prov. 19:9; Ex. 23:1; Deut. 19:16-20).
7. Biblical counselors should make clear how they cooperate with a church discipline process in their informed consent so that counselees can make informed decisions. If discussions regarding church discipline need to take place, we should inform the counselee first, prior to escalating the issue (Matt. 18:15-17; Titus 1:10-16; 1 Cor. 5:2-13; Gal. 6:1-2).

Fuller Discussion Needed

Some have suggested that since biblical counseling does not uphold the exact same ethics of confidentiality as clinical counseling models, that it clearly must be viewed as inferior to the safety of clinical counseling. However, a fuller discussion about best practices regarding confidentiality needs to take place among biblical counselors to assure excellence in all aspects of our counseling.

Simply adopting secular counseling ethics within biblical counseling would be confusing and difficult. Furthermore, the advantages of holding to a well-reasoned “do no harm” standard for disclosing confidential information would be lost.

Biblical counselors hold Scripture as our authority for our principles of operation and we recognize the local church as the governing body for the care of God’s people. We must commit to clearly articulating our thinking to both counselors and counselees. We must be clear on why we do what we do and seek to demonstrate the benefits of caring beyond the limits of blanket confidentiality.

Question for Reflection

What other principles regarding confidentiality would you add to the list?

[1] Leslie Vernick, “Professional Boundaries. Do We Need Them?” Association of Certified Biblical Counselors, February 8, 2016,  https://christiancounseling.com/blog/counseling/professional-boundaries-do-we-need-them/.