Test and Trace…….Corona and Confidentiality!

The UK Government has announced that it has started the Test and Trace service, currently based on text, email and phone but with the intention of moving to an App-based platform.  And this leaves me with the question:  What am I going to do when perhaps in the distant future I get a beep on my app and a request to list all the persons I have been in contact with that day and their contact details?  This is not a problem if I have been sat in the garden with my partner and children, but what if I have just finished an intensive day of therapy, and have spent six hours with six separate clients?

How is the Test and Trace service going to work?

The Test and Trace service is intended to reduce the spread of the virus by instructing individuals who have been exposed to another who is infected to self-isolate for 14 days.  This is currently described as a “civic duty” but with a lack of clarity how it might be potentially enforced.  The good news is that, from today, if you have Coronavirus symptoms you can access accurate testing as part of the Test and Trace process but it does rely on those infected declaring who their recent contacts have been (more than 15 minutes contact I think) and those declaring their contacts, and down the pyramid we go.

What are the implications of this for the normal “bod”?

We can imagine some really tricky situations, some potentially red faces or perhaps people will simply lie.  Key to life for many is sex and drugs and rock ‘n’ roll – and being in places that we would prefer others don’t know about, doing things that we might prefer not to become public knowledge.  People have affairs, have one-night stands or simply bunk off for the afternoon from college or work.  What is the implication of this when your app buzzes in your pocket, or you get a scripted call from the Test and Trace service asking for your whereabouts and contacts from the last 48 hours?  And most importantly – what are the implications for us as therapists or indeed clients?

How do we think about this together?

My mental image throughout isolation has been a pie cut into three thirds!  Mostly because when I get stressed, I get hungry – and I do love a good pie.  But more importantly, I think a professional response is made up of three responses:
1.  What does our parent professional organisation say?  What is their position?
2.  What does ethics say?  How do we think ethically about this?
3.  Training.  Is it possible to access any training, CPD or development that might help me?

It is very early days with Test and Trace, so I am not aware yet of any guidance from BACP or UKCP – this will emerge soon.  So at this time, I am left to consider things from an ethical stance.

If I think about ethical principles from EATA and UKATA I am minded of:

• Commitment in Relationship
• Respect
• Responsibility
• Empowerment and
• Protection

The tension here seems to be my responsibility to keep my client physiologically safe and well, yet to protect their confidentiality but also maintain their autonomy in decision-making.

The EATA and UKATA principles are very helpful in that they invite us to think about many audiences, not say just the individual client.  So what about my responsibility to society as a whole for example, or to all my other clients if I don’t co-operate with a Test & Trace request?  Is it about the autonomy of each client or a more holistic approach to the societal responsibility of all of us working towards safety and reduction in risk for all?

UKCP Ethical Principles and Code of Professional Conduct around Confidentiality

UKCP charges the therapist with focussing on the best interests for our clients.  This includes respecting the client’s best interests, their autonomy – and not harming the client or the client of others.

Confidentiality is based on the following areas:

• Respecting, protecting and preserving confidentiality.
• We are to notify our clients if there are ethical limits to confidentiality and circumstances under which the therapist might disclose confidential information to a third party.
• We must protect information
• We must take advice in judicial or administrative proceedings.
• We must really watch ourselves when publishing material

BACP and its thoughts around Confidentiality

• Information needs to be protected
• How clients’ information will be used and who is in, and who is outside of the circle of confidentiality.
• Those that are communicated with – also protect the information
• Informing clients about reasonably foreseeable limitations of privacy – eg supervision, legal disclosures
• Ensuring that contracts are reasonable and match
• Disclosure of information is either authorised by  client consent or there is a legal or ethical justification
• Using anonymised information if possible.

Where does that leave the therapist with Test & Trace?

I will still be alert and mindful of advice from my professional bodies, but in the interim, I do think there is the “foreseeable limitation to privacy” that the shadow of the Test & Trace service will fall on my private practice.  This demands that I respect my clients’ autonomies, and discuss this eventuality with them, and how I should proceed.  I will need to record their thoughts and our agreed actions.  I hope that they will share my sense that we do have a social responsibility and that means cooperating with the Test & Trace process is an act of civic humility and usefulness.  It may save others’ lives potentially.

Rules don’t necessarily work, and there will be clients who disagree with this stance.  This is going to demand ethical courage, negotiation and navigation.  As the Test & Trace service becomes clearer in its functioning, perhaps this will make our decisions easier.  I am wondering what responsibilities a client can take on for themselves, rather than being “named” by their therapist.  Perhaps the communication can be between therapist and client rather than therapist and App? – the ever-hopeful therapist looking for a way out!

I hope this blog article may appear naive in a few months’ time.  The functioning will become clear as will the guidance and agreed practice – but here are my embryonic thoughts as we move towards this new age.