About confidentiality and competence

I am subscribed to an online group of counsellors and the posts range from job postings, to mental health trivia and information, to case discussions.

I remember being taught that one of the central tenets of a therapeutic relationship with a client was maintenance of confidentiality about the client's identity and disclosures. However, as we were still learning, we were permitted to have our case discussions with our supervisors and professors to gain a perspective. I now wonder the limits to which this exception in confidentiality is stretched. In the group I subscribe to, therapists often discuss cases to overcome roadblocks in case progression. And the responses range from ill-informed (sometimes dogmatic) opinions to those that serve to be genuinely helpful. Recently, there has been furor regarding the particularly graphic description of a sensitive case, and the exasperating part was that the original poster was quite oblivious about her gaffe. I don't know if this emanates from a lack of adequate training, or work ethic, or even both.

The current training at Masters level in Psychology over most of India is appalling in its lack of standards. The syllabus is redundant and the process towards achieving change is mired in bureaucracy. There is a severe shortage of adequate number of qualified and skilled professors to impart knowledge. Supervisors in field work are pressed for time and might not feel the sense of responsibility of overlooking the work of their juniors.

I believe that competence in practice of mental health should be governed by stringent qualifying criteria, so that the practice is not offered by all-and-sundry. Tackling the problem of incompetent mental health service delivery should begin from the grass-root level of competitive education and proceed upwards to competent training. Its high time consumers of mental health ask for accountability and competent service delivery.