Why does my therapist ... talk about consent & confidentiality?

In this episode of Therapy Backstage, we pull back the curtain on the opening spiel every therapist gives—about consent and confidentiality. But what does it actually mean? And why does it matter so much?

Joh Knyn, Australian psychologist and your host, explains how consent and confidentiality are more than legal formalities—they’re the backbone of a safe, collaborative therapy experience. We explore how these practices shape the therapeutic relationship, what can go wrong if they're handled poorly, and how to advocate for yourself in the therapy room.

Whether you're a client, a clinician, or just curious—this episode will help you understand the consent and confidentiality spiel in real-world practice.

Want therapy to feel safer, clearer, and more human? This is your invitation backstage.

Transcript

Welcome to Therapy Backstage.

I’m Joh Knyn, an Australian psychologist and your host, - and this is the podcast where we talk about what actually happens in the therapy room and why.

So, whether you're a client, a clinician, or just curious...

this is your invitation backstage.

Today’s episode is called, “Why Does My Therapist Talk About Consent and Confidentiality?”

If you’ve been to therapy before, you’ve probably heard the speech.

It might feel formal, clinical, or even bit confronting, especially if it’s your first time in therapy, or when you’re about to open up. But this conversation is more than a disclaimer—it’s about safety, clarity, mutual understanding – it’s a foundational piece that sets the stage for your therapeutic journey.

So, let’s unpack what consent and confidentiality actually mean in the therapy room, what would happen if we didn’t talk about them, and some things you might want to ask or look out for as you begin your own therapy journey.

What is the consent and confidentiality 'spiel'?

Let’s start with the basics.

In Australia, it’s a legal and ethical requirement that psychologists explain confidentiality and obtain informed consent before therapy begins.

This is a vital part of establishing a safe, collaborative space—not just a checkbox. It’s your right as the client to understand what therapy is, how it works, and what your rights are within it.

So, when your therapist talks about confidentiality and consent, they’re laying the groundwork for trust and transparency. 

So, what it might sound like is this,

Welcome Kerri (pseudo client), I’m Joh your psychologist and before we begin I’d like to go through the spiel that is consent and confidentiality. Consent and confidentiality are fancy but important terms. Consent meaning choice, and confidentiality meaning privacy. What we speak about here in session, stays in session – your information is kept private – confidential. Meaning – we don’t just finish up session and I get home and tell me partner ‘oh my god, my client Kerri said all of this.’ When it comes to consent, its important you understand that I actually mean informed consent – that it is your choice what you share in these sessions, how much you disclose and how you choose to engage with me, if your choice. I ask a lot of questions, but you always have the choice to answer or not answer – you’re allowed to say pass, ‘I don’t want to talk about that’. 

There’s more to that spiel, but we’ll talk on that later. 

What consent really means, and what it doesn't mean.

Consent in therapy isn't just about saying “yes” once and moving on.

It’s about making an informed, voluntary, and ongoing decision to engage in therapy.

That means:

- You understand what therapy involves – the type of therapy you are engaging with, with your specific therapist

- You know the limits of confidentiality – that’s the other part of the spiel I haven’t got to yet and that 

- You’re choosing to participate, in the way you are in the room — and can withdraw at any time.

Consent doesn't mean you’re agreeing to give up your power or privacy. It means the therapist has your permission to engage with you in the therapeutic process. And that you are in control of that permission – you can rescind that at any time. 

So what about Understanding confidentiality – the privacy part of the spiel

Confidentiality is one of the core pillars of therapy and essential that every client truly understands what it means and its limits.

Everything you share is private. It isn’t shared with our partners, the admin staff, our friends. It is private.

There are some limitations to this privacy, that again is really important for any client to understand. 

So, let’s get back into that spiel, where I left off. 

I’m sitting with my client Kerri (pseudo client) and am saying.

‘When it comes to consent, its important you understand that I actually mean informed consent – that it is your choice what you share in these sessions, how much you disclose and how you choose to engage with me, if your choice. I ask a lot of questions, but you always have the choice to answer or not answer – you’re allowed to say pass, ‘I don’t want to talk about that’. It’s important to understand, however that there are some limitations to our confidentiality agreement. If in my clinical judgment, I believe you are at risk of harm or someone else is at risk of harm then I may have to breach that confidentiality in order to keep you or that other person safe. It is also important to understand that if I receive a valid subpoena by a court, I may have to provide information about your sessions. 

End of spiel. 

It can be a mouthful, and an earful – but again – it is a legal and ethical requirement.

Your therapist should explain these upfront. In your very first session, before you get into any other conversation. And ensure there is time and space to discuss, ask questions and seek clarification – as part of informed consent. 

I often throw in a little narrative as well, to ensure my clients understand what informed consent is. It’s the poison cookie. 

If you were hungry, and I have a cookie. I asked you if you wanted my cookie. And you said yes and took a huge bite. Only for me to tell you ‘oh, its actually a poison cookie’. Perhaps, had you been informed of said poison, prior, you may have made a different choice. That’s not to say therapy is like a poison cookie – but to highlight that when we say yes, without all the information, we may be making a decision that isn’t right for us. 

When it comes to that moment, where your therapist believes, in their clinical wisdom, that they need to break the confidentiality agreement – the ideal situation is that they talk with you about it beforehand – that you are aware of this need to break, and why. And, where possible are able to collaborate on what happens next. 

So why does this matter – the spiel. High level, its for safety and trust. Key factors to success therapeutic process. 

When therapists are transparent about consent and confidentiality, they help you feel safer.

Without it, therapy can feel one-sided or even manipulative — especially for people who have experienced trauma.

These conversations build the foundation of informed, empowered therapy. They show you that your therapist sees you as an equal participant in the process. Sure, your therapist is the expert in the room about the therapy stuff, but you are the expert in the room about your life, your experience, even if it doesn’t feel that way – so you and your therapist are equal, collaborators.  

Let’s consider What might happen if your therapist skips the spiel 

If a therapist doesn’t explain confidentiality or consent clearly or at all, you may feel confused or betrayed later—especially if something you shared is acted on.

This isn’t about scaring clients—it’s about respecting them, their expertise, their autonomy.

A lack of clarity can lead to, a fear of being honest, ruptures in trust, avoidance of deeper work and hurt and mistrust.

So if this conversation happened in your therapy, a while ago, it’s okay to bring it up again now. You’re allowed to ask your therapist about their process – their thinking. You’re allowed to ask about what’s behind their curtain when it comes to consent and confidentiality. 

Some Tips for clients – what to ask and look for

a few things to ask in your first session—or even before therapy starts:

- Hey therapist, “What does confidentiality mean in your practice?”

- “When would you need to break confidentiality? And what would that look like, in reality”

- “Do I have to answer all your questions?’

- “How do you handle conversations about sensitive topics, that might sound close to one of those times you might need to break our confidentiality agreement?”

These are fair, reasonable questions. And asking them doesn’t mean you’re being a difficult client — it means you’re being an informed client.

So here’s a couple questions to think about:

- When you started therapy, did your therapist explain things clearly? In a way that made sense to you

- Did you know that, just because your therapist asks you something – even if it’s a great therapeutic question – you don’t have to answer if you don’t want to or feel ready to at that point in the therapeutic relationship – there is no therapy goal. You will not be put in the ‘naughty corner’ because you said ‘I’m not ready to go there today’. Just as there are no winners in therapy, there are no losers – there are those who attend and those who do not attend.

For my fellow therapists – especially early-career or provisional clinicians

If you’re a provisional or early-career therapist, don’t get too much in your head if the consent spiel feels scripted. Because it is – and that’s kind of the point, to ensure we cover all parts of the spiel, as part of our legal and ethical duty. After almost 10 years of working with clients, I still feel scripted when it comes to the spiel in that first session. 

You’re not messing up therapeutic rapport by being thorough—you’re building it.

Explaining consent and confidentiality warmly and clearly is a way of showing respect for our client’s autonomy.

What if something changes though.

Consent isn’t a one-time thing – a permanent yes to all—it’s an ongoing process.

You can say yes, and then say no. You can pause therapy – take a healing hiatus. You can ask your therapist to explain the spiel again.

And your therapist has a responsibility to continue checking in—especially when new issues come up or if things start to feel emotionally complex. It might sound like this

Kerrie (pseudo client) has attended 5 sessions and is at her 6th now, and last session toward the end, she said she’d like to talk about some difficult moments in childhood between her and her dad. But when she sat down, in this 6th session, she just hasn’t felt quite ready for it. Her therapist might say;

 ‘Hey Kerrie (pseudo client), It’s good to see today. I’m wondering if you still feel comfortable going there, about your childhood and your dad?

Your therapist, by asking this somewhat simple question – is gently reminding you that you are in control, and can talk about it, or not talk about.

Reflection time. 

Think about a time when someone assumed you were okay with something, but you weren’t. Maybe a time, you shared something vulnerable with a friend, assumed confidentiality – but then heard your story said back to you by another friend – who you did not want knowing that about you. 

How would things have felt different if that first friend had asked if it was heard in confidence — if you’d had real choice about where that information went?

That’s the heart of informed consent. In therapy, it’s the therapist’s job to open that door—but it’s your right, your choice to walk through it.

As always. 

Thanks for joining me backstage.

I hope this episode helped make sense of something that can feel formal and clinical —and allowed you see how it’s really about establishing clear boundaries, empowering you as the client, and showing mutual respect for each others expertise.

If you did find this helpful, I’d love it if you shared it with someone who is contemplating going to therapy and may need peak behind the curtain of what session one involves, well at least the spiel.  Or leave us a review.

And if you’ve got a “Why does my therapist…” question you’d like me to answer, send me a message on Instagram @therapybackstage.

Make sure you’re subscribed so you don’t miss any future episodes.

and however you found your way here—I’m so glad you did.

This is your invitation backstage, anytime.

and

I’ll see you soon.