A therapist may always listen. The wall families hit is a habit wearing a legal costume

A mother calls the clinic about her grown son. She is not asking for his file. She is asking whether someone there knows that he has stopped eating, that he sat in the dark all weekend, that she found the pills counted out on the table. And the voice on the other end says the sentence every Dutch family eventually hears. "I'm sorry, I can't tell you anything, it's confidential." She hangs up and stands in her kitchen holding the most important information in her son's care, with nowhere to put it down.

Here is the strange thing about that sentence. It answers a question she never asked. What did she actually want? Not the diagnosis, not the file, not the session notes. She wanted to tell, not to be told. And telling is the one thing confidentiality has nothing to say about.

Confidentiality only points one way

Beroepsgeheim is real, and it matters, and nobody serious wants it gone. But look closely at what it actually governs. It restricts what a clinician may say to a relative. It is a duty about disclosure, about information flowing out of the room toward the family. About information flowing in, from the family toward the clinician, it is simply silent. Listening to a mother does not breach a son's secret. Receiving what she knows does not breach it either. There is no version of confidentiality in which a clinician hearing "he counted out the pills" has done something wrong.

So why did the wall go up anyway? Because "I can't tell you anything" is easier than the conversation underneath it, and because somewhere along the way an entire profession learned to treat a duty of silence as a duty to refuse contact. The family organisation Ypsilon, which exists for the relatives of people with serious mental illness, puts it in almost exactly these words: there is much more permitted than what you often hear in the ggz. Their guidance for clinicians is sharper still. You may not say everything to a relative, but you may ask a relative anything. The asymmetry is the whole point, and the sector's own body states it without flinching.

What the sector's own standards actually permit

If listening were the only thing allowed, the wall would still be a misunderstanding, but a small one. It is not the only thing allowed. With the patient's consent, far more opens up. The Akwa GGZ quality standard, the document that defines what good care for relatives looks like, does not treat involving the family as a risk to be managed. It treats it as the recommended norm. A clinician may, with consent, share general information about the illness and the course of care, about what it means to live alongside it, about where a relative can find support of their own. Ypsilon goes further on the collaboration itself: working as a triad, patient and family and clinician together, only works if you also share some things, and what those things are is something you can agree on freely with the patient and the relative. Not a forbidden zone. An agreement, made out loud, by the three people in it.

This is the part to hold carefully, because it is a claim about what these bodies say is permitted, not legal advice from anyone. Confidentiality genuinely binds the outbound direction; there are real situations where a clinician cannot share, and that line stays where it is. But the everyday refusal to engage families at all, the reflexive "I can't tell you anything" that ends the call before it starts, is not what the law requires. It is a habit that found a legal costume and wore it for years.

The carers who pay for the habit

Who absorbs the cost of a habit like this? The people standing in the kitchen. Roughly one in six Dutch informal carers now looks after someone with a psychological or psychosocial problem, up from one in eight just five years earlier (SCP, 2020). The share is rising, not falling. And this is not the gentle end of caregiving. Carers of people with mental-health problems are far more likely than carers in general to feel heavily overburdened, 34% against 19%. Sit with that gap for a second. Nearly twice the rate, in the group most often told there is nothing they can be allowed to know.

Now make it your own. Picture your current caseload, and behind each name the one or two people at home who are carrying the weeks between sessions, who notice the relapse first, who get the three a.m. version of the illness you only ever see at ten in the morning. How many of them have been turned away from a phone call this year with a sentence that was never legally required? And what were they trying to hand over when the line went dead? A warning sign? A missed dose? The one detail that would have changed the next session? The number is not abstract. It is sitting in your own appointment book, one relative deep behind every patient.

And the one advocate they have does not cover them

You might think there is a backstop. There is, sort of, and its shape is the sharpest injustice in the whole story. The Netherlands does have a statutory family advocate, the familievertrouwenspersoon, written into law to stand beside the relatives of someone in care. But read the law that created it. The family advocate exists only within the Wet verplichte ggz, the act that governs compulsory care, the zorgmachtiging and the crisis measure. So the families who get an advocate are the families of patients who were committed against their will. Everyone else, the relatives of the entire voluntary majority, the mother on the phone whose son is not under any order at all, has no advocate written for them anywhere. The one structural support that exists was built for the smallest, hardest group, and it leaves the largest one standing outside.

So here is where the mother's call actually lands. She was never asking to be told her son's secrets. She was trying to hand over the one thing she had, what she had seen at home, into the only system that might use it. Confidentiality was never built to stop that. It limits what a therapist may say. It never once stopped them from listening. The next time the sentence rises automatically, the one that ends the call before it begins, it is worth asking which of the two duties it is actually serving, the patient's, or the habit's.

If you or someone you care for is in crisis, contact your GP, the out-of-hours GP service (huisartsenpost), or 113 Zelfmoordpreventie (113 or 0800-0113, available 24/7).

Researched by Freudche.