Persistent difficulties have been identified in relation to confidentiality in mental health settings. The objective of the current investigation was to develop practical options enabling clinicians to negotiate this issue in a manner that in sensitive to families.A review of the international literature, the current legal and policy settings, and the needs of clients and their families was undertaken. Additional material was drawn from the authors' own practice and advocacy experience.The literature and policies reviewed emphasised the importance of meaningful collaboration between clinicians and families. A close reading of the relevant legislation revealed possibilities for an interpretation of confidentiality that facilitates such collaboration. Options for negotiating the engagement phase which are consistent with meaningful collaboration were then developed.Rather than assuming that confidentiality is an intransient problem, the authors conclude that dealing with the question of confidentiality sensitively presents clinicians with an opportunity to develop quality relationships with both clients and their families.