Therapy and Confidentiality

What Therapy Clients Should Know About Confidentiality

What you share with your therapist, online or in person, is by law confidential. This allows you to feel safe sharing difficult issues with your counselor. However, all mental health professionals must break confidentiality if they suspect someone’s life is currently at risk. There are other circumstances where your confidentiality may be legally breached, as well.

Risk of Harm to Self or Others

Talking to a therapist about suicidal or homicidal thoughts does not require reporting, unless the counselor determines that:

  1. The client has a plan;
  2. The client has the means to carry out the plan;
  3. The client is in a frame of mind to follow through.

A therapist may also break confidentiality if a client’s life is at risk because he or she cannot care for themselves. An example would be a client who stops eating for a prolonged period because they believe all food contains poison.

Counselors are legally bound to report suspected child, or elder abuses, to their local Department of Child and Family Services. Following the report, social workers will investigate the suspected violation.

Legal Issues

Criminal activity does not have to be reported by therapists unless it is committed while the client is using therapy services and the client, or others, are at risk for harm. For example, shoplifting is not a reportable offense unless the counselor is aware the client packs a gun, in case he or she is caught. If the same scenario is part of the client’s past, it does not need to be reported.

Anyone who uses their state of mental health to justify a lawsuit, is expected to open their therapy records to the court. If they refuse to cooperate, it is likely the case will not be heard. In any trial, a judge may order therapy records be brought into court if considered necessary to a case. A judge’s order overrides client-therapist confidentiality.

Treatment Teams and Insurance Companies

If you are treated in an agency, institution, or by therapists online, your case can be discussed during counselor to counselor consultation. It is possible your chart is available to non-clinical workers as well, such as those who inspect client records for compliance to state regulations.

Also, be aware that in this age of managed care, insurance companies have access to your counseling records. Formerly, companies were only given the therapist’s diagnosis of your problem. Today, they have access to all your information. This should be indicated on any insurance form you sign, but probably will not be in bold print.

State by State

All the above is a general overview of confidentiality rules. Some confidentiality laws differ from state to state. If you are concerned about confidentiality, or about your rights in legal proceedings, you will want to check the laws in your state of residence.

Further Reading


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