This is a fantastic question that really strikes at the heart of one of psychotherapy’s cornerstones—confidentiality. You are not at all alone in feeling like you have something you desperately need to talk about. Many people crave the opportunity to confide in someone who is not part of their lives and who can guarantee complete and total privacy. This is exactly what therapy can provide. It is also one of the reasons therapy works. The promise of confidentiality allows people to say, feel, and explore things that they might not otherwise be able to.
Of course, there are some limits to confidentiality. For example, if you tell a therapist that you are going to commit suicide, your therapist is required to intervene in order to prevent the suicide. Under such circumstances, the intervention likely would be hospitalizing you. It would require acknowledging that you are a client in therapy, that you are planning to commit suicide, and any other relevant information the hospital might need to help you. Also, if you tell your therapist that you are going to hurt or kill someone else, your therapist is required to intervene not only to stop you, but to warn your potential target. Finally, if you reveal any ongoing child or elder abuse, your therapist must report this to appropriate authorities in order to protect the person, or people, being harmed. Under any of these circumstances, your therapist would be ethically and legally required to breach confidentiality. However, even when such situations occur, the therapist is obligated to reveal only what is necessary to address the crisis at hand.
Teaching and supervision constitute the only other contexts in which a therapist may ethically share information about your sessions. However, no identifying information about the client should ever be revealed in such cases. That is, your therapist might consult with a supervisor or colleague about how best to help a person in your situation, but he or she should never disclose anything that would reveal your identity. If your therapist is a supervisor or professor, he or she might also talk about your treatment (again, without revealing your identity) for training purposes.
Nonetheless, while therapists should not be sharing any information with anyone other than for the purposes of teaching and supervision, unfortunately some therapists do. I would venture to say, though, that when therapists let information about a session slip out when talking with friends or family (which, to be clear, they should not do), they still are not revealing any identifying information. It is very difficult for me to imagine a therapist getting all the way through graduate training and postgraduate licensing processes without a deep understanding and respect for the necessity of confidentiality. The vast majority of us go to great lengths to protect it.
I’ve shared a lot of information about the rules and limits of confidentiality and even a bit about what really happens, even if it isn’t supposed to. I’d like to leave you with a suggestion. Find a therapist and work on building a relationship with him or her. When you feel like you can trust your therapist, talk about your concerns about revealing this secret. If your therapist is someone who tends to let things slip here and there, knowing your concerns about revealing this secret should lead him or her to rigidly adhere to the strictest rules of confidentiality. This may also cue your therapist to get your permission before consulting with colleagues or supervisors, and before using your treatment as a training example. Therapy exists, in no small part, for people to unburden themselves of their deepest, darkest secrets. My hope for you is that you find a therapist you can trust, and that you experience the incredible relief that unburdening yourself can offer.
All my best,
Sarah
The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org.