Ruth Wyatt, MA, LCSW: Confidentiality is one of the cornerstones of therapy. Knowing that you can say anything to your therapist and it will remain in the room helps you feel safe and builds trust between you and the therapist. For this reason, all therapists are legally and ethically bound to keep their sessions confidential and not share with anyone else what was talked about. However, there are a few exceptions to this rule. For example, if your therapist has reason to believe that you are a danger to yourself or others, she or he must break that confidence in order to make sure that you and/or others are safe. There may also be times when you (or your therapist) would like your therapist to consult with someone else about your treatment, such as your doctor or psychiatrist, in order to coordinate care or clarify information. In cases such as these, your therapist should get your written permission to release information about you to the other party.
Erika Myers, MS, MEd, LPC, NCC: What you share with your therapist is confidential; you have the right to expect confidentiality and respect for your privacy. There are some specific exceptions to the confidentiality expectation.
Therapists are required by law to disclose information to protect a client or a specific individual identified by the client from “serious and foreseeable harm.” That can include specific threats, disclosure of child abuse where a child is still in danger, or concerns about elder abuse.
There may be circumstances when your therapist could be subpoenaed by the courts to share information from a session. Also, you may ask your therapist to share specific information with specific people at any given time. Ideally, you should be informed about any situation in which confidentiality must be breached.
Unless it is one of the specific circumstances in which exceptions to confidentiality exists, you will be asked to sign a release of information form before any information is shared. This may include sharing diagnoses with your insurance company to cover the cost of services, sharing results of testing with schools or educational services, or sharing information with other practitioners, like physicians, in order to help provide you with the best possible care.
Your therapist should have all of their guidelines and policies, including issues of confidentiality, explained in a written document called a Professional Disclosure Statement or an Informed Consent document. You and your therapist can review the limitations and expectations of confidentiality before you begin your work together.
Lisa M. Vallejos, MA, LPC, NCC: Therapy is confidential and therapists are bound by both laws and ethics to maintain client confidentiality to the best of their ability. There are exceptions that I will cover in detail.
The major exceptions for confidentiality are when a person in therapy is either an imminent risk to himself or others, or in cases of child abuse and neglect. That means, if a person comes to therapy and shares with his or her therapist that they are feeling suicidal, and if after assessing them the therapist feels they are a danger to themselves, the therapist is obligated to contact the proper authorities. Also, if a person in therapy is at risk of harming someone else, the therapist is required to notify the proper authorities and take measures to ensure the safety of those who are at risk. Finally, if the individual in therapy discloses situations of child abuse or neglect, the therapist is obligated to report that information to the proper child protection agency in the area.
The last exception is the therapist being subpoenaed or compelled by a judge to testify. Those circumstances are rare and therapists can usually claim “privileged communication.” By and large, your therapist should never reveal your identity or any information that makes you identifiable to others. There may be times when your therapist discusses your situation with other therapists or their supervisor, which is known as consultation, but even in those situations, the therapist is obligated to keep your identity and privacy as much as possible.
Ethical therapists NEVER share information about people in therapy casually with friends, family or co-workers.
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