Many people interested in therapy may be hesitant to share private information or stories about themselves with a stranger. They may fear judgment from the therapist, or worse, that the therapist is going to share their details with others. For therapy to be effective, trust must be built between the individual seeking therapy and the therapist.
Is Therapy Confidential?
In almost every instance, therapy is absolutely confidential. You therapist is required to maintain confidentiality about everything said in sessions between the two of you, just like a doctor is required to keep your records private. While there are laws and regulations in place to protect your privacy, confidentiality is also a key part of psychology’s code of ethics. This means your therapist understands from the very beginning that in order for you to feel comfortable sharing openly with them, you need to know your information is safe.
Remember, you can always talk with your therapist if you have questions about the confidentiality agreement between the two of you during your sessions.
What Are the Limits of Confidentiality in Therapy?
For your own safety, there are some exceptions to the rule when it comes to confidentiality in therapy. Generally, these rules have to do with the well-being of the patient or people in the patient’s life.
For example, therapists are required to report if a patient is a threat to themselves or others. This may mean the patient has threatened suicide, is repeatedly harming themselves, or has threatened to harm another person. In this case, a therapist may recommend hospitalization so the patient can be monitored. Once the patient is deemed stable, the therapist may then work with close friends or family members to develop a support plan for the patient in order to maintain that sense of stability.
Additionally, therapists are also required to report cases of ongoing child abuse or neglect. In these cases, a variety of public servants may be brought into the fold, including law enforcement or child protective services. Again, this is a measure created to ensure the safety of a patient and it should not deter you from being open and honest about your situation with your therapist.
Finally, if a minor is seeking therapy and is engaging in risky behavior, their parents or guardian may be informed. Different states have different laws regarding minors in therapy, so it can be a good idea for the parent, therapist, and patient to sit down in an early session and establish ground rules.
HIPAA and Rules of Confidentiality in Therapy
The group of federal laws and regulations protecting the privacy of your health information is known as the Health Insurance Portability and Accountability Act, or HIPAA. They very clearly and thoroughly define when your therapist is allowed to talk about you or your treatment outside of your sessions. These instances may include but are not limited to:
- When you are talking to your family. HIPAA allows your therapist to talk with your family about your mental health treatment in a variety of ways. If you are present and capable of making decisions and want your family to be involved in your treatment, HIPAA allows your therapist to share your information.
- When you are at a mental health care appointment. If you are seeing a mental health care professional for prescription medication, HIPAA allows for some information to be shared with the family you may have present. For example, if there are warning signs your spouse needs to know in regard to your medication, then the provider is allowed to share that with them.
- When you are incapacitated. If you are unable to make decisions for yourself, either because you are unconscious or deemed not of a sound mind, then your therapist may use their own reasonable judgment to share pertinent information with family or friends involved directly in your care. This usually means immediate family members or partners.
What Therapists Have to Say About Confidentiality
Here, several therapists discuss confidentiality of therapy sessions:
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.
When in Doubt, Ask Your Therapist
It’s crucial for the therapist-patient relationship that you feel at ease sharing personal information during therapy sessions. Your therapist understands this and is happy to answer any questions you may have about your privacy or well-being during treatment.
If you haven’t started therapy yet, remember as you begin to find a therapist that any mental health professional is held to HIPAA laws and reporting protocols. No one wants you to feel uncomfortable as you begin the journey to improved mental health—especially not your therapist.
- Larson, S., & Londoño-McConnell, A. (2019). Protecting your privacy: Understanding confidentiality. The American Psychological Association. Retrieved from https://www.apa.org/helpcenter/confidentiality
- U.S. Department of Health and Human Services. (n.d.). HIPAA privacy rule and sharing information related to mental health. Retrieved from https://www.hhs.gov/sites/default/files/hipaa-privacy-rule-and-sharing-info-related-to-mental-health.pdf
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