Client confidentiality is the requirement that therapists, psychiatrists, psychologists, and most other mental health professionals protect their client’s privacy by not revealing the contents of therapy.
WHAT IS CLIENT CONFIDENTIALITY?
Confidentiality includes not just the contents of therapy, but often the fact that a client is in therapy. For example, it is common that therapists will not acknowledge their clients if they run into them outside of therapy in an effort to protect client confidentiality. Other ways confidentiality is protected include:
- Not leaving revealing information on voicemail or text.
- Not acknowledging to outside parties that a client has an appointment.
- Not discussing the contents of therapy with a third party without the explicit permission of the client.
For licensed mental health professionals, confidentiality is protected by state laws and the Health Insurance Portability and Accountability Act (HIPAA). Therapists who break confidentiality can get in trouble with state licensing boards. They can also be sued by their clients in some cases.
Some people working in mental health, such as phone crisis counselors or life coaches, are not licensed by their state. These people may not be legally required to protect client confidentiality. Yet most agree not to reveal identifying information about their clients anyway.
EXCEPTIONS TO CONFIDENTIALITY RULES
Licensed mental health professionals can break confidentiality in some circumstances. One of the most common scenarios is when a client is a threat to himself/herself or others, in which case a therapist must notify the person in danger or notify someone who can keep the client safe. In these circumstances, therapists often seek hospitalization for their clients.
It is important to note that a therapist will not automatically break confidentiality if a client reports thoughts about suicide. Typically, a client needs to state an intent to act on those thoughts and have a specific suicide plan before hospitalization is considered. An individual will not be hospitalized against their will for simply seeking help.
Most therapists are happy to go over any confidentiality concerns before starting therapy. A therapist may also be required to break client confidentiality if they believe a child or disabled person is being abused. For example, if a child has unexplained injuries and acts frightened of their parent, a therapist may have reasonable suspicion of abuse. As a mandated reporter, they have a legal duty to report their suspicions to authorities.
In rare cases, therapists can be forced to testify against their clients through a subpoena. However, it is much more difficult to force a therapist to testify than it is to force a non-licensed mental health professional. Laws governing therapists are much stricter about confidentiality.
Confidentiality for Children
Confidentiality for children is a hotly contested issue. In many jurisdictions, minors are not considered developed enough to consent to treatment, so parents are expected to consent on their behalf. Thus, minors do not have the strong confidentiality rights that most adults have in those places. However, in states like Washington, minors 13 or older do have comparable or even identical rights to seek health care (including mental health care) and to have their privacy protected as adults.
A lack of confidentiality can interfere with the therapeutic relationship. A child may be reluctant to disclose information to a therapist if they know their parents will eventually learn about it. To promote trust with the minor in therapy, many clinicians seek the permission of the clients’ parents to keep therapy confidential.
Even when parents do not agree to confidentiality, therapists will not typically reveal details about their discussions in therapy. Instead, they will give information about broad treatment goals and progress. For example, a therapist may report that a child has anxiety and is being treated with cognitive behavioral therapy. However, they would not have to report that the child is stressed about getting low grades in school.
Most confidentiality forms start off with a small paragraph explaining how the information shared in therapy will be kept private. The form may then list scenarios when confidentiality may be broken, such as if a person declares suicidal intent.
If a therapist takes insurance, they may ask for a client’s permission to share relevant information with the insurer. Typically, the information revealed is limited to the diagnosis being treated and any medications required. According to HIPAA, therapists should not reveal any more information than is necessary to ensure coverage. If an individual refuses to give permission, they may still go forward with therapy, but they will not be able to get insurance to pay for it.
Most therapists are happy to go over any confidentiality concerns before starting therapy. You can find a licensed therapist here.
- Behnke, S. H., & Warner, E. (n.d.). Confidentiality in the treatment of adolescents. American Psychological Association. Retrieved from http://www.apa.org/monitor/mar02/confidentiality.aspx
- Confidentiality agreement template. (n.d.). Retrieved from https://psychology-info.com/confidentiality-agreement-template
- Confidentiality. (n.d.). Retrieved from http://www.4therapy.com/therapy/about-therapy/confidentiality-1841
- Does a parent have a right to receive a copy of psychotherapy notes about a child’s mental health treatment? (2017, September 12). Retrieved from https://www.hhs.gov/hipaa/for-professionals/faq/2094/does-parent-have-right-receive-copy-psychotherapy-notes-about-childs-mental-health-treatment.html
Last Updated: 12-14-2020
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Joshua PNovember 29th, 2016 at 9:24 AM
Can a grievance counselor date a patient while still under there care? Shouldn’t that be terms for termination?
MaryApril 25th, 2019 at 7:07 PM
It is not illegal but it is unethical and can result in loss of license or job.
handyDecember 24th, 2016 at 7:39 AM
As nursing personal do need to tell family members about the condition of my patient without permission of the patient?
KathyMarch 10th, 2017 at 9:39 AM
My husbands sycotherapys blames his issues on my telling him i am insecure, that i am as abusive as his mother except i dont hit. That he should get a divorce when shes there to talk about his issues as a child. Not to blame me she often talks against me to him with out him being there. That married couple that have been married for long should get a separation to see were things go & if not to leave that he should connect to social media to talk to other people, its ok to watch porn even if i dont like it. Often talks about other things not relayed to the issue. often excepts gifts from my husband. I am not allowed in there orwhen i call to talk to her she often hangs up on me when i ask her a question or comment on the way his treating the family. She has change him to the point he doesn’t talk to me or anything when we use to be close, now he distance this waa a man who was always out going hixking cooking baking & did anytbing to stay close to the family & she don’t see a issue with that she gives him bad advice, then she says oh i was worried about you. She watches him or waits for him threw the window when we get there. I sit outside since she dont want me there. shes by the window as if she was waiting on him .To me that not normal , she often text him about what i dont know . He has evn blocked me from facebook & has put a secret code on his phone when we never had anything to hide from each othe. When i try talking ti him & i get sad about the way ower relationship is going he tells me to join the crowed if i depress he says me crying makes him laugh at me even mimics me . When he was always so caring calles my daughters fat. He says he loves me but can’t stand me now. He doesn’t talk to me no longer nor care about my feelings or anything or what i got to say . Shes always right i am wrong . He does only what she says. now every time he talks about divorce we no longer have intimacy, he doea even want me to touch him. he has called me many name as perv. ext. He doesnt feel comfortable been naked or even changing infront of me, he acts so strange now .he changes clothes in the bathroom never in the room or infront of me. he have been married 35 yrs for him to be acting so strange towards me . These changes have been since he has been seeing her. She has told him about other people we know that go to her office also about there issues that they have had with the same person we had issues with also. For example my neighbor has an issue with my landlord & so do we so she said oh yeah thos person comes to my office also to complain about there landlord that loves were you live so we know who she talking about.
She keep what is convenient to her as confidential. & to think his head of physicians recommended her to him. She has done nothing but separate and change the ways he was with me and his family completely my kids dont even come to the house not call since his been seeing her everyone has notice the change. His family & friends
He has hit me but she doesn’t even let me tell her the ways his been axting i guess tbat ok for her. Hes more like my room mate we sleep in the same bed but he buts a big body pillow between us now & his owen blanket. She has gotten in his head that me i am the issue that i watch him when i am hardly home now . She has a licence to robbe & mess up peoples lives as far as i am concerned.
maryJune 3rd, 2017 at 8:12 PM
i only read the beginning, but you can be emotionally abusive not physically to your kids. but like i don’t know you so i am just gonna mind my own bussiness.
randomperson349June 22nd, 2017 at 11:13 AM
I have a peculiar inquiry. I understand the confidentiality between a counselor and client however if the client is being asked by his/her relative(s) to provide proof and information of counselling sessions is that considered a breach in confidentiality if he/she does not want to give that information to the relative(s)?
NateJune 24th, 2017 at 9:40 PM
Yes it is a breach. Unless the counselor has consent to release this information, he is obligated to not even confirm the client is attending counseling.
SabrinaJuly 25th, 2017 at 3:20 AM
What if the client killed someone accidentally. Should the counselor tell the officers about it, or not? And why? I need some answers please!
ElenaFebruary 27th, 2019 at 7:53 AM
Nope, as long as it wasn’t a child. If the therapist disclosed this to the police, even anonymously it’s a breech of confidentiality and grounds for losing their license
Christine A.August 17th, 2017 at 11:36 AM
My.. Hum.. Christian counselor finally confirmed To my husbands co worker That im No GOOD After 2 years Of progress.. That my fiance.. Should leave me When im so ill All the time. To much stress on him!! I concur.. However.. He wont leave.. No Matter What i say.. Wow.. True love.. What do i do About this.. Not sure..
ConcernedSeptember 19th, 2017 at 9:26 PM
Counselor in a family counseling setting disclosed a parents personal medical information to their minor child without their parental consent. In how many ways is this a violation?
Lena pJanuary 9th, 2018 at 11:22 PM
If a patient tells you that there going to kill someone is it breaking doctor patient confidence if the thearapist reports it to the police to save the alleged victim, and if the doctor doesn’t report it and the victim does end up dead can’t the family come and sue the doctor for not saying something and a crime could have been prevented
JaidenJanuary 10th, 2018 at 8:17 AM
I think that pretty clearly falls under Duty to Warn. This is a part of many codes or considered by most licensing boards. This site even has a page about if you want to know more: https://www.goodtherapy.org/blog/psychpedia/duty-to-warn
Disclaimer: I’m not a therapist, but I do look like one. You should ask a real therapist.
MaryApril 25th, 2019 at 7:13 PM
Here in California there is something called “Duty To Warn”. It basically grants counselor/therapist access to warn the third party who is potentially at risk. This became about due to a case awhile back. A man seeking counseling had told his counselor he was going to kill this girl when she came back to town from vacation. Nothing ever became of it, the girl or the family was never warned. When she came back from her trip he killed her.
Sick and worriedJune 3rd, 2019 at 10:06 PM
My licensed therapist told me that she would prefer to not fill out an attending provider statement for my impending disability case because it would leave her open to being forced by court order to reveal parts of our sessions that could harm my case. If she doesn’t fill out the form, can’t the liability insurance company just subpoena my health insurance records to sniff out my providers and subpoena her anyway? If so, it ruins the built-up trust and negates any benefits from therapy.
PatriciaJune 21st, 2019 at 2:45 PM
This is actually for a book I’m writing. But I see that Arizona has a Duty to Warn and Duty to Protect law. If a patient told her therapist that she was in danger, and asks him not to tell, does he have a duty to contact the authorities?
DianeJune 28th, 2019 at 4:17 AM
I recently saw an article in which a therapist got into some ethical stickiness after a client recorded their sessions without counselors knowledge. The client intended to use the information in a pending child custody legal issue. I am re-vamping my consent and would like to put a section in there prohibiting the recording sessions. What is the proper wording to use in a consent that prohibits the recording of sessions? Any suggestions?
GretchenJuly 21st, 2019 at 5:33 AM
What happens if you live in a small town and you are seeing two people that you didn’t realize were related and then that whole connection, through talking, suddenly becomes apparent to all the individuals involved.
ConfusedSeptember 17th, 2019 at 8:41 PM
My childs father is an undocumented immigrant working and living under a different name. I’m currently in therapy because of his issues and stress. If I bring this up do they have to report him?
MindyNovember 18th, 2019 at 10:50 AM
That’s interesting that confidentiality is such a hotly contested issue because they don’t give the consent for treatment. My friend wants to take her daughter to a psychiatrist because she has severe anxiety. She’ll have to make sure she gets the right of counseling for her daughter’s mental illness, and accept that confidentiality might apply to some things.
JonNovember 23rd, 2019 at 2:43 PM
Is it a breach of confidentiality for my counselor to tell the courts I refused to give them permission to talk to the courts? They could have said they can’t give them that information rather than say it was refused to be given to you.
KimDecember 4th, 2019 at 6:23 PM
If my child is the patient and I as the mother have a meeting with the in school therapist regarding her treatment and discuss school related things and the therapist in turn goes and tells the teacher what was said. Does this violate confidentiality?
MikeApril 24th, 2020 at 10:33 PM
Has anyone read about naked therapy? Before you laugh, read about it. I would find it very helpful. But there’s only one person in the country that does it. Is it illegal to let a patient be nude during a session?
ChristinaApril 26th, 2020 at 1:04 PM
A teherapist wrote in a report about me saying that I’m unfit I never get my requirements can a judge he has nothing to do with me I’ve never spoken to him and he told a judge what can I do
DawnAugust 6th, 2020 at 10:20 AM
I saw a therapist (Masters of Counselling Psychology) for some time. She invited me to her home to teach her children how to crochet. Her husband was present. She stated, ” oh, I hope you don’t mind that I told my husband everything that happened to you”. I was shocked. As a medical professional myself, I would never dream of sharing my patients issues with my family. In Canada (in the province I live) there is no licensing body which regulates and disciplines individuals for any irregularities and improprieties. She is in total violation of her profession. I would have lost my job if ever I had done something like that. She still appears to be a practising professional in the discipline of mental health and counselling. Just a word of warning…. be cautious about who you deal with.
JessyJanuary 10th, 2021 at 12:54 AM
If a minor went to therapy and disclosed that they had been sexually harassed/assaulted online would the therapist have to tell the guardians or file a report to investigate
LynJuly 13th, 2021 at 12:24 PM
My job wants me to share an office with two other therapists and provide therapy in front of them. I have tried to explain the ethical dilema with doing this and they say that is a good way of having more people helping me out. Is there anything that can be done about this?
CasSeptember 14th, 2021 at 6:27 PM
I have question about confidentiality. So I told my therapist about how my roommate tried to commit suicide (with a gun) I believe that this was so to him not taking his medication and had been drinking heavily. So it concerned me because of his safety (not necessarily mine). After three days of me telling her this she tells me she is obligated to make a report. Next thing I know I get local police at my front door. She broke confidentiality correct??
BrookNovember 13th, 2021 at 3:58 PM
No, in this case they didn’t break confidentiality. The roommate had a gun and wasn’t taking their prescriptions. That’s cause for concern and potential harm could’ve came to that person. They are obligated to report when when you or someone else is in danger of themselves or someone else.
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