Client Confidentiality

confidentialClient 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. 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.

However, 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.

Confidentiality Forms

At the beginning of treatment, a therapist may offer a client paperwork detailing their privacy policy. This information may be part of the informed consent form, or it could be its own paper.

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.

References:

  1. 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
  2. Confidentiality agreement template. (n.d.). Retrieved from https://psychology-info.com/confidentiality-agreement-template
  3. Confidentiality. (n.d.). Retrieved from http://www.4therapy.com/therapy/about-therapy/confidentiality-1841
  4. 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: 07-29-2019

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  • Joshua P

    Joshua P

    November 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?

  • Mary

    Mary

    April 25th, 2019 at 7:07 PM

    It is not illegal but it is unethical and can result in loss of license or job.

  • handy

    handy

    December 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?

  • Kathy

    Kathy

    March 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.

  • mary

    mary

    June 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.

  • randomperson349

    randomperson349

    June 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)?

  • Nate

    Nate

    June 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.

  • Sabrina

    Sabrina

    July 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!

  • Elena

    Elena

    February 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.

    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..

  • Concerned

    Concerned

    September 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 p

    Lena p

    January 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

  • Jaiden

    Jaiden

    January 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.

  • Mary

    Mary

    April 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 worried

    Sick and worried

    June 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.

  • Patricia

    Patricia

    June 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?

  • Diane

    Diane

    June 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?

  • Gretchen

    Gretchen

    July 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.

  • Confused

    Confused

    September 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?

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