When Can Counselors Disclose Confidential Information?

Confidentiality is a cornerstone of the relationship between a therapist and a client. It encourages clients to share their personal thoughts, feelings, and beliefs, knowing that their therapist will protect their privacy. However, there are situations where therapists are legally and ethically required to break confidentiality, such as when a client is in danger or when there is a legal obligation to do so. These situations can vary depending on location, and therapists must be aware of the laws and regulations in their specific state or country. In some cases, therapists may have discretion in deciding whether to break confidentiality, while in other cases, it may be mandatory. It is important for therapists to understand the limits and exceptions to confidentiality to provide effective care while upholding legal and ethical standards.

Self-harm and suicidal thoughts

If you self-harm with suicidal intent, your therapist will likely provide a consequence, such as restricting your access to therapy for a period of time. If you express thoughts such as "sometimes I feel I'd be better off dead", your therapist will explore these thoughts further to determine the level of risk. Together, you might develop a safety plan to help you monitor or manage any thoughts of suicide. This could involve using coping strategies that don't require contacting someone else, such as taking a walk in nature or listening to music, or contacting someone you enjoy being around or a family member or friend to ask for help. If the self-harm risk appears high or imminent, and all of the steps in the safety plan have been followed, then the therapist will likely take action to get you set up with a higher level of care for your safety and well-being.

In most cases, therapists are required to keep everything you say in confidence. However, there are a few exceptions to this rule. Therapists must report any present or future crimes that concern the immediate safety of others. They may also be required to break confidentiality if they believe that your life or another person's life is in immediate danger. In these cases, they will share the minimum amount of information needed with a third party, such as a family member or a government organization.

Licensed psychotherapists generally have a legal and ethical duty to protect their patient's privacy. However, the state's interest in preserving life and preventing abuse trumps the right to confidentiality. If a person is at imminent risk of suicide, there may be doubts about their mental capacity, and a professional judgment will need to be made based on an understanding of the person and what would be in their best interest. The practitioner should take into account the person's previously expressed and current wishes and views in relation to sharing information with their family and/or friends and, where appropriate, consult with colleagues.

Threats of harm to others

Confidentiality is a cornerstone of the working relationship between a therapist and a client. It encourages the sharing of personal thoughts, feelings, and beliefs. However, there are certain situations where confidentiality can be broken to protect the client or others from "serious, foreseeable, and imminent harm". This includes instances where the client poses a threat of harm to others.

Therapists are generally required to maintain confidentiality. However, in extreme cases, they may be legally required to break confidentiality to protect the client or others from harm. This includes situations where the client discloses a current or future crime that poses a threat to the safety of others. Therapists are trained to carefully navigate such disclosures and will only share the minimum amount of information necessary with relevant parties, such as family members or government organizations like child protective services or the police.

When working with minor clients, counselors must navigate the delicate balance between maintaining confidentiality and involving parents or guardians. In situations where the minor client discloses harmful behavior or intent, counselors may need to collaborate with the parents or guardians to ensure the safety of the client and others. Counselors may offer a firm explanation of confidentiality and emphasize that they will inform the parents if the child discloses anything that puts themselves or others in danger. Counselors may also give minor clients the option to inform their parents themselves, provided the risk of harm is not imminent.

It is important to note that the decision to break confidentiality is not always clear-cut and may involve some level of judgment. Therapists will consider the client's intent and plan to act on any threats of harm. They will also develop safety plans and provide coping strategies to manage thoughts of causing harm to others. Ultimately, the goal is to protect the client and others while fostering a sense of safety and trust within the therapeutic relationship.

Child, elder, or dependent adult abuse

Confidentiality is a key component of the therapeutic relationship between a counsellor and their client. It provides a safe and trusting environment for individuals to share personal information and seek help without fear of disclosure. However, there are legal and ethical exceptions to confidentiality, particularly when it comes to protecting vulnerable populations

National security investigations

Confidentiality is a cornerstone of the working relationship between a therapist and a client. It encourages clients to share their personal thoughts, feelings, and beliefs, in the knowledge that their therapist will protect their privacy. However, there are certain circumstances in which therapists are either permitted or required to disclose client information. These circumstances vary depending on the location and the therapist's association.

In the United States, the federal government provides guidance in the Health Insurance Portability and Accountability Act (HIPAA), which protects people's personal health information, including mental health records. State laws also dictate when confidentiality can be broken, and these vary across the country. For example, in Florida, therapists are mandated to report certain misconduct by any healthcare professional.

In addition to legal requirements, therapists must also adhere to the ethical guidelines of their professional associations. The American Psychological Association (APA), for instance, states that psychologists can disclose confidential information without the consent of the individual when mandated or permitted by law, or for a valid purpose, such as to provide professional services, obtain appropriate consultations, or protect themselves or others from harm.

One situation in which therapists are required to break confidentiality is when their client is the subject of a national security investigation. In this instance, therapists are not only mandated by federal law to disclose information, but they are also prohibited from informing their client that they have done so. This scenario is an example of how confidentiality laws can be complex and sometimes contradictory. Therapists must navigate these complexities while also maintaining the trust of their clients, which is essential for effective therapy.

Court orders and subpoenas

Subpoenas

A subpoena is a legal document issued by a court that requires a person to appear and testify or produce documents. Psychologists and therapists who receive a subpoena may be required to disclose or testify about a client's records or test data. However, it is important to note that a subpoena is not a court order unless it is signed by a judge. In the case of a subpoena, therapists should first contact their client and ask if they consent to the disclosure of information. If the client signs a Release of Information form, the therapist can then respond to the subpoena. If the client does not consent, the attorney requesting the information must obtain a court order.

Court Orders

A court order is a legal mandate issued by a court that compels a person to testify or produce documents. If a court order for testimony or documents is issued, therapists must comply or risk being held in contempt of court. Therapists may want to consult a lawyer to ensure that the breach of confidentiality is valid, but they will likely still have to testify even if the lawyer advises against it. It is important to note that court orders and subpoenas can also be used to obtain information about deceased clients, as confidentiality laws generally do not apply in these cases.

Exceptions

There are some exceptions to the rule that therapists must comply with court orders and subpoenas. For example, if the information requested falls under an evidentiary privilege, it may be protected from disclosure. Additionally, test materials, such as manuals, instruments, and test questions, may require a protective order from the court before they can be disclosed.

Frequently asked questions