When you talk to a therapist, psychiatrist, or other licensed mental health professional, you probably do so with the understanding that what you say will not be shared with others—that it will be kept confidential. Client confidentiality is important to the therapeutic relationship. Unless you can trust that what you say will be kept private, you probably won’t feel comfortable opening up completely to your therapist so that they can truly help you.
Confidentiality is so essential that many therapists, if they encounter a client outside of the therapy session, will not even give an indication that they know the client. This is especially true if the therapist or client is with another person. The lack of acknowledgement is not to be rude, but to protect anyone from even inferring that the client is in therapy.
Because client confidentiality is so central to therapy, it is a breach of the therapeutic relationship for therapists to break confidentiality in most situations. (There are exceptions, which we will discuss.) If a psychologist, psychiatrist, or other therapist reveals private information, they could face consequences from their licensing board. They might also be sued for therapeutic or medical malpractice.
You probably wouldn’t be completely honest with your therapist if you knew she would reveal things you said in a therapy session. In order for therapy to work, you need to be able to trust your therapist and believe that she will keep your private information in confidence. In other words, the confidentiality requirement is to protect and help you, the client.
However, there are some situations in which your well-being, or someone else’s, could be at risk if the therapist does not reveal what you said in a session. One of the most common is if the therapist believes that you are at risk of suicide or serious self-harm. Many people express suicidal thoughts in therapy; simply expressing those thoughts is not enough for a therapist to break confidentiality. However, if what you say gives your therapist reason to believe that you intend to act on those thoughts and have a plan and the means to do so, she may tell someone else in order to keep you safe. That might involve taking steps to have you hospitalized.
Another reason a therapist might have to reveal confidential client information is if the therapist believes the client is likely to harm someone else. Again, this requires more than just a vague expression. The therapist must have reason to believe that unless she breaks client confidentiality, the client will actually hurt or kill someone. The therapist may warn the person who has been threatened, or contact professionals who can admit the client to a hospital for inpatient mental health treatment.
Therapists, like professionals such as teachers and doctors, are also mandated reporters. That means that they are required to report abusive behavior that they learn about, even in the context of therapy. For instance, if a therapist learns that a client has been physically, mentally, or sexually abused, or has abused someone else, she is required to report the abuse to the appropriate agency. It is not necessary for the therapist to be certain that abuse has taken place. For instance, a child psychologist is required to make a report if a client says, “My mom and dad beat me and lock me in a closet.” But the therapist is also obliged to report if they have reason to believe the child is being abused.
For instance, a child who is being abused may be afraid to say that out loud. But if the therapist sees that the child regularly has unexplained bruises or other injuries, and cowers when the parent is nearby, the therapist might reasonably suspect abuse and make a report to protective services.
Less commonly, a court might try to compel a therapist to testify regarding confidential client information in a legal case using a subpoena. However, absent one of the exceptions above, a therapist may be liable for breaking confidentiality.
A licensed therapist is required to act in their clients’ best interests. That includes keeping confidential information private, with the limited exceptions we have discussed. Breaking confidentiality may constitute therapist malpractice.
If you think your therapist has committed malpractice by revealing your private information, or committed some other form of abuse, you should consult with an experienced medical malpractice attorney to discuss next steps. Those might include filing a report with the therapist’s licensing board, filing a malpractice lawsuit, or both. We invite you to contact The Fraser Law Firm P.C. to discuss your options.
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