Marriage and Family Therapist
Cyndi Sarnoff-Ross is a licensed psychotherapist with almost twenty years of clinical experience in the fields of clinical psychology and organizational management. She has worked extensively with a wide variety of…
The Boundaries of Confidentiality in Therapy
Posted in Anger Managemen... by Cyndi Sarnoff-Ross on Jun 20, 2008

One of the essential features of therapy is the notion of confidentiality. What you say to your therapist is held in the strictest of confidence. This is designed to assist the client to feel free to share their deepest thoughts, fears and feelings. It is a crucial part of the process. Even the nature of the relationship is considered confidential so that if you were to run into your therapist in the supermarket they could not introduce you as their client without your expressed permission. 

There are exceptions to these rules, and before entering onto a therapeutic relationship a client should be very clear about what those exceptions are  Each State in the U.S. has its own governing body that oversees the profession of therapy and even within the profession there are divisions between Psychiatrists, Psychologists, MFTs (Marriage and Family Therapists) and Social workers. Many of the laws cross over between these professions and in California all are considered mandated reporters. What this means is that there are a handful of things that if you tell your therapist they will be required to "report" the information to a specified source.

Since I am licensed in the State of California I can only speak about those laws but, as I have mentioned, many of them are the same throughout the country. I am unaware of the laws that pertain to countries outside the U.S. but I would imagine many countries have similar guidelines.  In California if you tell your practitioner that you have hurt a child or an elder, they are required to report that abuse. If you disclose to your therapist that you have committed an act of child abuse in the past, even if that child is now an adult, your therapist must report the incident if you are currently around minors. In addition, we are required to report if someone is a danger to themselves by being gravely disabled, or to others, or if they make clear threats of harm towards a specific individual. 

The laws are subject to interpretation but it is incumbent upon a therapist, to the best of their ability, to ensure the safety of their client and those persons with whom their client comes in contact.  This is by no means a comprehensive list of possible scenarios that would require a therapist to break confidentiality but it is a basic guideline. I advise that prior to initiating any therapeutic relationship a client should be aware of the laws that govern their practitioner.

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What about if you are minor seeing a school counselor, for example? It seems to defeat the purpose of counseling to me if the counselor goes hollering to your parents if you even mention self-harm or an eating disorder or suicidal thoughts. And often times parents are the cause of these problems in the first place. Wouldn't it be better if the minor got help from a counselor who couldn't tell anyone than if they got no help at all because they were afraid of what the counselor might tell their parents?
By saraluvsgpigs  Aug 14, 2008
My therapist told me very clearly in what circumstances she would share information before we started. UK
By KayBeth  Aug 05, 2008
I had a therapist,and she worked for a family owned business. I had never really talked to anyone about the abuse I suffered as a kid. I finally opened up with this therapist. I told her everything, the first person I ever really told. Next thing I know I get called into a meeting, she had told her sister, who also told a lady "friend" at CPS, now mind you I am 30. They were trying to convince me that I should press charges. Hell I had just come out with it. I mean come on!!!! I felt so betrayed that I felt like I could not be honest with her anymore. The reason I don't talk to people is because they run back and repeat. We all know what happens when it starts to be repeated, facts get changed, and lies get added.
By KSS1977  Jul 06, 2008
i hate psych and donot trust everytime i opened up os said something they would threating to put me away and it would be nothing big i just do not trust them
By bratpack  Jul 02, 2008
Thank you for the information. I've been seeing my therpist for about 6 months. I can say that I'm glad I have one she is great. I've come a long ways for the better.
By sunnystars58  Jul 02, 2008
This is really funny. If a therapist reports that a person may harm another person the police will step in but when a private person calls the police and tells them about a friend who says she was buying a gun and was planning on shooting her psychiatrist the police say sorry they can't step in and maybe take her to a hospital for possible treatment. This was my friend and she was dead serious. Another friend showed me the receipt from the gun shop and I wrote it down. This was a VA psychiatrist so I thought it might help to call the security police at the VA. I gave them my friend's name and the name of the gun shop and asked if they could stop my friend from picking up that gun. They said they could and did because of the seven day waiting period in CA. This is one time the Brady Bill worked. My friend later got treatment in a State Hospital.
By SuzanneCol  Jun 29, 2008
that's only sensible, we'd be pretty upset if a member of our family ended up hurting themselves or others, or get hurt by others when the situation could've been avoided - just wanted to add that australian laws are along the same lines as the californian ones mentioned.
By cagedDreams  Jun 27, 2008
It took me years to trust my therapist enough to "start talking" He swore that he wouldn't tell anyone what I said in therapy, That turned out to be a lie, He did. Not only that, But after finally talking about my trauma, things got worse instead of better, I got extreamly suicidal, and while in the hosp, He dumped me. The whole thing ended up being more trauma. It's been over a year, and it's still very raw to me. I don't know if I will ever trust a therapist again. I mean, if you can't trust your therapist, who can you trust?
By Owshen  Jun 23, 2008
My MD broke confidentiality when he consulted legal help for mismanaging my head injury. I was not involved in a lawsuit. He was just paranoid that he had screwed up so badly that I would. I decided to leave his practice and am much happier at the clinic where my care is now being managed. Just another example (for me) that other's behavior cannot be controlled--even when ethics and legality prohibit certain acts!
By shakysara  Jun 22, 2008
Thank you for the information. My best friend was murdered by her husband (he admnitted to it) and during a counseling session with both husband and wife he admitted to hurting her and threatening to kill her. Now the prosec. has to subpoena the counselor - I guess she did not fell like my friend was threatened - and her testimony will be used in court. I really wish she had come forward sooner to maybe stop the murder or after to let the cops know this guy intended to hurt her. I know about the law in CA - her family is there, her sister is a lawyer. I hope the law is the some here in NC.
By Goosegirl  Jun 22, 2008
Good information. It's kind of a scary thing for someone with OCD. What if you obsess that you have done something to someone in the past even though you have no clear recollection of it? If you confess that, are you then going to be under scrutiny by the law? Mentally ill patients might want to think twice about divulging their delusions if that's the case.
By clutter  Jun 22, 2008
Yeah I know my therapist has broken client confidentiality a few times to Vocational Rehab, but with the HIPPA Act in place, that has gotten loads better over the years. The HIPPA Act states that no information can be given to people who call, except for certain individuals that you specify, like say a mother or father or relative or something, but I don't think therapists follow that as closely as medical doctors do, and maybe thats why.

personally if it were me in an MFT or psychologist role, I wouldn't tell anyone what my client told me in confidence, unless it was something serious like you describe, and even then I wouldn't tell anyone unless a policeman or sheriff asked me specifically, to figure out a rape or murder case for instance. I wouldn't believe its my place to report anything unless I'm confronted with it.
By tcoburn  Jun 20, 2008
I start therapy next week and I am extremely nervous.
By poohscorner  Jun 20, 2008
if it goes over the boundary i mean, it screws up everything and trust gets wiped out believe me.
By MrsLadybird  Jun 20, 2008
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