Is Everything I Say in Counseling Confidential?

Therapist-patient privilege is a sacred trust, much like that between a priest and parishioner or a doctor and patient.

For a therapeutic relationship to exist, there must be some trust that what you tell your mental health care provider stays with them.

But this kind of relationship can raise some questions. Are there some circumstances when reporting what is said in counseling mandatory? Is a therapist or a psychiatrist required to report a crime? When is it appropriate to breach confidentiality?

In this post, we’ll look at how it applies to issues like past crimes, sexual abuse and actions, self-harm, and other things that are spoken of in confidence.

Note: This post is for informational purposes only and not intended to serve as a replacement for legal advice.

Privileged Relationships with Psychologists, Psychiatrists, and other Mental Health Professionals

In the USA, Confidentiality laws regulate healthcare and mental health professionals under the privacy standards of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Certain elements of the regulations are more specific to psychotherapy.

A therapist's first session covers confidentiality laws, for example. This communication regarding confidentiality laws can be verbal or in written format. The patient has the right to:

• Consumers have the right to obtain their data and records.

• We will only share their details with others if they agree to this themselves.

• If there is a danger to a client or anyone else, or if disclosure is required for legal reasons, the therapist may share the information with other relevant agencies.

• If the therapist violates confidentiality, the client may press charges.

• For a minor patient or a patient without sound mind and judgment (as determined by a qualified health provider) who has lost cognitive function due to a serious mental health condition, a guardian may exercise these rights on the patient’s behalf, in which case applicable laws shall govern.

When Therapists Can't Divulge What's Said in Therapy

And because therapy is so personal and intimate, what you say to a therapist has to be kept confidential.

That means things like affairs, past, crimes, and “bad behavior” that are not technically considered criminal behavior. You can tell a therapist anything about the way you have been abused in the past, and they cannot share that. Plus, with some exceptions, a therapist can’t report a past crime you committed.

When a Therapist Can or Must Break Confidentiality

Here, we explain a few exceptions to breaking confidentiality. Here are a few instances in which information from a therapy session can be spread if the therapist deems it necessary:

• A client is exhibiting suicidal behavior indicative of potential danger to self.

• Their client demonstrates the prospect of inflicting serious injury on another human being.

• The client admits in advance they are going to commit a criminal offense.

• The client is a minor or a dependent adult who is a victim of physical, sexual, or emotional abuse, neglect, or exploitation or is a victim of a crime.

• A therapist can also break confidentiality if there is a legal duty to assess such risk, as in a criminal case or any other legal matter when a patient's mental condition or ability is questioned.

“Under a ‘duty to warn,’ a mental health therapist or counselor might be considered a mandatory reporter, meaning he or she could be subject to legal ramifications if the information is not disclosed, including things like a patient’s risk for suicide, intent to harm and child abuse.

What Happens If You Confess Crime to a Therapist?

There are some states where the law mandates a duty to warn or protect; others are permissive, allowing the therapist to decide which path to pursue. In some states, they don’t permit a breach of confidential information at all, so the duty to protect is out.

There are also varying views among mental health experts regarding therapist confidentiality and the duty to report old crimes.

Some believe reporting on serious self-harm is their responsibility, but crimes are not. Some people fear that a leak can cause people to avoid therapy out of fear. Other therapists might shirk from treating potentially violent individuals for fear of a lawsuit if they fail to report the danger.

What Kinds of Crimes Are Therapists, by Law, Required to Report to the Police?

Where state laws mandate that therapists report — and they might legally obligate them to notify the authorities when patients are imminently endangering themselves or others, report in a therapy session that they are going to commit a crime, are a child abuse at home, or that abuse is taking place — then they must do so.

What Can a Therapist Decide to Report?

In states that have a permissive duty to protect or warn but no mandatory duty, as is the case in Arizona, Oregon, Texas, and Florida, and in states where a therapist cannot repeat the content of what a patient has disclosed.

This rule applies to Maine, North Dakota, and North Carolina - ultimately left to the discretion of the therapist to decide what, if anything, to report to the police or other law enforcement agencies. For others, therapy is a sacred experience, and they may believe that any violation of confidentiality is unethical.

In general, permissive disclosure allows a therapist to decide what is in the best interests of their client regarding disclosure.

There is wiggle room in most states' laws, which allows someone to consider emotional distress. A psychiatrist uses judgment to determine intent and provide help to the patient. Individual therapists may feel inclined to report if they think the patient or victim is in immediate danger, but that will not be the default decision.

Final Thoughts

Do therapists have a legal means to contact the police that conflicts with their moral compass?

Aside from state-regulated confidentiality laws regarding patient privacy, therapists often consult with one another to form therapeutic alliances that benefit their patients most. Some may be more prone to report crime, while other therapists may be more likely to report patients who they feel may be more prone to self-harm.

Finally, a therapist will usually understand the sacred trust established between therapist and client and weigh the privacy situation when considering disclosing information about you.

Confidential Therapy in Albuquerque or Rio Rancho

Suppose you’ve been holding onto pain from trauma in the past and have been unable to share that history for fear of alienating people who would prefer unchallenged news coverage. In that case, therapy can help you accept and understand your emotions, allowing you to move forward in your life.

At Healthy Families, we understand how scary it can be to revisit the past, and our counselors provide a safe and confidential path toward healing.

Call us today, and our patient coordinator will match you with a therapist who is a good fit for you and can effectively address your counseling needs.