Is Individual Counseling Confidential?

Confidentiality in counseling is a cornerstone of the therapeutic relationship between a client and his/her psychologist and it also covers nearly everything there is to say about that relationship.

But there are a few important instances where just about everything you tell your therapist is not confidential, and it’s important to be aware of them.

One of the most amazing and life-changing parts of counseling is the sacred space we get the opportunity to create for our clients where they feel free to be who they are.

Compositional safety is exemplified in the certain confidentiality the client is promised through counseling.

And that can be a very comforting and freeing thing for the client to know, the words that they say are only exchanged between them and (if need be) their therapist.

That said, it’s critically important for practitioners and clients to understand the bounds of confidentiality in counseling.

The Importance of Informed Clients

Confidentiality laws are passed at the state level, and these are the state laws that dictate the specific times a person seeking counseling may have to break client confidentiality.

Professional codes of ethics are also useful to guide conduct.

Clients should also know why these confidentiality exceptions in therapy exist… it’s primarily to provide some level of safety or protection.

When you're making therapists confidentiality laws known to your clients, you can set expectations and prevent nasty surprises later on.

The Importance of Informed Therapists

Confidentiality in counseling may be restricted to certain instances, while confidentiality is always the rule for students.

Codes of ethics can also vary slightly by profession, such as for licensed counselors in contrast to marriage and family therapists.

All psychologists should know the specifics of this ethics panel and the laws which they must abide by in the state(s) they work in. This is crucial for those who are therapists as well so that they can uphold to these confidentiality laws, and not risk their license status, and so that they are able to enlighten their clients concerning these confidentiality laws.

Factors for a therapist to consider when contemplating use of the confidences in counseling exceptions to confidentiality. Having satisfied the test for determining that an exception to confidentiality applies, the therapist must further be cognizant that:

The limits to confidentiality.

• The precise circumstances in which confidentiality would be breached.

• The procedure to be pursued once it’s decided that it’s time for therapist action.

• How to communicate and engage with client throughout the process.

3 Limits to Confidentiality in Counseling

Three primary concerns that are exceptions to confidentiality in counseling include danger to self, the duty to warn, and child or adult abuse/neglect.

Danger to Self

As a role of a therapist, the latter has to adopt an attitude to identify and notify when a client is demonstrating as high risk of self-harm.

Under most interpretations, being a “danger to self” includes the “imminent” qualifier. 

This indicates the therapist believes the client may do something to hurt themselves in the near future if action is not taken. This notional calculation relies on the observation of state of mind and the client’s own affirmation.

There are many levels of risk that the therapist should be trained to evaluate when they suspect a client may be suicidal.

Passive thoughts of death, where the patient is thinking that it would be nice to fall asleep and never wake up, usually by being run over by a truck (without specific plan or intent to do any act to cause such an event) would not launch a breach of confidentiality. This is frequently manageable through safety planning.

Once the decision has been made that a limit to confidentiality has been mandated, it is helpful for the clinician to know what kind of reporting they can make for protection of client safety.

This will vary depending on level of licensure, setting, and level of specialized training.

Staff who are not fully licensed may not be automatically licensed to independently report a client as “danger to themselves” or write an involuntary hold and might also have to involve a higher licensed colleague or supervisor.

The kind of clinical setting a therapist has can dictate the manner in which any reporting can take place.

For instance, some facilities can add an involuntary hold for a client themselves. In other clinical settings, they may only be permitted to call outside crisis teams to intervene with the client or summon law enforcement for a welfare check.

In some jurisdictions or settings, specialized training or certification is required before a clinician is authorized to apply holds to clients.

All of these differing things that need to be known, in order to be compliant, clinicians must know.

Duty to Warn

Another standard exceptions to confidentiality in therapy is the “duty to warn.”

This is where a client poses an immediate threat to inflicting bodily harm on themselves or someone else.

One of the keys to such reporting is that the possibe victim(s) must be distinguishable.

Here the therapist makes an injunction to save the physical welfare of target-identifiable individuals. “We don’t have such a duty to warn” for a client who says, “I’d like to hurt people in general,” without mentioning anyone in particular.

Like the “danger to self” condition, laws vary from state to state.

It is important for the therapist to be aware of the contact numbers of local law enforcement, in addition to being versed in the “duty to warn” laws in the state(s) they practice.

There are three main categories that these laws fall under: mandatory, permissive and no mandate.

Most states fall under the mandatory law, whereby it is required that therapists report these serious threats.

Failure to do so can have negative consequences for the therapist.

There are also states where the “duty to warn” is permitted but is not legally mandated.

Finally, there are a few states that have no law in place for the “duty to warn” confidentiality exception. 

There are, finally, a handful of states with no provision at all for a “duty to warn” exception to confidentiality.

A therapist should know which category their state law falls in.

Suspected Child and Elder Abuse or Neglect

Suspected child or elder abuse or neglect are mandatory reportable in all states.

It is one of the most consistently mandated exceptions to confidentiality in counseling.

In these situations, the clinician does not need to prove or disprove the abuse or neglect.

They need only report what they see or have been told that arouses their suspicions.

There must be some notable facts that have been reported that create a reasonable suspicion of abuse or neglect.

The details of what constitutes abuse or neglect can vary from state to state. The devil is very much in the details as the distinctions must be transparent to the clinician, who can then assess based on the statutory framework of the jurisdiction(s) in which they practice.

The laws will also specify to whom to report, what to report and the time period in which the report must be made. The report is typically made to a local child protective services (CPS) or adult protective services (APS) agency.

Understanding of Law and Code of Ethics

I can’t emphasize how important it is for professionals to get to know the confidentiality laws and exceptions in their own local and state therapist practices.

These laws are the primary criteria for clinician evaluation and reporting protocols.

There will also be key recommendations to follow in the code of ethics for a therapist’s specific license.

It is the clinician’s responsibility to be knowledgeable about the laws, as well as the ethical considerations, with respect to the boundaries of confidentially in the counseling session.

Communication With the Client

Breaking counseling confidentiality can be a difficult topic to broach with a client.

In general though, it's appropriate to be fairly clear with clients about it, unless there's some obvious way in which doing so will cause a huge amount of harm to the client or someone else.

Even with been an effective informed consent from the beginning of the cleaning process, client’s responses may vary.

It is crucial that the clinician explains the situation in a clear, reassuring and empathetic manner.

Where breaking confidentiality is necessary, the practitioner should be certain of their pathway to this decision and be able to provide the client with a clear explanation of why they are breaking this particular confidence.

Knowing that this news will likely come as a shock to the client, and possibly also those around him or her, the therapist should listen with compassion and validate the client’s experience.

You can care about them, try and keep the therapeutic relationship positive, and still act on the conviction that it is the right decision to breach confidence.

Therapist Confidentiality Laws Are Intended to Prevent Harm

It can be useful for clinicians to recognize that some laws and systems can be flawed, biased and discriminatory.

It’s not breaking confidentiality to report a client, it is done to promote and ensure safety and prevent harm. But there are instances where the reporting is partial, punitive, or driven by nothing but the practitioner’s desire not to be sued. Any of these can be harmful to the client and relatives.

The superior ethic of preventing injury and providing for safety should always be kept in mind when weighing these rationales for violating client confidence.

Physicians should always use caution, thoughtful clinical judgment, and as much objectivity as possible when considering the circumstances.

As therapists, we have to be particularly mindful of these exceptions to the confidentiality in therapy.