Will your therapist keep everything you tell them confidential? It depends on what you tell them. Generally speaking your therapist is supposed to keep your communications with them and even your identity in confidence, but confidentiality has its limits under the law.
In certain situations, therapists are allowed to break confidentiality and in some other situations they are required to do so.
A therapist becomes what is known as a “mandated reporter”, when you tell them about any of the following:
- Child abuse and/or neglect;
- Elder abuse and/or neglect;
- Dependent adult abuse and/or neglect;
- Client’s threat to harm an identifiable victim.
All of the above is self-explanatory, but I’ll briefly clarify the legal definitions of “child”, “elder”, “dependent adult” and “identifiable victim”.
“Child” is legally defined as any person under 18.
“Elder” is legally defined as any person, who is 65 or older. (Yes, once you are 65, legally you are an “elder”)
“Dependent adult” is any person between 18 and 65 years of age with either physical or mental disability, who cannot function independently.
“Identifiable victim” is a person whom the client threatens to harm and whose personal information is known to the therapist.
In case of abuse/neglect of a child or an elder or a dependent adult, a therapist is suggested to use their own judgment to define if the situation requires reporting. Therapists are mandated to report such cases whenever they have a “reasonable suspicion” that abuse is taking place. In other words, it is not a therapist’s responsibility to investigate if abuse is really happening. A simple suspicion, a “gut feeling”, a belief that a child or an elder or a dependent adult is being abused/neglected mandates the therapist to report it to the authorities so they could properly investigate it. A mandate to report holds therapists immune from liability for breaking confidentiality.
Keep in mind that therapists are ethically but not necessarily legally required to inform you that they are mandated reporters. This means that if you tell your therapist that you often see your neighbor beating their child, he or she might report it to child protective services or the police but might not tell you about it. Check the law regarding mandated reporting in your state.
Another important thing to remember is that therapists are mandated reporters only when they operate in their professional capacity. In other words, when a therapist learns about any instances of abuse mentioned above from a client, he or she is required to report it to authorities. However, when the same therapist learns the same thing from a family member or a friend or a neighbor, they are not legally obligated to do anything about it.
Another situation when a therapist is legally required to disclose confidential information to a third-party is when a client communicates with a serious threat of physical violence to an “identifiable victim”, e.g. a client’s girlfriend, employer, neighbor or someone else who can be easily identified. In such instances, a therapist has a legal “duty to warn”.
A “duty to warn” refers to a therapist’s legal obligation to warn the intended victim about a client’s intend to harm them and also to notify police about it. A therapist has a “duty to warn” also when he or she learns about a client’s threat of violence toward an identifiable person from a client’s family member or another credible third-party.
The above information refers to the rules and procedures used in California. If you want to know your state laws regarding confidentiality in psychotherapy contact your state’s licensing boards and mental health professional organizations.
Read more about confidentiality exceptions in my other post “When Is a Therapist Allowed To Break Confidentiality?”