When Can Client Confidentiality be Broken?As a therapist, your relationship with your clients has therapeutic, economic, and legal dimensions. These relationships are governed by laws which require confidentiality on your part as a therapist. Confidentiality is a legal construct which prevents the disclosure of the events of therapy. Therapist confidentiality gives the client the assurance they can share whatever they want with you. Nonetheless, there are a number of critical limits of confidentiality in counseling. In some cases, due to forces outside your and your client’s control, your client can’t expect you to keep their disclosures private. Certain exceptions to confidentiality in counseling are at your discretion. In other cases, you are obligated to breach confidentiality in the name of public safety or your client’s health. In this article, we’ll discuss the concept of therapist confidentiality, describe when to break confidentiality in counseling, and give you a handful of tips on using your best judgment to keep confidentiality as intact as legally and ethically mandated.
The Definition of Therapist ConfidentialityConfidential information is information which is produced by a person who has a reasonable expectation that the information will only be shared by other people with the explicit consent of the person who produced it. Confidentiality of information is applicable without any time limit unless otherwise specified by the originating party. The therapeutic relationship between a therapist and their client contains an abundance of confidential information. This means that it cannot be shared without the consent of the client. Confidentiality applies legally to information which people are exposed to firsthand, but also secondhand. In other words, if you handle a piece of confidential information, you may be in a breach of confidentiality if you were not the one who was explicitly authorized to see the information or to disclose the information. Confidentiality is encoded in the HIPAA privacy rule in the US. If the regulations regarding confidentiality are breached, there can be legal recourse against all of the parties who were involved in the breach except for the originating party.
Why Does Confidentiality Exist?As a therapist, you are obligated to uphold your profession’s ethical standards. Your clients have a right to privacy, and you have a duty to hold up your end of the bargain by respecting that right. Clients will share their most intimate problems with their therapists, and they do so with the understanding that their comments will not leave the room. Without the legal guarantee of therapist-client confidentiality, performing effective therapy would be much more difficult, especially if the client struggles with shyness or social anxiety. Furthermore, if clients couldn’t be certain of the privacy of the privileged communications they share with you, many wouldn’t be attending therapy at all. Confidentiality serves to protect clients from the outside world and provides a therapeutically essential way of compartmentalizing their life.
Who Does Confidentiality Protect?As a legal construct, confidentiality protects your clients first and foremost. The proceedings of therapy sessions are not events which are open to the public record as a result of confidentiality, which means that clients are allowed to discuss things which might be problematic in a wider context. Clients can be emotionally secure when they confide in their therapist, and they can also be certain they are protected from most admissions of crimes or breaches of contracts so long as they are made during therapy. Confidentiality also protects the therapist to a much lesser extent by relieving the therapist of the obligation to testify in legal matters involving the client’s therapy. If confidentiality were not enshrined in law, therapists could be compelled to testify regarding their client’s therapy for various legal or criminal proceedings, which would be a substantial amount of unpaid time resulting from therapeutic work with a client. Lastly, confidentiality laws protect the state. If confidentiality had to be agreed upon with a unique contract between every therapist and client, breaches of that contract would inevitably end up in court. This would add an additional burden to the court system, which confidentiality laws mitigate by preemptively defining critical elements of the legal and economic contract between therapist and client.
Which Circumstances Are Exempt from Confidentiality?There are a handful of situations in which the normal rules regarding confidentiality do not apply. These exceptions to confidentiality in counseling crop up fairly frequently, and therapists need to know how to navigate them because they’re intertwined with essential business practices like billing. These situations do not necessarily obligate the therapist to breach confidentiality, but rather pertain to the situations in which confidentiality is subject to structured disclosures. Knowing the difference between these sanctioned openings in confidentiality and the situations where therapists are obligated to report a breach is critical to understanding confidentiality as a whole. According to the privacy and confidentiality section of the APA’s ethical code of conduct for therapists, there are four general situations which are exempt from confidentiality:
- The client is an imminent and violent threat towards themselves or others
- There is a billing situation which requires a condoned disclosure
- Sharing information is necessary to facilitate client care across multiple providers
- Sharing information is necessary to treat the client
Which Situations Obligate Therapists To Break Confidentiality?Knowing when to break confidentiality in counseling is key because there are certain situations in which the therapist is legally obligated to do so. If the therapist confidentiality is not breached in these cases, the therapist may be subject to censure if there is subsequently a discovery of their failure to fulfill their legal obligation. The following situations typically legally obligate therapists to break confidentiality and seek outside assistance:
- Detailed planning of future suicide attempts
- Other concrete signs of suicidal intent
- Planned violence towards others
- Planned future child abuse
- Formerly committed child abuse
- Experiencing child abuse
- Expecting to experience future child abuse
- Money laundering
- Drug trafficking