Many families and friends express frustration with confidentiality when healthcare information is needed. Confidentiality is defined as your legal and moral right to privacy in a therapeutic setting. A therapist has an obligation to protect the rights, confidence, and information shared in a therapy session from the public (even family members or spouses). Great controversy has arisen over the years regarding these tight restrictions. Parents, spouses, caregivers, therapists and other healthcare providers all have had difficulty with the legal components of confidentiality.

Confidentiality has become increasingly complicated due to what is known as HIPAA, the Health Insurance Portability and Accountability Act of 1996. This act prevents anyone from gaining access to healthcare records. An individual will be required to sign a document known as informed consent or receive permission from the patient or client to retrieve information.

Despite confidentiality, therapists have various duties to carry out in a therapeutic relationship:

1. Duty to warn: This standard refers to the therapist’s duty to protect other people who are possibly in danger at the hands of the person receiving mental health care. For example, if a client states that he is very angry with his spouse, has a PFA order, and verbalizes his desire to kill his wife, a therapist has a duty to warn her.
2. Duty to report: Therapists are required by law to report incidents of potential abuse (sexual, physical, emotional) in the event it is strongly suspected.
3. “Duty to comply”: If required by a court-order to provide information in a case regarding an individual’s mental health records, a therapist must release information.

In the event an individual in therapy is perceived as needing intervention, there are three exceptions to breaking confidentiality:

1. If an individual threatens to harm someone else
2. If an individual threatens to harm him/herself
3. If an individual reports that he/she has been abused

Some therapists use their discretion in also reporting promiscuous behaviors of adolescents, extreme drug and alcohol abuse, or other risky behaviors.

For children and adolescents, confidentiality isn’t as concrete as it is for adults. Children and adolescents are entitled to confidentiality, however, parents have the right to inquire or speak to the therapist. The therapist also has the right to report or reframe from reporting certain details.

Adherence to confidentiality is based primarily on the morals, standards, beliefs, and wise discretion of the therapist. It is also based on the laws of the state and agency. Most therapists will discuss in great length confidentiality and how it affects you before you enter care.

I encourage you to make a list of questions regarding confidentiality and ask a mental health professional to explain it. In the event an emergency occurs, you need to know what your rights are or the rights of your loved one.

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All the best

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    Last reviewed: 16 Mar 2013