When Does a Therapist Have to Break Confidentiality?

Ah, confidentiality. One of the primary reasons clients choose to enter into a counseling relationship. They want to know they can share their inner fears, secrets, and desires with a neutral party, and that individual will not, and cannot, share that information with anyone else.

If you’re wondering, “when does a therapist have to break confidentiality?” know that the answer is black-and-white (and also gray).

Confidentiality is one of the primary reasons clients choose to enter a counseling relationship. When a client chooses to visit a health and wellness professional, they want to know that they can share their inner fears, secrets, and desires with a neutral party, and that the individual will not, and cannot, share that information with anyone else. Sometimes, however, what happens in a session doesn’t always stay in a session. It’s important to know when a therapist has to break confidentiality, why they decide to share private information and, more importantly, to whom.

01-when-does-a-therapist-have-to-break-confidentialityThe basics on confidentiality disclosures

In a counseling atmosphere, therapist confidentiality is one of the most important aspects of building a strong rapport with a client. This is why it’s a therapist’s duty to not only notify the client of their privacy policies, but also explain in detail of any circumstances in which the confidentiality agreement of counseling gets broken.

As a health and wellness professional, a good way to initiate the conversation of confidentiality is to include all your privacy policies (which include confidentiality disclosures) into your new client welcome letter. Then, when processing and reviewing all the paperwork in the initial session, review and ask questions to your client to ensure they understand the privacy policies.

As a therapist, you value the trust you’re working so hard to build with your clients, but you want to make sure that you’re following any state or licensing board regulation about information that is pertinent to disclose (and when). You also need to know how to best explain confidentiality disclosures to your inquiring clients. Check with your state and federal legislature, as well as your licensing board’s ethical code, for precise information about handling information a client shares in a session. Below is a general overview of when counselors can break confidentiality:

When does a therapist have to break confidentiality with a client?

1. If the client may be an immediate danger to himself or others
2. If the client is endangering a population that cannot protect itself, such as the case of child or elder abuse
3. To share diagnosis information as necessary to obtain payment for services
4. As required by federal or state laws

Ultimately, the best way to ensure that you honor client-counselor confidentiality, and also follow any mandatory or permissive regulations, is to read, analyze, and adhere to any state, federal, and association rules.

02-when-does-a-therapist-have-to-break-confidentialityWhen does a therapist have to break confidentiality? Rules from 3 Associations’ Codes of Ethics

According to the American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct standard 4.05(b), “Psychologists disclose confidential information without the consent of the individual only as mandated by law, or where permitted by law for a valid purpose such as to (1) provide needed professional services; (2) obtain appropriate professional consultations; (3) protect the client/patient, psychologist, or others from harm; or (4) obtain payment for services from a client/patient, in which instance disclosure is limited to the minimum that is necessary to achieve the purpose.”

In section 1.07 c of the Code of Ethics of the National Association of Social Workers, it clearly states, “Social workers should protect the confidentiality of all information obtained in the course of professional service, except for compelling professional reasons. The general expectation that social workers will keep information confidential does not apply when disclosure is necessary to prevent serious, foreseeable, and imminent harm to a client or other identifiable person. In all instances, social workers should disclose the least amount of confidential information necessary to achieve the desired purpose; only information that is directly relevant to the purpose for which the disclosure is made should be revealed.”

In addition, the American Counselors Association’s Code of Ethics states, “The general requirement that counselors keep information confidential does not apply when disclosure is required to protect clients or identified others from serious and foreseeable harm or when legal requirements demand that confidential information must be revealed. Counselors consult with other professionals when in doubt as to the validity of an exception,” in section B.2.a.

03-when-does-a-therapist-have-to-break-confidentialityWhen does a therapist have to break confidentiality? Information on state laws

While an association’s ethical code dictates expectations, state laws vary on whether or not it’s mandatory or permissive for counselors to break the rules of confidentiality in therapy. The National Conference of State Legislatures provides a detailed guide which allows clinicians to find information on confidentiality disclosures in their state. Even though 14 states and Washington, D.C. enforce a mandatory duty to warn/protect, it is considered to be permissive, but not obligatory. Three states — Arizona, Delaware, and Illinois — have different regulations for different professions. Some states don’t even have any duty to warn/protect laws. These include Maine, Nevada, North Carolina, and North Dakota.

Regardless of what type of mental health professional you are or which state laws apply to you, it’s important to focus on maintaining and protecting your client’s confidentiality. At SimplePractice, we take confidentiality seriously, which is why you can expect secure document storage and safe electronic claims in our product. If you don’t use SimplePractice yet, what are you waiting for? Try us today — the first 30 days are free.

Do your clients often ask about your confidentiality disclosure policies? Let us know how you address their concerns in the comments section.

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Looking for more therapist tips?

If you found this post useful, here are more blog posts you may like:

• Encountering Fear and Loathing in the Therapist’s Psyche
• What Do I Do With This Therapeutic Anger?
Why is Self Care Important for Mental Health Practitioners?

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