When Does a Therapist Have to Break Confidentiality?

Written by Howard Spector on October 26, 2016

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

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. But does what happen in a session always stay in a session? When does a therapist have to break confidentiality, why do they decide to share private information, and even more important, 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 clients. Which is why it’s a counselor’s duty to not only notify them of your privacy policies, but explain in detail any circumstance in which the confidentiality agreement of counseling gets broken.

A good way to initiate this conversation is to send out all privacy policies (which include confidentiality disclosures) in your new client welcome letter. Then, when processing and reviewing all the paperwork in the initial session, review and ask questions of your client to ensure he understands it.

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 explain confidentiality disclosures to your inquiring clients best. Here’s a brief overview of when counselors can break confidentiality. However, double check with your state and federal legislature, as well as your licensing board’s ethical code for precise information about handling the information a client shares in session.

Generally, 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

The best way to ensure that you practice honoring client-counselor confidentiality, but 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.”

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 law varies 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. While the majority of states do enforce a mandatory duty to warn/protect, fourteen states and Washington D.C., consider it 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. 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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About the Author

Howard is the CEO and Co-founder of SimplePractice. Howard has over 20 years of experience in the information technology industry. He is proud to have earned his MA in Counseling Psychology with an emphasis in Depth Psychology at Pacifica Graduate Institute.

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