People going to therapy are often worried about what to say to their therapist (or whether they should say anything at all about certain topics).

They may have worries, such as: “what if my therapist judges me?”, “what if they think I am crazy and tries to institutionalize me?”, or “what if they tell my spouse or family about my issues?”.

Closing yourself off from the therapist can weaken the therapeutic relationship (Keijsers et al., 2000). Moreover, the therapist may not be able to properly work with you because they do not have the full story, which can negatively affect outcomes in therapy (Corso et al., 2012).

Addressing concerns of confidentiality

In this post, I provide information and address specific concerns about confidentiality and what topics are off limits in therapy.

The short answer is that there is none. Certainly, there are limits to confidentiality (which we will talk about), but you should generally feel comfortable discussing with your therapist about anything you wish to share.

Your therapist is trained to be empathetic and understanding in their response and will certainly appreciate your vulnerability and openness.

What if my therapist thinks I’m crazy?

It is understandable to feel vulnerable and anxious about sharing things about yourself that you may have never talked to others about before.

However, I can assure you that your therapist has likely heard it all before. And I can be even more certain that your therapist will respond in a non-judgmental and empathetic manner.

In the same vein, it is unlikely for you to be ‘institutionalized’ for discussing certain thoughts. The only limit to confidentiality that would be a concern is if you were in ‘immediate risk of harm to yourself or others’. This means that you are in significant danger of hurting yourself or somebody else.

Even in this case, the therapist will never go behind your back; they will have an open and honest conversation about your thoughts and work with you to get you to where you want to be.

What if my therapist shares things I don’t want them to?

Some patients may have concerns that the therapist will share information with other people, such as family members or loved ones.

Rest assured; the therapist will never share any information to other people in your life unless you provide explicit consent. In fact, if someone who is not authorized calls and asks about your appointment, the therapist cannot even disclose if you are even a patient at the clinic.

For minors, this can sometimes be a different case. For example, the therapist may have to disclose information to parents regarding assessment and treatment. However, it is also possible to set confidentiality rules with the parents before treatment starts so that the minor has full autonomy about what information can be shared with parents.

Limits to confidentiality

Generally speaking, there are 5 instances where a therapist may have to break confidentiality to let the right people know.

1. Presenting immediate danger to oneself or others. Note: this means an urgent situation where a person’s life is in imminent danger. Therefore, self-injury would not be included in this limit to confidentiality.

2.  Inappropriate behaviours from healthcare professionals. In this case, if the therapist hears that a healthcare professional has ever engaged in behaviours that are not ethically appropriate. In this case, the therapist must let the right regulatory know.

3. Knowledge of ongoing abuse of a minor.

4. Knowledge of ongoing abuse of someone in a long-care facility.

5. A court of law subpoenas records. This is a more unlikely event, but if the court rules that a psychologist must provide records, then this may be one instance where confidentiality may be broken. The psychologist, however, can work with a lawyer to alter what can be disclosed.

Confidentiality and the circle-of-care

Patient information is shared with what is called the primary ‘circle-of-care’ in health settings. These are individuals that directly work with you in healthcare settings (e.g., physicians, nurses, psychiatrists) to ensure that everyone is working together and has all the appropriate information.

In this way, your doctor may know what you have discussed with the therapist, so they have all the up-to-date information to provide you with the best possible care.

If there is information you don’t want shared with others in the healthcare team, then you can ask the therapist for a ‘lock-box’, in which this information will be ‘locked’. This information will not be shared with anybody in the circle-of-care.


Overall, you should feel comfortable knowing that you can share anything with your therapist. Limits to confidentiality do not mean that you cannot share this information with your therapist; in fact, it’s encouraged to make sure that we can protect the patient and others from further harm. Information shared as part of the ‘circle-of-care’ is to ensure that we are providing support in the best and most up-to-date manner.

For first time patients in therapy, here’s a couple additional posts that might be helpful!

1. What should I expect in therapy as a first-time patient?

2. How do I get the most out of therapy?

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Best wishes,