Confidentiality – what therapists can and cannot share with other people outside the therapy room – is often a concern that people have when thinking about starting therapy.
They worry that their “crazy” thoughts and/or urges to harm themselves, could mean that the therapist will immediately tell the police and send them to the hospital. (Rest assured, that’s not what happens).
In most cases, confidentiality means that the information will be kept between you and therapist, as well as your primary circle of care. This means that only people who are actively working with you will have access to the information. For example, if you are going to a hospital to see a psychologist, and you also work with a social worker there, that social worker will also have access to the information to ensure continuity of care. That is – all your clinicians on the same page to make sure they are providing you with the best services.
Limits to confidentiality
Although most everything is confidentiality between your therapist and you, there are a few instances where the therapist may have to let the right people know so that everyone stays safe.
- Immediate risk of harm to yourself and/or others
- Evidence of abuse of a child or someone in a long-term care facility
- Inappropriate behaviours of a health professional
- Court of law subpoenas records
- Record checking from the psychology association
Below, I’ll provide additional information on the five limits to confidentiality and give examples so you know what this actually looks like in practice.
Limit to confidentiality #1: Risk of immediate harm to self or others
Therapists may let the right people know if there is sufficient risk that immediate risk of harm could come to you or somebody else. For example, if you let the therapist know that you won’t be attending next week’s session because you won’t be on this earth anymore, or if you plan on seriously harming a colleague at work.
In both these cases, the risk if imminent. Therefore, this doesn’t include situations where you are just thinking about death or tell the therapist you really hate your colleague. It also means that therapists don’t say anything if you said you had attacked someone in the past because it already happened. There’s no current risk unless you said you were planning to do it again.
As you can see, unless there is very serious risk in the present context, confidentiality will still apply.
Limit to confidentiality #2: Abuse of a child or a person in a long-term care facility
In the event that there is knowledge of abuse of a minor or someone in a long-term care facility, the therapist will have to let the right personnel know (e.g., child services). Abuse can come in many forms – verbal/physical abuse and neglect, for example.
Some therapists will be more sensitive to information involving abuse, and will be more inclined to take a better safe than sorry approach. However, it is important to remember that the reporting doesn’t necessarily mean any one gets in trouble; it’s just a precaution to start a larger investigation.
In some cases, this break of confidentiality can of course impact the therapeutic alliance because some clients see this as a betrayal of trust. On the other hand, some clients actually might respect their therapist more because they recognize that the therapist truly cares about each person’s well-being.
Limit to confidentiality #3: Inappropriate behaviour of a health professional
There also limits to confidentiality if the therapist becomes aware that a health professional has ever been inappropriate to you as the patient. For example, making sexually suggestive comments. In this case, they would have to let the regulatory body of that professional know, so no harm comes to additional patients.
However, this is true only if you have provided enough information about the health professional to identify them; if you are fairly vague and do not give a name, then the therapist would not be able to raise this concern.
Limits to confidentiality #4: A court of law subpoenas the records
If you are part of a legal battle, it is possible for a court of law to subpoena the records. If the judge deems appropriate, then the files may have to be turned over.
However, this doesn’t mean that we have to provide all files related to the person. There can be ways to redact certain information that are not pertinent to the case.
Limits to confidentiality #5: The psychology association asks to do a record check
Once in a while, the psychology association might ask for a therapist to hand over files to see if the therapist is doing the right things for quality assurance purposes. Similar to #4, the therapist can discuss with the patient what they think is okay or not okay to share. This can be an ongoing conversation between the therapist and patient.
Summary
I hope this post was helpful in understanding more about confidentiality and when therapists might break confidentiality. Hopefully, this assuages your concerns a little that therapists will not report every little thing that is discussed in a therapy session.
And more often than not, it’ll be a conversation between you and the therapist.
Best wishes,
P
Simply mental health 