How much should you tell a therapist?


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By David Joel Miller

Do you wonder how much you should tell your therapist? What is it ok to talk about and what should you keep to yourself? Here are some guidelines.

1. The more you are able to talk about with your therapist the more likely the process is to help you.

If you feel the need to hold back on something you need to ask yourself why. Consider if this is something that might really affect your life or is it just embarrassing. You shouldn’t be embarrassed to talk with your counselor. They have probably heard it all before so they are not likely to be surprised. Their goal is, or should be, to be helpful. They can’t really help you if you won’t tell them things that are bothering you.

2. Ask them about confidentiality

When you first came to meet the counselor they should have covered the rules and the limits of confidentiality. Some things are confidential, meaning the therapist won’t tell anyone else, some things are not. When you meet your counselor for the first time there is so much on your mind that you may not have understood it all. If you signed a copy of a confidentiality policy you should have received a copy. This is a part of the “informed consent” they are supposed to do. If you have any doubts about this ask them.

There are certain things that counselors can’t keep secret. By law most counselors are required to report child abuse and the abuse of elderly or disabled people. If you have done something like that or know about someone who was abused, the counselor can help you by working on the reasons you acted that way. They should try to help you change. They can help you with the process of admitting what happened and helping the victim get treatment. If you were the victim of abuse when you were a child most counselors will not have to report that unless the abuser is still around and might be abusing someone else.

My suggestion to you is to ask the counselor about their procedures before you tell them something you might regret. This will give them a chance to explain the rules of their profession and the laws in their jurisdiction. Consider that even if there are consequences to you for telling it still may be worth doing. They say we are only as sick as our secrets.

If you are suicidal counselors are supposed to report this. Not to hurt you or take away your will but to try to save your life. Most times the client will report afterwards that they were glad someone cared enough to prevent their suicide.

In most places the relationship between a patient and their therapist is protected by law. So outside of specific things they must report like child abuse, therapists are not supposed to disclose other things you talk about. They are not police investigators and they don’t have to report most crimes.

3. How much do you trust them?

The whole process of therapy depends on the trust between you and your counselor. Despite all the laws requiring therapists to keep things confidential some people are not trustworthy. If you don’t feel you can trust your therapist- don’t tell them your secrets until you have resolved that issue. Now some of you have “trust issues.” You have trouble trusting anyone. Working with a counselor to learn to be more trusting should help that. So start by telling the counselor a small thing and see how that feels. You can work on the bigger things later on.

When I first started in this field I went to see a therapist. We are all supposed to have that experience if we want to understand how it feels for the client. The therapist should also work out their own issues in their own therapy not in sessions with clients. I asked the therapist I was seeing if what we talked about was confidential. Their response was to ask me what I meant by confidential. They never did answer my question. So I avoided talking to that therapist about anything which might reflect on my future career. The lesson I learned was that if my therapist would not give me a straight answer about my questions I did not feel like trusting them. I make an effort to never do that to one of my clients.

P. S. I did eventually find someone I did trust to talk to about those issues and everything worked out just fine.

4. What is the consequence of this getting out?

If you might be embarrassed by a revelation say that you had a crush on some movie star when you were eight, even if the therapist did slip and tell your family you might be embarrassed, you might never trust that counselor again, but your life should not be ruined. If you cheated on your taxes or your wife and now feel guilty, having that reveled might be life changing. Think long about telling your therapist where you buried the body unless you need them to help you confess that to the police and clear your soul. While therapists are not supposed to violate confidentiality and tell about clients past crimes sometimes it happens. When this happens the therapist loses their license and the client gets to feel really happy about that the whole time they are in prison. Neither of those outcomes is what therapy is supposed to be about.

The point of requiring therapist to keep clients secrets and to tell them up front what will and won’t be kept secret is to make it possible for them to discuss their problems without fear of reading about their issues in the local paper. Without that level of trust most therapy would not be helpful. This is similar to doctor-patient or lawyer-client privilege.

5. Who do they work for?

If you want your counselor to keep the secrets you tell them within legal limits, then you need to hire and pay them.
If you visit a court appointed therapist or one at the school or CPS they are working for the agency that referred you. They may have a duty to tell the court, CPS or the school what they think and what you said. They should be clear about this when you go to see them but if they are not – be careful and ask about confidentiality before you “spill the beans.”

6. Do they have a no secrets policy?

Some therapists, Marriage and Family Therapists and those working with children may have a no secrets policy. When I work with a couple I don’t want to be working on saving the marriage if I know that one of the parties is having an affair. I might tell both parties that I can’t keep secrets from the other partner if we are to work on improving the relationship.

This is a big issue when we work with children. Some parents want us to find out all the kids secrets. This does not work. After we tell the parent the first secret the child decides to never be honest again. This may require some balancing.

If an eight year old tells me they snuck a sip of dad’s beer or took some cigarette from a store and tried one, I don’t feel the need to tell the parent. I want to find out why the kid is doing this and work on that issue. What if the kids is injecting heroin in his arm? I think I should tell the parent that. So if it is life threatening I will tell the parent. I have covered this policy when I first start seeing the kid so he knows if it is life threatening or really scary stuff I plan to help him tell his parent but I can’t keep that secret. I do say that little stuff, the kind of stuff most kids do. That can stay just between us.

So there you have some guidelines for what to share with your counselor and when. Hope that was helpful.

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For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog there is also a Facebook authors page, in its infancy, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. Thanks to all who read this blog.

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41 thoughts on “How much should you tell a therapist?

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  6. what if you tell your therapist that you want to be admitted …. what would happen then? and if your young like i am (14) would your parents know?

    • Your comment raises some really important questions. Who goes to the hospital and why? What are the rights of a minor in treatment and can you expect confidentiality or will the therapist tell your parents? Sometimes a person under 18 can seek their own treatment and sometimes they need their parents’ permission. Since I don’t know you, your parents or your therapist I can’t give you specific advice or treatment. I think your questions will interest others also so over the next few days I want to post some things on this topic. Since you are currently seeing a therapist I suggest you discuss the issue of what they will tell your parents and what they can keep confidential with your therapist. But if this is an emergency, if there is any chance you would hurt yourself or others I would urge you to tell the therapist and let them help you and then let them help you with your parents afterwards. Watch for my first post on hospitalization coming soon.

  7. i will be 18 soon, like, in a couple weeks, so disregard my current state as a minor. will my therapist have to report any of the following if he is informed once i am a legal adult?
    – past sexual abuse (during teenage years)
    -self injury addiction (without suicidal intent)
    -any drug or alcohol use?
    thank you very much! (i live in ohio, BTW. we have most of the ACA rules are actually laws here.)

    • Some general answers here. I am not up on laws in your state. One major factor is who is paying for your therapy and why you were referred. If it is court ordered then probably the drug abuse or results of any tests will be reportable. You should be asked to sign informed consent and releases when you turn 18 if you have not done so already. You should probably ask the counselor to explain the rules of confidentiality and how they have changed since you are now 18 before you go any further.
      Generally past abuse is not reportable if you are an adult when the counselor learns about it. The exception to that would be if you know of other minors that same person is abusing. Then that abuse of other minors will get reported. Counselors are mandated reporters in most places. The client is not. Clients or private citizens can make anonymous reports in most places; a mandated reporter is not allowed to make an anonymous report. They need the proof they did what the law required.
      Insurance companies need the diagnosis for payment. So they might get something like 309.81 Post-traumatic Stress disorder 305.20 Alcohol abuse. That’s all the details they normally get.
      I do not know of any place where non suicidal self-injury is reportable unless the injury requires emergency medical treatment. If you are bleeding to death the counselor will call an ambulance to keep you from dying, that is about the only thing they are likely to do.
      If you are in a drug and alcohol treatment program voluntarily you get an even higher level of confidentiality under 42 CFR than a mental health client gets under HIPPA (45 CFR) unless you were court ordered to the drug treatment.
      When in doubt ask the counselor to explain confidentiality. If they can’t or won’t explain it to make you feel comfortable consider looking for another counselor. Hope that helps.

    • Maybe yes. Maybe no. Counseling and psychotherapy is all about the relationship. Once a counselor reveals something about a client to someone else that relationships is probably damaged, maybe irretrievably. The professional should have told you at the beginning of counseling what they would tell and not tell. Personally, whenever possible, I would discuss the issue with the client before I made that call. Sometimes I even encourage to client to make the call to law enforcement or Child protective services themselves and I sit by while they make the call or have them listen while I make the call so they know exactly what I said.
      Reasons why a counselor would disclose something to someone else and not tell the client would include a potentially dangerous client. If they plan to go home and kill someone I would first try to talk them out of this. If that does not work I might wait for them to leave the office and then make the required and permitted warnings to the intended victim and law enforcement. If a child victim is involved I might also not tell the client to try to protect the child.
      Here in the U. S. potential terrorists do not get confidentiality under the patriot act and we are not allowed to tell the client that homeland security came around to ask about them. I do not know if this has ever happened as I don’t think terrorists go for therapy very often.
      Past crimes do not get reported unless child abuse was involved.
      The sticky area is minors who tell the counselor something and then the parent wants to know. Parents can get awfully demanding, wanting to know what their child says and the laws can get extremely complicated. I prefer to have a discussion with the child, the parent and me all in the room together before we ever start therapy. That way we all know up front what will be told and not told to the parents. This still does not keep the child from trying to tell me something and asking I keep it a secret from the parent or the parent changing their mind and demanding to know something.
      Most common parent questions are 1. Are they having sex? 2. Are they doing drugs? If the parent is asking the chances are the answer is yes and so a better question is what we should be doing about this activity.
      Hope that helps you. The laws and customs in your area may be different. Ask your counselor for more clarification if you are not sure.

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  10. I am 15 and i live in Indiana. I have a history of alcohol use, self-harm, a violent past that nobody knows, and suicidal thoughts. Would i be able to talk to a therapist without them telling my parents anything? Like not even telling them that i went there?

    • With that list of problems Charlie I strongly believe that you need to seek help. Without help those problems will only get worse. With counseling it is very possible for you to live a happy positive life.
      I am not sure about the laws in your state. You would have to ask a lawyer or counselor in your state about that. Another question that comes to mind is your parents. Do they care? Would they care if they knew? A counselor might be able to help you tell them and set up treatment that they could agree to.
      If you have been abused in any way that will get reported to the authorities in most any place I know of. If you are currently suicidal then any professional will follow the procedures for notifying authorities in your area. Those authorities will have to talk to your parent.
      In some places you could talk to the professional without telling your parents but then you need to pay for the counseling or see someone that will do it for no fee. At 15 the standard for you consenting will probably be very high. You need to think you are in danger, but then they will need to do anything and everything to protect you.
      That past violence stuff does not need to come out until your get a working relationship with the counselor established unless you have been the victim of the violence and the person who did it was an adult.
      I can’t do counseling over the internet but I would urge you to find an adult you can trust and talk to. That might be a school counselor, teacher, religious person or even someone at a boys club or mentoring program. You might also be able to walk into Children’s mental health or a mental health clinic in your area. Also check your local listings, there should be a local A.A. or N.A meeting and some of those meeting have a teens or young people’s meeting. If you are old enough to drink or use then you are old enough to go to meetings.
      Please keep looking for help because I can promise you that it can get better.
      If there are any readers in Indiana who can hook this kid up, please leave a comment with suggestions or numbers he can call.

      • Thank you for the advice. And im afraid my parents would treat me differently if they knew and i dont want the way they treat me to change. I havent been abused in any way. The violent past was with teenagers when i visited Illinois for 3 months. It’s all said and done now. My school counselor tell parents everything in a situation so I’m crossing that off my list of where to turn to for help. And thank you again for the help. Very much appreciated.

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    • Rules may vary from place to place but generally the answer would be no. What you may be talking about is deliberate self-injury sometimes called cutting. I have had clients who rage all the way from scratching their arm with a paper clip to serious deep cuts all over there body. Most cutting comes from deep emotional pain not a desire to die or really harm themselves. Unfortunately some people who cut get carried away and cut to deep and could bleed to death or get infected. Sometimes people who cut also become suicidal and that has to be reported. A good counselor should want to know a lot more about why and how risky this is before deciding if this meets a criteria for being reported. This gets problematic if the self-harming person is under 18. Then the counselor may want to put a plan in place to keep the person safe and therefore will need to tell the parent or parent. Also some kids, but not all, who cut are being abused or neglected in some way. That abuse or neglect is reportable if the victim is a child, senior or a disabled person.
      Some people think that counselors should report or try to stop any dangerous behavior. Doing drugs or driving drunk is risky behavior. So is unprotected sex. Most of the time counselors try to help the client through the pain but do not report the behavior unless there is a legal mandate to do so. If in doubt ask the counselor what things they have to report and what is confidential. Remember also that if you pay there is more of a relationship. School counselors may have to report more things than those in private practice.
      I hope that helps a little. I encourage you talk this through with a professional who is willing to help you with whatever your problems are.

  12. So a not so friend of mine had sex with a minor, my daughter. He was 24, she was 16. It has been 2 years since I last heard from him and he asks me if he can talk about this to a therapist. He was a close friend of mine and I care about him. I encorage him to seek help and my daughter and I did not and still do not want to press charges. So my question is this, will his thrapist report him for this crime?

    • Laws vary a lot so I can not be sure about the laws in your area but here is the basic idea. Counselors do not report crimes. If we did not one would be able to tell us much of anything and then we could not help people who have done something wrong in the past change. We do report child sexual abuse. While sex with a 16 year old is a crime (statutory rape) in most places it is not child sexual abuse. A 16 year old is supposed to know enough about sex to be able to say yes or no. Child sexual abuse laws, as I understand them are meant to protect the weaker from the predator. So in Californian we have some extra protection for children when the “perpetrator” is at lest ten years older than the “victim.” Children under 14 get extra protection.15-16 year old get a all little less protection and over 16 get less protection yet. The only exception to that would be any age retarded or disable person may get extra protection.
      FYI laws in some places are different depending on the sex act. Vaginal intercourse is less likely to be reportable child abuse than anal or oral. As a counselor I don’t need those details unless this is sounding like reportable child abuse. This is not sounding like reportable child sexual abuse to me but it could be a crime (statutory rape) if someone wanted to press charges. Not sure it that answered your question but for more details you need to ask someone in your legal jurisdictional, a lawyer or therapist.

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  14. Hi,
    I was recently reading about OCD and sexual thoughts. If a person was experiencing obesssive thoughts that they will act out sexually towards a child, and shared that information with their therapist what would happen to them?

    Never having acted on them, and completely disgusted by them but they are still there.

    Thanks!

    • Thoughts are not acts. The therapist is prohibited by confidentiality laws from disclosing that clients thoughts to anyone else. A good therapist would want to work with the client on ways to avoid acting on those thoughts and possibly a safety plan if they become concerned they will act. Who will they call, what will they do, and so on. Lots of people struggle with thoughts for many years and never act on them. Being afraid they will act on those thoughts sounds like a good thing because they are working on controlling themselves. The point of keeping this sort of thing confidential is to allow that person to work with a therapist on reducing or controlling those thoughts. Hope that helps explain the process. If some one is having those sort of thoughts I would urge them to talk with a licensed counselor.

      • I’m a mom, I know deep down I am a good mom but I don’t think I believe it as much as I know logically. I have obsessed about being a phedophile since I was molested, and for some ungodly reason, told that “phedophiles were usually abused as children.” This to me translated to, “you will probably become one.” Even though I know that isn’t at all what they meant.

        Now that I have a child I am even more obsessed that I too will become a phedophile. I know I should talk to my therapist, and I do believe it would help. I am just TERRIFIED of losing my daughter. I would have no reason to live without her.

        Thank you so much for responding right away. I know I need to speak up; I’m just so scared of what I have to lose. Also just to be clear, I have never acted on them or even thought at the action, just the thought that I could. If that makes sense.

  15. In case it helps Pedophile is not the same thing as child molester. A huge number of women have been molested as children and it is extremely rare for them to go on to molest anyone. A counselor can talk you through all of this. Absolutely you should talk with a counselor and unless you act on those urges there is no reason for the counselor to report anything. Best wishes on getting over your past and your fears.

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  17. I’m 15 and I live in Alabama. I want to go to therapy to deal with sexual abuse that I suffered when I was young. The perpetrator is not a danger to anyone else now. I do not want to report this to police, but I do want to work through it. My parents know everything, by the way.
    Thank you so much!

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  19. This is something that I’ve been curious for awhile. I saw my previous therapist during most of my childhood. He, I believe was a family therapist, and there seemed to be zero confidentiality between us. I don’t even remember this man telling me that there was a law for confidentiality between patients and their therapists. At the end of each and everything session my family would be called in, sometimes I was told to manual do this and once everyone was seated he would proceed to tell them everything that was said between us! I didn’t like this and I was lead to believe that this was how all therapy sessions were. I didn’t find out about the law until about the last or second to last year of me seeing this man. Besides this, there were many times where he tricked me into saying things and accused me of terrible things like me and my friends being drug addicts, which wasn’t true, and me accidentally telling him that I was suicidal in the past. He tricked me into saying that las bit because 1. I felt that I wouldn’t get the diagnoses I believed I had at the time and 2. because he promised that it would stay between us. However, I soon as I told him he did a 360 and told me that because I was a minor at the time that because of the law he HAD to tell my family. I panicked and desperately tried to get him to understand that he had misunderstood. He tend told me that he wouldn’t tell them, but I was betrayed again because as soon as they were brought in he told them and as well as told other lies on me. I am wondering if what he did was illegal.

    • Complicated situation and this deserves a full answer. Unfortunately in the space and time I have it will have to be a brief one. The legality is an issue for a lawyer. Your description does not sound like the process was as helpful for you as it should have been. One factor to consider is the age you were at the time. The younger the child the less the child will understand the whole issue of confidentiality. One thing this therapist should have been doing is helping you be able to express your feeling and what was going on with your parents. This should not be done as prying out the secrets and telling them but as helping you feel confident to tell your parents how severe your problems really were. He may have explained the requirements of confidentiality and what he was required to report to your parents but that information was not passed on to you, or if it was you did not catch the significance of this. The sick person in the hospital does not usually understand what the doctor is trying to explain. The circumstances also would depend on what the therapist thought your “diagnosis” was. Someone will severe impairment may need a different approach than someone who is bright and high functioning. You sound older now and wiser. I hope that you do not let a bad past experience deter you from using counseling or any other form of help for your emotional problems. Now that you know more make sure to ask more questions upfront and if you do not feel comfortable adjust your behavior accordingly. Hope that helped answer your question and thanks for sharing your comment with the rest of us.

      • I’m a minor, 15 in New Jersey. I regularly talk to the counsellor in my High School about my life and what not. If I tell her about PAST experimentation with prescription drugs does she have to report? What if I tell her I have no intentions of moving forward with taking drugs? Which I don’t. I don’t want any problems whatsoever but I want to get it of my chest. By law must she divulge this information to my parents? What about to authorities? It is considered theft I guess. I’m a honor roll, intelligent charismatic kid and I really don’t need problems over things I tried. Thank you.

      • You probably need to ask the counselor you are seeing what things they will tell your family and what things they will keep confidential. Many school counselors here in California are not licensed and while they had some training in law and ethics their requirements are different from those of a licensed Therapist or Licensed Counselor. They may have the added duty to tell the school administration if things you did in the past could involve other students or activities on school grounds or on the way to or from school. I have no idea about the laws in your state. The school counselor may also have a requirement to tell your parents certain things. Ask first in a general way and if you are uncomfortable with the answer find a person you can trust to talk this through. At your age you probably need your parent’s permission to see and outside therapist. If you have a religious faith consider talking to someone in your faith or telling God (or your higher power) about this and see if that is enough to clear your need to tell. Hope that helps.

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  23. What about a therapist telling a client something they should not have. This was not what I wanted to here. It looks like there’s a trend towards therapists disclosing more but some things are just way too much to hear.

    • Not sure what you are referring to here. This might depend on whether this information was about them or about you. If all therapists did was listen, then you could get that advantage from talking to a dog or cat. We should model health behavior and it is not health to have someone who always agrees with you about everything so sometimes we need to let you know that not everyone would agree with what you are saying.
      I think counselors need to give people feedback. Unfortunately sometimes we have to tell clients things that they do not want to hear. Say they are telling us about doing something and we tell them that as long as they keep up that behavior they will not get their children back from Child Protective Services. If your therapist has talked about something that made you feel uncomfortable then talk with them about this and see if this is something they shared trying to be helpful or if this is something they really feel you need to face. Hope everything works out for you.

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