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 revealed 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 therapists 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 kid 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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