By David Joel Miller.
Just how confidential is confidentiality.
Just what is confidential and what is not is a major concern to clients in mental health treatment. I have written several posts in the past on this subject but from the number of searches on this subject, we need to talk some more about this. Links to some of the past posts are at the end of this post.
Confidentiality and its cousin privilege, are legal as well as ethical concepts. Laws can vary greatly from place to place. Check in the jurisdiction you live in and ask the person you are seeing if you have concerns about this.
We spend a lot of time on these issues in graduate school. We are supposed to explain this to clients when we first see them. Beginning counselors tend to spend a lot of time telling new clients more than most clients want to know. After a few years of doing therapy, the amount the client gets told declines and sometimes slips below the minimum the client needs. If your provider has said less than you need to know please ask.
Please remember I am talking about this from a counselor’s point of view, how we try to meet our legal and ethical responsibilities in practice. For the law in this, you should consult a lawyer.
Here are the general rules.
Everything you tell your therapist-counselor is confidential UNLESS it falls into a required or permitted exception.
1. Danger to self is reportable.
If you are eminently suicidal we can break confidentiality to keep the client alive. We are supposed to do this whether we want to or not. In practice, it is a judgment call whether the client has thoughts but does not intend to carry through or if they plan to kill themselves soon. Our response may vary depending on the circumstances.
2. Danger to others gets reported.
If you say you intend to kill someone in the future this gets reported. Past crimes are generally not reportable unless they fall under one of the other exceptions. Throwing a book at your sister is not a danger to others.
3. Child abuse, abuse of an elderly or disabled person needs reporting.
Generally, all abuse of a child gets reported if the provider has a reason to suspect the child is being abused. The counselor is not responsible for investigating, only to report to authorities. Someone who murdered a child would have committed child abuse and this past crime could be a mandated report in some places.
4. If the counselor needs to consult with another professional.
In this case, they tell the minimum they need to get the answers they need. They might talk to another professional about your treatment, to a lawyer about what is reportable or to a billing person. They can “use” the information you give them to help in your treatment and their getting paid for providing it, but they are not supposed to “disclose” that information to people who do not need to know. Counselors sometimes call their lawyers to find out what they need to keep confidential and what they need to disclose.
5. If you are Gravely Disabled they need to report to get you help.
If the client can’t feed themselves or use clothing and shelter the counselor needs to call someone and get this person help.
6. You sue your counselor and they can talk about treating you.
If you sue your counselor for doing a bad job they get to introduce your records and prove what you said and why they did what they did.
7. If you introduce your mental status into a court proceeding they will be required to tell things.
Once you use your mental illness as a defense in court for something you are charged with all your mental health records may come out.
8. You are not the client and are not paying for the counseling.
If you are sent for a court-ordered examination, a child protective service interview or other assessment paid for by someone else you will probably be asked to sign a release of information so that the person paying for the services can see what happened.
No release and there will be no treatment. Once you sign that release the person who is paying or who ordered the assessment and or treatment gets reports. You can revoke this sometimes, but not all the time, and what has been disclosed cannot, of course, be taken back and remade confidential.
9. You are a collateral person in a session.
If you go with your partner or child and they are the person being treated you may not be getting any confidentiality on what you say. You should ask about this before you stay things and then want them kept secret.
10. A court subpoenas your records.
This gets problematic. The counselor or therapist will try to keep some things confidential by asserting privilege but that is up to the lawyers and the judge. If this is a worry to you talk to your lawyer before you see the counselor and see if there is a chance this will come up in court.
One last thought. There are some clients who come for therapy and talk extensively about how guilty they feel about past crimes and how they want to change. They don’t usually give all the details of the crimes. There are others who seem to want to brag about what great criminals they are and they don’t want to change. The ones who don’t want to change frequently say things that end up needing to be disclosed.
Facing the things you have done wrong and trying to change is a huge part of recovery.
- Why the therapist doesn’t care about your problems- unit of treatment (counselorssoapbox.com)
- Must psychologist report patient planning a crime (counselorssoapbox.com)
- How does my therapist know?
- How much should I tell a therapist?
- Do therapists have to report a crime?
- Abuse of seniors
Staying connected with David Joel Miller
Two David Joel Miller Books are available now!
You can recover. Your cruising along the road of life and then wham, something knocks you in the ditch. If you have gone through a divorce, break up, or lost a job your life may have gotten off track. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.
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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 or my Facebook author’s page, David Joel Miller. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.