Will the Counselor, therapist, psychologist keep your secret or tell?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Keeping your secrets?
Photo courtesy of Pixabay.com

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.

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. 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.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Books are now available on Amazon, Kobo, iBooks, Barnes & Noble, and many other online stores.

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

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Does abuse of seniors and the disabled get reported?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Older people

Elderly couple.
Photo courtesy of Pixabay.com

Reporting abuse of a senior citizen or a disabled person.

Most people are well aware that child abuse and neglect get reported, but reporting abuse of other vulnerable people gets forgotten. This is a legal and an ethical question. For legal advice please consult with a lawyer or your local statue. There are lots of ifs, and’s and exceptions here. I will keep this simple.

From a California LPCC and LMFT’s point of view here are some things to think about. Every two years when we renew our licenses we have to take a refresher course on Law and Ethics, so we stay up to date and don’t forget things we are required to do. Sometimes we need to check out the fine points of the law also.

There are two types of report categories, mandatory and permitted and then there are categories of victims of abuse, children, seniors and the disabled.

Mandated Reports.

In most places, there are groups of people called “mandated reporters.” These are people who work with a vulnerable group of people, may learn about abuse or neglect and are required by law and ethical codes to report abuse and neglect.

In California, mental health professionals (LMFT’s LPCC’s, LCSW’s, etc.) are mandated reporters. In short, if we know or should know about some abuse or neglect, we have no choice, we have to make the call and report this.

This does not mean that we go around the neighborhood looking over fences for a crime. Mental health professionals are not police. We don’t report crimes and as a rule, are required to keep anything the client says confidential EXCEPT that abuse and neglect stuff.

But if while doing therapy, we are told about abuse or neglect we can’t let that go. We have to make this report.

There are some iffy areas here that can vary from place to place and are open to interpretations. Cruelty to animals and domestic violence are deplorable but most of the time this does not trigger mandatory reports. Some agencies would like to expand the number of things we have to report but if the list swells beyond what is absolutely needed it keeps people from coming to their therapist and telling them things that they need help with.

Because we have to make this report and others, we are supposed to inform our clients of the things that we must report. This along with fees and other stuff like that is called “informed consent.” You can’t very well consent if you have not been informed, can you?  Remember in most counseling settings, abuse gets reported, like it or not and neither you nor the counselor has a choice in this.

Permitted reports.

Any member of the public can report abuse at any time. Permitted reports can be anonymous. The reporting person is supposed to be kept confidential but sometimes people do things they are not supposed to do like tell the person involved who reported them.

My understanding of this is – if I am a mandated reporter, I can’t make an anonymous report. Some of my colleagues have argued with me about this. But the first thing they ask me on the phone is “are you a mandated reporter?” Once I say yes I can’t very well try to make an anonymous report. Besides if I am required to do this I want a record that I did it. It took a lot of work to get these licenses and I want to keep them.

One difference between mandated and permitted reports may be that mandated reporters have lots of protection if they make a report, whether it turns out to be true or not. We don’t investigate people. We report it once and unless we learn more down the road we are done.

People who make Permitted reports get in a lot of trouble for making too many unsubstantiated reports. In divorce cases, there is this temptation to think your ex should never be allowed to see these kids again. He cheated on you right? Cheating on a spouse is most likely not abuse of the child. If you make daily reports on your ex, pretty soon the authorities stop listening to you and they may even come after you for false reporting.

So the people who might get abused or neglected are Children, the elderly (seniors) and the disabled.

Child abuse and neglect are the most common by far.

Remember abuse is really bad stuff, not just stuff we don’t like such as strict parents. Lots of parents want their 17-year-old daughter’s 18-year-old boyfriend arrested for them having sex. That may be statutory rape, a crime, but it is not generally child sexual abuse. Counselors don’t report crimes they report abuse or neglect, which just happens to be a crime also.

If that 18-year-old boy is having sex with your eleven-year-old daughter that is pretty much child sexual abuse everywhere and that will get reported to the proper authorities in a heartbeat.

Abuse or neglect of Senior citizens and the disabled is also reported.

It is probably a mandated report if you are a mandated reporter. For sure it is here in California. These are classes of people who because of their age or disability cannot fully take care of and or protect themselves. Society steps in to take care of them.

Besides the types of abuse that apply to children, another type of abuse is common when it comes to the elderly and the disabled, financial abuse.

Now some seniors choose to have relatives live with them or give those relatives gifts. But if that other person does not care for the elderly person and bullies them or cheats them out of the money then it may be a crime. It may also be elder or disabled person abuse.

One warning here

Some people come to therapists and tell us tales of people being abused but they don’t want to get involved or make the report. All that second-hand information may not meet the criteria for a “mandated report.”  Calling a therapist to tell them about your suspicions will not help the person. The therapist can’t go out and investigate. If you think someone is being abused, you should be the one making the report.

Hope this helped to get you thinking about the problem of abuse and neglect in our society and the role of the mandated reporter and the possibility that abuse and neglect could include senior citizens and the disabled.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. 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.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. 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.

More child sexual predators?

Counseling questions

Counseling questions.
Photo courtesy of Pixabay.com

Have you lost track of the number of reports in the news of people abusing children? I know I have. One topic of discussion around the water coolers and in the media these days is the number of these reports and the number of times the thing we fear most, turns out to be true. Which makes one wonder- is there more child abuse, especially child sexual abuse, going on these days?

We are correct to distrust reports of more – or fewer predictors these days. More people being arrested does not mean more incidents. It is very likely that children have been victimized since time began, which is not to excuse it, just to say we can’t be sure there is more going on now. But the number, frequency, and severity of children being abused are beyond troubling.

With children, professionals like myself are what is called “mandated reporters” which means if we know or reasonably suspect someone is harming a child we are required to report this. From the number of adults who end up in therapy as a result of being victims of sexual abuse, it seems clear that this has been going on largely overlooked for a long time. Mostly we don’t like to think that someone who is working with children might be harming them. The stranger molester is very rare, most of the time the person harming kids is someone that is close to them and is respected by the community.

Beyond the pain of the first abuse, most adult victims will tell you the most painful part of being a victim was the number of adults who dismissed the claim or covered up for the perpetrator. I read that one child victim was punished for “making stories up” about his abuser. Years later we find out that this victim was telling the truth but was intimidated by adults into silence.

The shocking thing about so many of these reports of an adult sexually abusing a child is not just that the incidents are occurring but that the activities have gone on for so long, involved so many children and the perpetrator was allowed so much access to children. There may be some societal changes that account for this.

We live in a more anonymous society than ever before. This is the first time in the history of the world that the majority of people on earth live in large cities instead of rural communities. In the small town, there was always someone who was considered “weird” and the children were told to avoid them. This may not have protected anyone. Kids back then disappeared and things happened to them on the way home from school but we felt safer then, thinking that by avoiding certain people we were keeping kids safe. Today we have little idea who lives next door let alone on the next block.  We also know very little about public figures like the teacher, pastor or priest.

Some people think that putting lists of child predators online will help reduce children being victimized. This process has proved inefficient in practice. I was at a county fair a while back. It was a relatively small county. The local police had a map in their booth with pins showing the location of registered sex offenders. In this one small town, there was no street that did not have a pin within a block or two. The sex offenders we know about are everywhere. What about the ones we won’t know about for years to come?

There is some likelihood that in times past most predators were solitary creatures. They were afraid to let anyone know their secret. That reduced their ability to abuse children and may have limited the number of victims. You don’t share secrets in a small town where if one person found out your secret everyone might be out to get you.

There was also a lot more social disapproval of people who might be abusing a child especially sexually. There were and still are families in which child sexual abuse is a family tradition. Older relatives abuse children and the parents who were abused themselves cover it up. More than once an adult has cried while talking about their child’s victimization and then they told me they had been a victim themselves, sometimes the adult was molested by the same uncle or cousin that had now molested their child.

In addition to the reduced social disapproval, these days it has become easier for predators to find others who approve of their behavior. They are able to connect via the internet and other electronic media. Children who don’t understand victimization, we all think things won’t happen to us when we are young, put themselves in risky online situations.

The increase in pornography and sexually explicit materials makes deviant behaviors look more normal. A few years back people who wanted sexually explicit materials had to go to a particular store and buy something that was kept under the counter. By today’s standards, most of that stuff was pretty mild. Today situation comedies have more sexual content and more violence than the girly magazines used to portray. Violence and sexual content are a lot more interesting to watch most of the time than normal behavior. If you watch a lot of violence or sex it is easy to get a distorted view of reality and think that things are normal that in times past were clearly off limits.

The widespread abuse of stimulants has added to the problem of inappropriate sexual behavior, especially the increase in hypersexuality. Meth users report that under the influence they felt extreme sexual urges and participated in sexual acts that when off drugs they would never have considered. Much, but not all child sexual abuse is reported to be connected with drug abuse.

If it were possible to put aside the emotional cost of child mistreatment, which is not possible for most of us, there is still a huge monetary cost to society. According to the CDC, a single year of child abuse cost society over $200,000 in additional lifetime treatment costs. That is more than the cost of a stroke or most physical diseases. More years of abuse means more pain and more expense. We also know from studies of PTSD that the sooner someone gets treatment the less likelihood there will be a severe permanent disability. This makes the early detection and treatment of abused children all the more important.

So this blog post is running long.

The point of all this is that there may not be any more people who are having urges to sexually abuse children now than in times past. What we are seeing now are more cases involving people we all thought we could trust. There are societal factors that may be reducing the inhibitions of people who have these urges. These incidents can make us start to fear and distrust everyone. Some of these cases involve large numbers of victims and have gone on over long periods of time. Being a victim of abuse causes lifelong suffering and we as a society need to do more to prevent and treat these victims. The questions before us are how to prevent or reduce the number of these incidents and do we as a culture have the will to use resources to heal the victims?

Any thoughts on this?

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. 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.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. 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.

How much should you tell a therapist?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Whispering secret

Keeping your secrets?
Photo courtesy of Pixabay.com

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 afterward 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 into 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.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. 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.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. 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.