One of the most frequently asked questions about therapy is: "Will what I tell the therapist be kept private and confidential?" The answer is "yes." You have a right to expect absolute privacy and confidentiality in therapy. Without your explicit consent, the therapist is prevented by law from discussing information you share during your sessions with anyone else. Knowing and trusting that anything you say will be safely contained in the therapeutic space is essential to meaningful therapy.
In addition to maintaining absolute confidentiality, the therapist is responsible for establishing an environment that ensures your privacy in every way possible. It's important to be aware of the impact even the subtlest intrusions can have on your sense of privacy. Encountering another client in the waiting room, hearing someone speaking in the next room during your session, or having your therapist speak on the phone to another client or personal friend are all situations that could make you feel that outsiders are intruding on your therapeutic space and that there is not sufficient privacy for you to talk freely. If this should ever happen to you, tell your therapist as clearly and immediately as possible.
Are there ever instances in which the therapist does reveal what a client tells them?
There are some limitations to confidentiality in therapy. The legal system acknowledges that there are times when the client, society or both can benefit from release of information. The circumstances in which confidentiality can be breached are defined by State and Federal case law. The most common circumstances include:
If your insurance coverage pays for any of the costs of your therapy, you are giving your consent for information such as your diagnosis and appointment dates to be shared with your insurance company.
Collection of debt:
If you fail to settle an account balance for your therapeutic treatment, your name and the amount you owe can be made known to a collection agency.
Defense of malpractice or professional complaint:
If you were to allege that your therapist engaged in malpractice or some other unethical act, the therapist has the right to disclose information from your sessions in their defense of your charges.
Danger to self or others:
All states allow a therapist to reveal the name of a client who is deemed a real and present danger to self (e.g., suicide) or others. Some states even require that the therapist warn or attempt to protect the person against whom the threats are being made.
Abuse of children, elderly, or mentally or physically handicapped:
In most states a therapist is required to report credible knowledge of current or past abuse. This applies to situations in which the client is the one who was abused as well as to situations in which the client is the abuse.