Therapy is where you can share your deepest, darkest secrets, fears and vulnerabilities with the expectation that you won’t be judged and what you say won’t be shared. In fact, that’s the whole point of the whole process.
“Psychologists must abide by a professional code of ethics to protect the confidentiality of information pertaining to their clients,” said Karaine Sanders, a licensed clinical psychologist in White Plains, New York, who added that this is set in place to guarantee that no information will be released outside of a client’s session without their consent to do so.
However, there are some specific situations when mental health professionals are legally obligated to report something that a client does or says during a therapy session.
“I like to tell my clients that therapy is kind of, ‘What happens in Vegas stays in Vegas.’ What happens in therapy, stays in therapy ― unless a client is a danger to self or others,” explained Kisha Walwyn-Duquesnay, a licensed professional counselor supervisor at and owner of the Optimistic Counseling Practice in Houston, Texas.
Therapists are held to very high ethical standards by their governing state board and a violation of those ethics could result in fines, loss of licensure, or even jail time, said Walwyn-Duqesnay. While each state has its own set of guidelines and regulations on what its mental health professionals are required to report, there are common themes that transcend across the country.
Here are some instances in which a therapist would be legally obligated to break a patient/client confidentiality clause and report on what they’ve heard in a session.
If A Person Is A Danger To Themselves
If you’ve made statements that make your therapist worried that you’re going to inflict serious harm upon yourself ― especially suicide ― they may need to take action for your own well-being.
“If a client informs the therapist that they have a plan to harm himself or herself, the therapist is required to break confidentiality and either initiate a 5150 [an involuntary psychiatric commitment] or notify someone who can keep the client safe,” explained Saniyyah Mayo, a licensed marriage and family therapist in Los Angeles.
Safety concerns also apply to young children who attend sessions.
“I work with kids. If they are concerned for their safety or the safety of someone else, we talk to the parent together and plan for safety. If there are concerns about whether or not the child can still stay safe, we discuss hospitalization,” said Ashley Menke, owner of Allied Counseling in Saint Louis, Missouri.
If A Person Is A Threat To Someone Else
A therapist may be forced to report information disclosed by the patient if a patient reveals their intent to harm someone else. However, this is not as simple as a patient saying simply they “would like to kill someone,” according to Jessica Nicolosi, a clinical psychologist in Rockland County, New York. There has to be intent plus a specific identifiable party who may be threatened.
“I cannot break confidentiality if my patient says they want to punch, hit or kill someone. I can, however ― and should ― report when a patient states he or she has thoughts of harming John Doe, has a plan and intends to carry it out,” she said, noting that all three elements must be there in order for her to have to take action.
Judi Cinéas, a psychotherapist in Palm Beach, Florida, added that this also includes an intent to harm to a group of people, like in the case of a mass shooting.
“Threats have escalated to where mass casualty situations are a reality … before a general threat to do harm that did not have a specified target may not have been seen as an imminent threat,” Cinéas said. “If a therapist is aware or believes that someone is going to do something like that, they will need to report. This would also extend to secondary reporting in the case of a client [saying] they are aware that someone else is planning something.”
In these instances, the warning must typically be given to the intended victim, the intended victim’s family and friends as well as law enforcement, added David Reischer, an attorney and CEO of LegalAdvice.com.
Abuse Of A Child Or Elder
Cinéas said a therapist may have to step in and report a situation when vulnerable people are threatened, which could include children, elderly individuals and those living with a disability.
“A clear case of abuse of any of the above should be reported to protective services,” she said.
In the case of suspected child abuse, therapists must file a report if they have “reasonable suspicion” about child abuse.
“If a patient discloses that they are engaging in those behaviors, I am required to contact Child Protective Services or Adult Protective Services,” Nicolosi said.
And if a client is or was a victim of abuse and discloses their abuser, that could get reported as well under circumstances.
“If a client experienced child abuse but is now 18 years of age then the therapist is not required to make a child abuse report, unless the abuser is currently abusing other minors,” Mayo said.
“We must also report elder abuse ― age 65-plus ― and abuse to dependent adults, [which is] adults age 18 to 64 who cannot carry out their normal activities or protect their own rights because of physical or mental health issues,” Beck added.
This includes anything from physical abuse to abandonment, abduction, isolation, financial abuse and neglect.
Know That Most Things Stay Confidential
“Clients should not withhold anything from their therapist, because the therapist is only obligated to report situations in which they feel that another individual, whether it be the client or someone else, is at risk,” said Sophia Reed, a nationally certified counselor and transformation coach.
Most situations will stay under wraps. For instance, Reed noted that even if a wife is cheating on her husband and they are going through a divorce, the therapist has no legal obligation whatsoever to disclose that information in court.
The last thing a therapist wants to do is defy their patient’s trust. Reporting something that was said in a session is only done in the event that they truly think that an individual is in danger.
“Therapists’ No. 1 concern for clients is safety,” said Walwyn-Duquesnay. “Not only are therapists responsible for creating a safe therapeutic environment, they also work to make sure that clients take care of themselves and the people around them on a daily basis.”
And in the event that they have to report something, they are simply doing what they are required to do by law.
“If a therapist fails to take reasonable steps to protect the intended victim from harm, he or she may be liable to the intended victim or his family if the patient acts on the threat,” Reischer said.
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