Trust is a key part of any relationship between a therapist and a client, and confidentiality helps to build that trust. However, there are times when keeping confidentiality can potentially harm the client and those around them.
But when can a therapist break confidentiality?
There are very few scenarios in which a therapist can legally break confidentiality. For the most part, everything that occurs in a session must remain private. However, there are limited situations when breaking confidentiality is not only expected but a legal obligation.
When Can A Therapist Break Confidentiality?
Confidentiality is key to establishing the bond between a therapist and a client. It reassures the client that they can speak openly and can share emotions and thoughts they might not want others to know.
Without confidentiality, vulnerable clients might not feel safe talking honestly to a therapist.
However, there are times when confidentiality needs to be broken. These occasions are rare, and no therapist should take the decision to break confidentiality lightly.
Confidentiality can primarily be broken when the client appears to be at risk, or pose a risk to others.
When The Client Poses A Risk To Themselves
If a client seems likely to harm themselves, you might be expected to break confidentiality so the client can receive correct care. It’s important to note that simply expressing suicidal thoughts isn’t enough to compel a break in confidentiality.
The client must intend to act on their thoughts and have a suicide plan.
When The Client Poses A Risk To Others
A therapist can typically break confidentiality if they believe a client is going to harm another person. Again, the client needs to have expressed an intention to cause harm.
When They Suspect A Vulnerable Person Is Being Abused
If a therapist suspects a vulnerable person, such as a child or a disabled person, is being abused, they can break confidentiality. A therapist is considered a mandated reporter in many states, and they’re required to report suspected abuse.
When The Therapist Receives A Qualifying Court Order
The law tends to be in favor of keeping confidentiality, but on rare occasions, you might be required to break confidentiality in court.
When Billing Requires Disclosure
This typically applies to clients seeking therapy on insurance. Some insurance providers require a diagnosis and other health information before they’ll authorize payment.
When Sharing Is Necessary To Receive Correct Treatment
Although you try to do your best for each client, there will be occasions when you aren’t the right person to provide treatment.
If it’s necessary to provide a client with the help they need, it’s generally considered acceptable to break confidentiality. In some of these situations, you’ll be able to discuss this with the client first.
When The Client Request The Therapist Shares Information
Sometimes, a client will ask you to break confidentiality. There are many reasons why a client might want this, but it’s important to remember you are only allowed to share the specific information the client requests.
A client asking you to break confidentiality once doesn’t mean all previous and future sessions are outside confidentiality.
When Does A Therapist Have To Break Confidentiality?
Essentially, a therapist has to break confidentiality when they believe not doing so might be putting someone in danger. If the client might hurt themselves or others, then a therapist is expected to break confidentiality.
In this scenario, it’s assumed that the client has not permitted a break in confidentiality.
It’s important to note that confidentiality agreements are defined by state law, not federal law. The exact laws differ depending on where you practice. It’s important to double-check the laws of the state in which you’re licensed.
Some states will require a breach of confidentiality in certain circumstances, while others will only allow it. Know what your state expects before you act. A therapist is always required to break confidentiality when the client is the subject of a national security investigation.
This is a federal law, and any therapist is legally obligated to comply. In this scenario, you are not allowed to inform the client that you have broken confidentiality.
Ethical Standards And Confidentiality
The reasons we’ve listed above cover when a therapist must break confidentiality, as defined by state law. The details of when a therapist can break confidentiality vary from state to state, but the general rule is that when a person is in danger, a client can break confidentiality.
In these scenarios, breaking confidentiality is a legal obligation. However, there are times when you might not be legally required to break confidentiality, but you feel compelled to do so anyway.
Ethical standards direct you to maintain confidentiality unless legally obligated to do otherwise. You should always think twice before breaking confidentiality, as there are many gray areas.
For example, it can be difficult to determine exactly when suicidal thoughts become suicidal intentions. Making the wrong call could have serious ramifications for you and the client.
How To Break Confidentiality
If you are obligated to break confidentiality, the situation must be approached carefully.
Share the information with only the people that need to know. You want to involve as few people as possible. You also want to share as little as possible. Only discuss absolutely relevant information.
If possible, you should inform the client of your actions after the fact.
Breaking confidentiality isn’t a free-for-all. Share as little as possible with as few people as possible.
Discussing Confidentiality With A Client
The best time to discuss confidentiality is when you first start working with a client. Be clear about what the rules are, when you might be required to report information, and how you would go about doing so.
Reaffirm that confidentiality is important to you, and that all conversations are private unless it’s legally necessary to act otherwise.
Final Thoughts
Breaking confidentiality is never an easy decision, and you should think carefully before sharing any private client information. Be upfront with clients about your legal obligations when you first start the relationship, to avoid difficult conversations at a future date.
Finally, familiarize yourself with state laws, so you know what’s expected of you.