8 Reasons Therapists Have to Break Confidentiality

We trust our therapists with our deepest secrets  – But how do we know exactly what stays secret and what won’t?

In this article, you’ll learn more about the limited situations in which a therapist has to break confidentiality- from the perspective of a therapist and illustrated for easy understanding. 

A central feature of therapy is confidentiality. Therapists work hard to make sure therapy stays a private, confidential space. However, there are some rare and important exceptions that allow therapists to break confidentiality in order to keep us or a vulnerable person safe.   🚨💙

With this goal in mind, here are some specific scenarios in which therapists might break confidentiality to tell trusted others. 

When We’re Not Safe with Ourselves or Others: 

If we are having thoughts about seriously harming ourselves, therapists are legally and ethically obligated to take steps to help us stay safe.

But don’t worry, a good therapist won’t just drop a session to call an emergency number. Therapists are trained to slow things down and support us through a crisis.

If a client discloses thoughts of harming themselves, a therapist will listen, use their clinical experience to assess risks, and help us plan how to stay safe (sometimes involving outside support).

If we aren’t able to collaborate on that plan to stay safe, a therapist’s help might involve sharing information with others who can offer support. This might look like contacting a family member or helping us connect with inpatient mental health treatment. 

Harm to others: Similarly – if we express a serious intention to harm another person, therapists must act to prevent that from happening. This could mean alerting law enforcement or notifying the person at risk. (Read more about the laws about this ethical mandate, called “Duty to Warn”.)

When A Child or Elderly Person is Being Abused 

If we tell a therapist that we know of someone vulnerable being abused – a child, or an elderly person for example – then our therapist will need to follow up, seek more information, and potentially disclose some information to keep that vulnerable person safe. While not always possible, most therapists will collaborate with us when they need to file a report. 

Reporting laws vary across states in the U.S. – especially when it comes to child abuse that occurred in the past.

Because of this, it’s a good idea to ask our therapists about their legal duty to report before we disclose our own or others’ stories of past harm. If past abusers could still be harming others that increases the need for our therapists to share what we tell them .

For example, if tell my therapist that I was abused as a child and my abuser still has access to other children, my therapist may need to report my experience. This is an example of ‘mandatory reporting’ – because in this case there is a legal mandate on my therapist to protect others.  

Whenever possible, our therapist will collaborate with us when they need to file a report and in many cases will support us through making that report ourselves.

When a Therapist Breaks Confidentiality to Discuss Your Case with A Supervisor

Sometimes, therapists discuss their clients with a clinical supervisor (this is a good thing!) Good therapists often get ongoing supervision long after they are no longer required to- this can help therapy be more effective. 

Therapy supervisors and consult groups (consult groups are small groups of therapists professionally discussing cases together) are held to the same confidential and ethical standards that therapists are – so, even though some information from your therapy might be shared, they’ll avoid sharing your name and identifying details (like your exact age, where you work/go to school, unique things about you, etc). Through supervision, therapists get insight and advice to better support us. 

When We Need to Be Involuntary Hospitalized 

 (aka, when we need care and we’re too unwell to choose it for ourselves)

If a therapist determines that we are a danger to ourselves or others, and we are unwilling or unable to seek that help for ourselves, they may start the process of a temporary involuntary hospitalization. 

For most therapists, this is a rare occurrence. Long before this process begins, our therapists should be aware that we’re struggling and helping us explore, proactively, whether medication, more sessions, or a higher level of care might be helpful. (After all- the best crisis planning happens when we aren’t in crisis)

Involuntary hospitalization is rare and often arises in connection with psychiatric needs that require more support. In the US, state laws vary, but most involuntary commitments are brief, lasting 24-72 hours, and occur only when a hospital’s psychiatric staff agree with your therapist that urgent hospitalization is necessary. A study of 1.5 million American patients found that the average length of stay in a psychiatric unit (both voluntary and involuntary patients were included in this study) is just 10 days.¹ 

When Client Records Are Requested

Therapists make notes after each session that cover the treatment goals, needs, and scope of care that was provided. When these notes discuss our treatment, diagnosis, or sessions times, they become technically a medical record.

There are US laws that protect our right to access this information to review or transfer to another provider. If we request our therapists’ records they must release them in full. While therapists will sometimes discuss the contents first to ensure we understand them, accessing these records is our right and doesn’t require a court order. Learn more about Individuals’ Right under HIPAA to Access their Health Information.

If We File A Lawsuit Against Our Therapist

If we are harmed by a negligent or unprofessional therapist – we can file a lawsuit against them.

If we file a lawsuit against our therapist, confidentiality can be broken so that our therapist can defend themselves against the claims made.

In these cases, a therapist may need to release therapy notes and details about our treatment to argue their case, but only the information necessary to the lawsuit will be disclosed.

When Our Therapist Receives a Court Order 

Sometimes, a court may request a therapist’s records as part of a legal proceeding. While therapists typically fight to keep our information private, they are sometimes required by law to share our information. 

What kind of situations might result in our counseling records being released due to a court order? Here are three examples:

1. Child Custody Dispute: In a disputed child custody case, a judge might order the release of therapy records to assess the mental health and wellness of one or both parents.
2. Criminal Investigation: If a client is involved in a criminal case, a court may order the release of their medical records – including therapy – as evidence. (Although there are protections in place and avenues to legally contest this)
3. Personal Injury Lawsuit: In a lawsuit for damages (e.g., emotional distress after an accident), a judge might order the release of records to evaluate how someone’s mental health was affected by the accident. 

Even in the kind of cases listed above, therapists will release only the information necessary for the case. When courts get involved, breaking confidentially gets tricky for therapists too! Because of this, a therapist will often seek their own legal counsel to better understand the limits of confidentiality given the legal proceeding. 

How to Talk you Your Therapist about Confidentiality

Sometimes, people feel nervous that what they share in therapy might not stay private. Stories we might have heard through social media or seen fictionalized on TV can fuel these fears.

Often, people wonder:

• “Does my therapist have to report me if I tell them I think about hurting myself?”
• “What if it’s so bad I’m scared I can’t keep myself safe?” 
• or “I was abused as a child – If I tell, will my therapist have to call somebody?”

Bottomline: The best way to know what our therapist might have to share is to ask them.

There are plenty of ways to start this conversation without overexposing ourselves. We can:

• ask for a reminder of what stays confidential,
• ask directly if something is repoortable before we disclose,
• or we can phrase our curiosity in the form of a hypothetical question.  

One way to ask for a reminder of confidentiality:

An example of how to ask directly if something will stay private:

A safe way to phrase a hypothetical:

It’s ok to ask hypotheticals! Therapists aren’t out to trick us. Hypothetical questions can be an empowering way to gain information to make an informed choice. And while a therapist might be curious about your question, a hypothetical question won’t trigger a mandated report.

If we open up a conversation with our therapist about when they have to break confidentiality, they can help us understand how these trickier situations work and help us make hard decisions about what, when, and how we share complex information. 

The Long and Short of Therapy Confidentiality Breeches:

A good therapist’s goal is always to support and protect us as we grow and heal. In most cases, maintaining strict confidentiality is key to making therapy a safe and healing space where this kind of recovery can occur. In these examples of when a therapist can break confidentiality, a therapist may involve others in our mental health care – but they will always do so for our benefit and while preserving as much privacy as possible!

1. Adepoju, O. E., Kim, L. H., & Starks, S. M. (2022). Hospital Length of Stay in Patients with and without Serious and Persistent Mental Illness: Evidence of Racial and Ethnic Differences. Healthcare (Basel, Switzerland), 10(6), 1128. https://doi.org/10.3390/healthcare10061128 [↩]