Therapy and Confidentiality

What Are the Expectations of Confidentiality in Therapy?

Confidentiality plays a key role in building a therapeutic relationship. Clients, whether they are new to a particular therapist or to therapy altogether, often feel a sense of comfort in knowing that they can be honest in their sessions without having their privacy leaked to a third party. Therapist confidentiality lays the foundation for trust, which can allow the therapy to become more individualized and effective.

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For their part, therapists are trained to protect their clients’ privacy. Many countries have their own laws and regulations regarding the handling of confidentiality and reporting. The General Data Protection Regulation (GDPR) is used in Europe, and the Health Insurance Portability and Accountability Act of 1996 (HIPAA) is used in the United States. With very few exceptions, a therapist will only discuss their client with others when the client has given their written permission. This concern for client confidentiality can affect the therapist’s choices both inside and outside of the office.

Oftentimes, therapists will be mindful of confidentiality when they write up their official session notes. Genevieve David, L.C.S.W., an analytically trained psychotherapist in Australia, has worked in private practice for more than 20 years and explains that sometimes less is more: A therapist might decide not to include a client’s dreams or fantasies in their notes, for example, if they were likely to be misunderstood and cause the client unnecessary harm if exposed.

There are times when a client might encounter their therapist in “real life.” Many therapists will prepare their clients for this possibility in one of their early sessions by explaining how they will handle it. For instance, David agrees with her clients on parameters in advance: “If they're with someone or if I'm with someone, I won't greet them. I will just walk past them. But if they're on their own and I'm on my own, I will wait for them to greet me or not. We set it up that way so they know I'm not ignoring them.”

When Might a Therapist Have To Break Confidentiality?

There are a few specific and clear instances when therapists are required to report personal information about their clients:

• If the client poses a danger to themselves or others
• If the therapist suspects the abuse of a child or an elderly or otherwise dependent adult
• If they are legally forced to by court order

Most therapists will include a detailed explanation of these exceptions in their privacy policy, which the client reviews and signs before their first session. They may also mention it in conversation in one of their early sessions in case the client has any concerns about confidentiality that could prevent them from fully engaging in therapy.

Even when a therapist is compelled to break confidentiality, they are generally careful about only disclosing what is necessary to protect their client or others, and they only tell third parties who urgently need to have that information.

What About Confidentiality in the Context of Supervision?

Many therapists, whether in a group or private practice, will have a supervisor. These individuals, David says, “are supervising your work, making sure that you're on track, that you're not getting burned out, that you're not breaching anything ethically.” To do their job, they need to have some understanding of a therapist’s current clients and any problems they may be experiencing in therapy.

However, therapists err on the side of caution and reveal only as much information as they need to during supervision. They are also careful to conceal any identifying details about their clients (such as their name, age, or profession) so that supervision can still be helpful without breaking confidentiality.

How Do Therapists Present Research Without Breaking Confidentiality?

Research and writing can be another gray area, where therapists may speak publicly about a client or an amalgamation of clients they have seen to illuminate some aspect of mental health. In these cases, again, therapists will not use any identifying clues, including the client’s name, age, profession, or other specifics. This gives the effect of describing the “every client” with a mental health concern that can then be addressed professionally and generally.

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Different therapists’ approaches to research and writing can vary hugely, David clarifies, “From not asking permission to asking permission and getting the client to read what you've written and getting their input. Some therapists think it's very therapeutic, and others believe it breaks the relationship.”

Do Therapists Talk About Clients With Their Partners or Family Members?

While therapists may not openly discuss their jobs with partners or family members, it’s unrealistic to think they don’t share some aspects of their work with important people in their lives. David elaborates, “We'd all be lying if we tried to say that we never talk about our patients. It's just attending very carefully to whether we're showing off about them, what we are doing with it. Are we just needing some comfort? Are we getting a different perspective? I find that my husband’s view, a male perspective for my male patients, can be incredibly helpful.”

Overall, being able to trust in client-therapist confidentiality can make a meaningful difference in whether someone’s therapy is successful or not. If a client has any concerns, they should feel encouraged to discuss them with their therapist. Gaining a better understanding of a therapist’s perspective and approach to privacy can only benefit the therapeutic relationship.

To find a therapist near you, visit the Psychology Today Therapy Directory.