Therapy is built on trust. People visit therapists, counselors, and psychiatrists to discuss their deepest emotions, anxieties, and life struggles, often believing that whatever they say will remain confidential. After all, confidentiality is one of the core principles of therapy. But there are some situations where therapists are legally required to break that confidentiality, especially when a person’s safety is at risk. This article explores when and why therapists have to disclose threats, the laws surrounding these disclosures, and what it means for both clients and therapists.
What is Therapist Confidentiality?
Therapist confidentiality refers to the professional obligation of mental health practitioners to keep the information shared by clients private. This duty is critical for building a trusting therapeutic relationship. When clients feel safe that what they say will remain confidential, they are more likely to open up about sensitive or troubling issues.
Confidentiality covers everything a client discloses in therapy sessions, including personal experiences, feelings, thoughts, and behaviors. In addition to verbal discussions, it also extends to any notes or records kept by the therapist, including appointment times and treatment plans.
However, therapist confidentiality is not absolute. There are some situations where therapists are required to break confidentiality for legal or ethical reasons. This leads us to the question: when does a therapist have to disclose threats?
Situations Where Therapists Must Break Confidentiality
While most conversations with a therapist are private, there are some circumstances where confidentiality must be broken by law. These are typically cases where there is a risk of harm to the client, others, or both. Let’s explore the most common scenarios that require therapists to disclose confidential information.
1. Threats to Harm Others
One of the most important exceptions to therapist confidentiality involves threats to harm others. If a client tells a therapist that they plan to hurt someone else, the therapist has a legal duty to act. This is often referred to as the “duty to warn” or the “duty to protect.”
The landmark case that established this legal obligation is the Tarasoff v. Regents of the University of California case from the 1970s. In this case, a man disclosed to his therapist that he intended to kill a woman. The therapist reported this to the police, but the police did not take further action. Unfortunately, the man carried out his threat and killed the woman. The court ruled that the therapist had a duty to warn the intended victim, not just notify law enforcement. This case set a precedent that if a client makes a credible threat to harm someone, the therapist must take steps to protect the intended victim, even if that means breaking confidentiality.
When Does This Apply?
For therapists, the decision to break confidentiality when a client makes a threat can be complex. The threat must be specific and credible. If a client makes vague or generalized statements about wanting to hurt others but doesn’t name a specific person or express a clear plan, the therapist may not have to break confidentiality. However, if the client names a particular individual and seems serious about carrying out the threat, the therapist must act to prevent harm.
Depending on the laws in the therapist’s state, this could involve contacting law enforcement, warning the potential victim, or both. The exact steps a therapist must take can vary, but the priority is always preventing harm.
2. Threats of Self-Harm or Suicide
Therapists may also need to break confidentiality if a client expresses serious intent to harm themselves, such as in cases of suicide. Many people experience thoughts of suicide at some point, and not every mention of suicidal thoughts requires a breach of confidentiality. Therapists are trained to assess the seriousness of these thoughts and to determine when intervention is necessary.
If a client is having suicidal thoughts but does not have a specific plan or means to carry it out, a therapist may not be required to break confidentiality. However, if a client has a specific plan, time frame, and means to attempt suicide, the therapist has a duty to intervene.
What Does Intervention Look Like?
Intervention in the case of self-harm or suicidal intent could involve contacting emergency services, arranging for hospitalization, or notifying a trusted family member or friend. The goal is to ensure the client is safe and receives the care they need to prevent them from harming themselves.
Like threats to others, the decision to break confidentiality in cases of self-harm is not always clear-cut. Therapists must weigh the seriousness of the situation and make a judgment call based on their assessment of the client’s risk.
3. Abuse or Neglect of Children, Elders, or Vulnerable Adults
Another situation where therapists must break confidentiality is when they suspect or know about abuse or neglect of vulnerable individuals. This includes children, elders, and dependent adults.
In all 50 states, therapists are mandated reporters of child abuse and neglect. This means that if a therapist suspects that a child is being physically, emotionally, or sexually abused, or if a child is being neglected (for example, not receiving proper food, medical care, or supervision), the therapist is required by law to report it to child protective services.
Similarly, therapists must report suspected abuse or neglect of elders (typically those aged 65 or older) or dependent adults (people who are unable to care for themselves due to a physical or mental condition). Elder abuse can take many forms, including physical abuse, emotional abuse, financial exploitation, or neglect.
Why Are These Laws in Place?
The purpose of mandatory reporting laws is to protect vulnerable individuals who may not be able to protect themselves. While breaking confidentiality can feel like a breach of trust between therapist and client, the law prioritizes the safety and well-being of children, elders, and dependent adults over the client’s privacy in these situations.
4. Court Orders
Therapists are also required to break confidentiality if they receive a court order demanding that they release client information. This usually happens in legal cases where a person’s mental health is relevant to the proceedings, such as child custody cases, criminal trials, or lawsuits involving emotional distress.
Therapists generally try to avoid sharing sensitive information in court, but if a judge orders them to testify or turn over records, they have no choice but to comply. Failure to do so can result in legal consequences for the therapist.
5. National Security Investigations
Although it’s a rare situation, therapists may be required to break confidentiality in the case of national security investigations. If a federal agency requests client information as part of a national security investigation, the therapist must provide it, even without the client’s consent. In these cases, the therapist is also prohibited from informing the client that their information has been shared.
What Happens After Confidentiality is Broken?
When a therapist is forced to break confidentiality, it can be a difficult experience for both the therapist and the client. Therapists are trained to handle these situations with care and professionalism, but it’s important for clients to understand that these exceptions exist for their safety and the safety of others.
Client’s Reaction
Clients may feel betrayed or angry if they find out that their therapist has broken confidentiality. It’s natural to feel this way, especially if the client wasn’t expecting it. That’s why therapists often explain the limits of confidentiality during the initial sessions, so clients know from the start that their safety takes priority over privacy in extreme cases.
Therapist’s Responsibility
When breaking confidentiality, therapists are expected to:
- Share only the minimum necessary information to resolve the issue.
- Report to the appropriate authorities (e.g., law enforcement, child protective services).
- Document the situation thoroughly in the client’s records, including details about the decision to break confidentiality and any steps taken.
Conclusion: A Balance Between Confidentiality and Safety
Therapist confidentiality is one of the most important principles in therapy, providing clients with a safe space to express themselves. However, there are situations where the therapist’s responsibility to protect the client or others from harm outweighs the need for privacy. These exceptions include threats to others, threats of self-harm, abuse or neglect of vulnerable individuals, and legal obligations like court orders or national security investigations.
For clients, it’s essential to understand that these exceptions exist and that therapists will only break confidentiality when absolutely necessary. For therapists, balancing the ethical duty of confidentiality with the legal obligation to protect can be challenging, but ultimately, these laws are designed to prevent harm and ensure safety.
Understanding when and why a therapist may have to break confidentiality can help both clients and therapists navigate these difficult situations with greater clarity and compassion.