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Limits of Confidentiality in Counseling and Therapy: When Counselors Must Disclose
Confidentiality: Essential but not Absolute
Confidentiality is one of the cornerstones of the counseling profession. Because private counselor-client interactions facilitate stronger trust and thus, when the therapist talks to her patient under the legal and ethical protection of confidentiality, the pair develop a better therapeutic relationship—one built on trust and nonjudgmental. Professional counselors are bound by both state laws and professional codes of ethics, however. These laws and ethical codes, such as those adopted by the American Counseling Association (ACA), do limit counselor confidentiality in several limited circumstances. These laws limit confidentiality only in extreme circumstances and do so for the sole purpose of protecting the client and general public.
Abuse and Neglect of Children and Vulnerable Adults
If a minor client discloses in therapy that she is being abused or neglected, the counselor has a responsibility to breach confidentiality and contact appropriate agencies, such as child protective services or law enforcement. Generally, the counselor will first talk to the child’s parent or guardian and help involve them in the process, provided that the parent or caregiver is not the alleged perpetrator. In such instances, the counselor will work closely with child protect agencies and law enforcement to protect the child, but only share those facts necessary to the case to protect confidentiality to the greatest extent possible.
Likewise, if an adult client admits to child maltreatment or abuse or neglect of the elderly or another vulnerable person protected under the law, the counselor must also report these unlawful actions, even if the client does not consent. In such cases, the counselor may need to refer the client to another mental health professional for further counseling, since breaking confidentiality without client consent may mean an irreparable breakdown in the therapeutic relationship.
Suicide Risk or Risk of Self-Harm
In many cases, a counselor must breach confidentiality if a client poses a risk of suicide or serious harm to herself. Prior to breaking confidentiality, the counselor will generally try to resolve the issue with the client, such as asking the client to sign a no-harm contract or working with the client and his family to create a safety plan. Such safety plans usually involve a family member monitoring the client continuously and scheduling more frequent sessions. If the client does not have a strong support system, the therapist may recommend that the client voluntarily check herself in for in-patient treatment and monitoring until she is stable and no longer has urges to harm herself. In these instances, the counselor will generally work closely with hospital staff to share information and work collaboratively on a treatment plan, but generally, this type of collaboration will require client consent.
If the client cannot promise that he will not harm himself or does not have the resources to maintain his safety, the therapist must break confidentiality and seek involuntarily admission for the client in a hospital or other secure mental health facility. This may involve sharing information about the patient’s diagnosis and personal history, particularly as it relates to self-injury or suicide threats and attempts.
Harm to Others
State laws vary on whether counselors must break confidentiality if a client says that she intends to harm another person. Although ethical guidelines generally allow the counselor to breach confidentiality in such situations, some state laws do not require it. Other jurisdictions require the counselor to notify the party at risk or law enforcement, as this may be grounds for involuntarily hospitalization in some areas. Ultimately, in some states, the counselor may have the final judgment call on whether to report possible harm to others, but most will err on the side of caution, privileging public safety over confidentiality.
The most common cases in which a counselor will break confidentiality is when the client comes to therapy with a defined plan to harm a specific individual and has the intent to carry out such a plan. Feelings such as “I would like to punch someone” or “Sometimes I wish my wife was dead” will rarely lead the client to break confidentiality and contact law enforcement.
Court Orders for Counseling Records
Although laws generally respect the confidential nature of counseling, if a judge orders a counselor to testify in court, she may be required to do so or face criminal charges for contempt of court. In such instances, the counselor is only required to disclose as little as necessary to satisfy the requirements of the court. In other words, if the court case involves child custody, the counselor will not needs to discuss unrelated matters such as the client’s frustrations about his job and career path.
In instances where a client is court-ordered to comply with therapy, the counselor must generally disclose the patient’s therapeutic progress to the court or his probation officer. However, the client will be informed of this beforehand and according to the ACA Code of Ethics, has the option of declining services. If the client does choose to participate in services, the counselor will outline the limits of confidentiality before beginning therapy.
Minor Children and Adolescents
Persons under age 18 typically have limited rights to confidentiality in the counseling process. Although the counselor usually meets with the child or teen in private and will not share all of the details of the counseling session, parents or guardians have a right to know their child’s diagnosis and have updates on his therapeutic progress. Likewise, parents and legal guardians generally have the right to access their child’s confidential therapeutic records. Parents may also consent to release the child’s confidential records to third parties, such as schools. However, child therapists often provide parents and third parties with generalized information on the child’s progress toward his treatment goals. Counselors will not release every detail of what the child said during the counseling session. This, as in other cases, protects the therapeutic relationship and promotes and honest exchange of information.
Ethical Guidelines for Confidentiality in Counseling
- Ethical Principles of Psychologists and Code of Conduct
The American Psychological Association's Ethical Principles of Psychologists and Code of Conduct provides guidance for psychologists in professional, scientific and educational roles. The Ethics Code also outlines standards of professional conduct.
Code of Ethics for the American Counseling Association