A critical component of a healthy therapeutic relationship is that it be confidential. In much of our ordinary lives, we conceal our true feelings and intentions out of fear of potential consequences or judgment. However, for the work of psychotherapy to take hold, vulnerability and honesty are core prerequisites. To encourage and elicit these qualities, a therapist must—and is legally required to—ensure a private environment free from judgment or legal consequence, and is protected by the assurance of privacy.
Exceptions to Privacy
The ethical responsibility of upholding confidentiality, however, contains exceptions. If a client outlines a clear intent and plan to harm either themselves or a named other, a therapist may be required to breach confidentiality to keep these parties safe. In these instances, a therapist has an ethical mandate, or duty to “warn and protect.” This may look like informing another medical facility that a client requires inpatient support through involuntary hospitalization after articulating a clear plan to take their own life, reporting child abuse or domestic violence where a person’s physical safety is imminently at risk, or warning a named party if they are under imminent threat of physical violence.
Risks of Breaking Confidentiality
It is important, however, to understand that breaching of confidentiality is often a last resort option, since it poses several risks: (1) it can impair or otherwise destroy the therapeutic relationship, halting work that may involve addressing harmful patterns, which removes critical support (which also benefits others in that person’s life); (2) it can threaten the safety of those who may have to deal without the fallout/repercussions of an anonymous report, particularly in abuse cases, where a partner may be unable or unwilling to leave, and face retaliation.
Therefore, it is crucial when considering breaching confidentiality to conduct a thorough risk assessment and often to seek both clinical and legal consultation. A decision to break confidentiality is not to be taken lightly, and it is not a reflexive, fear-based calculation. It requires careful consideration of how different ethical mandates, which may be contradictory, weigh against each other. Ethical decision-making models are helpful in these cases.
Don’t Be Afraid to Ask Questions
If you have questions about the difference between protected disclosure and reportable behavior, it can be helpful to ask your therapist. Licensed professionals are trained to have difficult conversations about how they conceptualize and navigate sensitive issues. Even when ethical mandates become relevant, therapy should always be collaborative, and clients have a right to be involved in the process!
This blog contains the views of Alex Thomson and is intended as educational content. It is not a replacement for therapy or formalized diagnostic assessment. Read full Disclaimer.
Alex Thomson is a licensed associate professional counselor in the state of Georgia and a certified trauma professional. He provides counseling services through Exhale Counseling Services in Acworth.
