Explaining Counseling Confidentiality to Clients

Counselors are professional secret keepers, meaning we are both ethically and legally bound to maintain confidentiality in counseling. 

This means we’re proficient in locking away the  information shared by our clients in sessions.

However, there are times when we may need to break counseling confidentiality. 

Therefore, it’s important we explain the limits to counseling confidentiality to new and existing clients. 

We build therapeutic alliances, which allow clients to trust us with their personal histories and struggles. We staunchly safeguard these disclosures under most conditions. 

In this article, we will discuss the importance of confidentiality in counseling, and the equally important process of notifying clients which situations would require breaking confidentiality.  

What is confidentiality in counseling?

By the time they enter an intake appointment, most of our clients have already brought up their presenting problem with someone else. They’ve hoped for help outside of counseling, but have limited what they’ve shared and how they’ve shared their problems with others.

Confidentiality in counseling is a high perk since there is no guarantee that what clients disclose to their friends, family members, or coworkers will remain private. Counselors are bound by ethical codes to protect certain client information, which increases clients’ trustworthiness towards us.

Counseling confidentiality is the apex of the client-therapist  relationship. It’s the assurance to clients that what they share during counseling remains between us and them. We promise to keep their identities private, stay away from gossiping about their problems outside of sessions, and avoid initiating conversation with them in the public sphere. We allow clients to disclose sensitive matters without fear of repercussions.

Every licensed provider who offers counseling must adhere to counselor confidentiality laws, which are set forth in their respective code of ethics. For example, the American Counseling Association (ACA), the National Association of Social Workers (NASW), and the American Association for Marriage and Family Therapy (AAMFT) all have counselor-patient confidentiality guidelines for those practicing under their licensure.

Additional standards are provided by the Health Insurance Portability and Accountability Act (HIPAA) and individual states’ laws. In order to adhere to confidentiality standards, we must comprehend our own profession’s code of ethics, HIPAA rules, and those guidelines offered by the states we practice therapy in.

The importance of confidentiality in counseling

Confidentiality in counseling helps clients get closer to the root of their problems. Up to this point, many clients have limited the amount and intensity of details they’ve shared with others about their struggles.

The confidentiality offered in counseling allows clients to more easily release those tightly held negative beliefs (i.e., “things are hopeless” or “I’m worthless”)and explore their sources (i.e., military combat experiences or childhood abuse).

Signing a confidentiality contract with our clients also establishes boundaries in the counseling relationship. At the onset of treatment, we tell clients that we won’t publicize or broadcast their particular identities or reasons for treatment, except for a few narrow exceptions to this privilege.

Why it’s important to explain counseling confidentiality and its limitations  

There are cases we must break counseling confidentiality—especially when it compromises our clients’ safety, or the safety of others. 

Clinicians should explain the meaning and limitations to confidentiality to clients during the very first session and reiterate them throughout treatment. 

If we want clients to be honest with us about their problems, they need to understand from the very start what information we’ll keep private. 

They also must know what scenarios would necessitate a break in confidentiality and the process involved.

If our client makes comments about planning suicide or enters a session with self-inflicted wounds, for example, we can’t ignore these dangerous signs, and we must inform an emergency contact. 

If a child describes domestic violence between their parents, or a teenager says they were beaten for coming home late, we must take action by reporting these events to Child Protective Services (CPS). 

However, there’s a possibility that reporting these incidents will be harmful to the relationship between client and counselor, or even worse, exacerbate the conditions that predicated your reporting.  

3 examples of how to stay compliant and maintain client trust

1. When working with minors   

While working at an outpatient program, I had a pivotal experience that taught me how to address limits in counseling confidentiality. 

A girl who’d been in our program for weeks entered group therapy one day with the glaring red marks of a handprint on her face. The van driver who’d picked her up that morning told me, “She said her dad slapped her.” I shakily called CPS and reported the incident.

The next day, the girl’s father called me fuming, “Why did you call CPS on me?! The worker who came here yesterday said you reported me.” I calmly explained my reasons for calling CPS, after which he promptly hung up the phone. 

All day, I replayed the situation in my mind, considering the legal, ethical, and moral implications of the situation. Though I’d acted correctly by legal standards, I was sure I could’ve better handled my ethical responsibility in this case.

I drove to work early the next morning and called the girl’s father. 

He answered in a suspicious tone, but listened as I apologized for not contacting him before CPS to discuss the situation. 

He groaned and said his daughter’s defiant behavior was out of control. He regretted slapping her, but didn’t know what else he could’ve done. 

We talked about new healthy responses to address the girl’s behavior, and set an appointment with the doctor for her medication evaluation.

This experience taught me to be  more direct with clients and their families when explaining the limits and extent of confidentiality. 

I also reference back to confidentiality throughout treatment, so my clients are more prepared if I need to break confidentiality. 

With children and adolescents, I now usually alert their parents before contacting CPS, unless I perceive this action would jeopardize their safety.

2. When billing insurance or faced with legal subpoenas  

If a client uses insurance to pay for therapy, their company may submit a records request in order to validate our client’s need for services. 

We must comply with those requests in order to continue receiving payment from the insurance company. 

If a client is involved in legal matters (i.e. court case or probation), we may receive subpoenas which request documentation or testimony about their treatment. 

Besides being a core part of our ethical codes, a thorough explanation of confidentiality and references to it throughout treatment help us maintain strong rapport with clients and their families.

3. When the client poses a risk to themselves

While working in another outpatient program, I met a woman who admitted to having frequent suicidal thoughts and access to guns at home. 

When I asked who could secure these weapons, she couldn’t identify anyone but herself. She said her husband was also suicidal, and that neither one had friends or family living nearby. 

Alarmed, many questions came to my mind, the largest one being, “How can she be safe?” I remembered my tense learning experience about making CPS calls, and wanted a better outcome with this scenario.

Thankfully, I had the woman’s signed admission forms handy, which included my hospital’s policy regarding welfare checks. The policy outlined counselors’ ability to contact the police if a patient was unable or unwilling to identify a reliable emergency contact. 

After reviewing the forms together, she quickly named a neighbor who knew she’d been struggling and whom she trusted to keep the gun cabinet key while she received treatment. 

This encounter taught me that we must personally and thoroughly review our confidentiality forms with clients in order to confirm their comprehension.

How to explain confidentiality in counseling to clients

1. Verbally before starting treatment 

Before clients share any information about their reasons for counseling, explain what you can keep confidential, what you can’t, and why. 

Consider an intake during which your new adult client discloses that they frequently cut themselves, or your new child client describes recent sexual abuse by their family member. 

These are scenarios which we can more confidently address if we’ve explained confidentiality in counseling from the very beginning.

2. Going over intake documentation and consent forms

I request that my clients review and sign all intake forms before meeting with them in counseling. These include a “Limits to Confidentiality” form, which explains what information can and cannot be kept private, based on ethical and legal standards. 

At the opening of their first session, I’ll ask my client if they have questions about the forms and highlight certain elements, including confidentiality. 

I’ll give examples of cases in which confidentiality must be broken, and stress how I’ll only share the minimal information needed if these situations were to occur.

Regarding children and adolescents, I’ll affirm parents’ right to know what happens during treatment while also emphasizing the value of privacy. 

I’ll explain to parents my protocol if their child discloses critical information: 

• The child can tell their parent while I’m present 
• I can tell the parent while their child is present 
• The child can wait in the lobby while I tell their parent 

I’ve found this practice incredibly helpful because it allows young clients to choose how their parents learn about sensitive details, while ensuring their parents have sufficient updates and safety directives.

3. Reminders throughout treatment

Even if we have our clients’ sign confidentiality forms, it doesn’t guarantee they’ll always remember the limitations to confidentiality. 

Many of us skim and scan lengthy documents, and sign forms without full comprehension of what they entail. 

We must remember this vulnerability with our clients, and remind them throughout treatment of confidentiality provisions and exceptions. We can make references such as, “as we discussed in our first session,” or “as we reviewed during our intake appointment.” 

We can also edit our confidentiality forms so they include simple facts, which are more easily read and understood by our clients.

Confidentiality is a substantial benefit of the counseling relationship. 

Clients are free to share their deepest secrets and darkest times, with the assurance that counselors won’t exploit this information. 

While a grand asset to counseling, confidentiality cannot be honored in all cases. Behavioral health counselors should explain counseling confidentiality to clients from treatment’s onset and consistently reference it throughout the counseling relationship.

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