Exceptions to Confidentiality in Counseling

Counseling confidentiality is an important key to the therapeutic relationship practitioners have with clients, and it extends to almost every aspect of that relationship. However, there are some notable exceptions to confidentiality in counseling, and it’s essential to be mindful of them. 

One of the most unique and powerful aspects of counseling is the creation of a safe space for our clients that allows them to freely express themselves. 

This relational safety is produced in part by the promise of client confidentiality in counseling.

It can be comforting and liberating for the client to know that the words they share are kept private between them and their therapist.

That said, it’s essential that practitioners and clients are aware of the limits to confidentiality in counseling.

The Importance of Informed Clients

Confidentiality laws are approved at the state level, and these state laws mandate the specific circumstances where it’s necessary to break client confidentiality in counseling.

Professional ethics codes also provide helpful guidelines.

It is also important for the clients to understand the reason for these exceptions to confidentiality in counseling, which is primarily to ensure some form of safety or protection.  

By informing your clients about therapist confidentiality laws and the purpose they serve, you can set client expectations and avoid unwelcome surprises down the road. 

The Importance of Informed Therapists

Depending on the state you are licensed in, laws related to limits to confidentiality in counseling can vary widely. 

Ethical standards can also slightly differ by profession, for example, for licensed counselors as compared to marriage and family therapists.

It is essential for therapists to be knowledgeable of the details of these ethics and the laws of the state(s) they practice in. This is important for therapists so that they can fulfill their professional obligations, maintain good standing with their licenses, and clearly communicate these confidentiality laws to their clients.  

When considering exercising the exceptions to confidentiality in counseling, a therapist must be aware of:

• The general situations that are the exceptions to confidentiality.
• The specific criteria that would mandate a break in confidentiality.
• The protocol to follow once it is determined that action is required by the therapist.
• How to communicate and manage the client relationship through the process.

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  3 Limits to Confidentiality in Counseling

  The three most common situations that are considered limitations of confidentiality in counseling include immediate danger to self, duty to warn, and suspected abuse or neglect of a child or elder. 

  1. Danger to Self

  It is considered the duty of a therapist to recognize and report when a client is presenting as a serious threat to self-harm. 

  Under most interpretations, being a “danger to self” includes the “imminent” qualifier.  

  This means the therapist has concern that the client will soon take action to harm themselves, if some form of intervention is not provided. This assessment is based on an observation of mental status and self-reporting from the client.  

  There are multiple risk factors that a therapist should be trained to assess when they get a sense their client may be suicidal.  

  Typically, passive thoughts of death, without suicidal plans or intent, would not initiate a break of confidentiality. This can often be handled with safety planning.

  Once it is determined that a limit to confidentiality has been triggered, it is important for the clinician to understand what type of reporting they can facilitate to ensure client safety.  

  This will depend on the stage of licensure, the type of clinical workplace, and level of specific training. 

  Clinicians who are not fully licensed are often not able to independently report that a client is a “danger to themselves”or write an involuntary hold; they would be required to involve a licensed colleague or supervisor.  

  The type of clinical setting a therapist works in can determine the ways reporting can happen.  

  For example, certain clinics may be allowed to directly write an involuntary hold for a client. Other clinical settings may only be allowed to call external crisis teams to assess the client, or rely on law enforcement to do a welfare check.  

  Certain laws or workplaces may require a specific training, or certification to allow therapists to directly invoke holds on clients.  

  Clinicians must know all of these various factors in order to be compliant.

  

  2. Duty to Warn

  Another of the common exceptions to confidentiality in counseling is the “duty to warn.”  

  This is when the client presents an imminent threat to commit physical harm to others. 

  One key to this reporting is that the potential victim(s) must be identifiable.  

  In these instances, the therapist creates a warning that will protect the physical safety of the identifiable target. A client reporting a feeling of wanting to generally hurt others, with no specific people in mind, would not trigger the “duty to warn.”

  As with “danger to self,” the danger to others must be imminent and foreseeable. 

  The therapist has determined there is intent from the client to cause harm and there is a high likelihood that harm could be inflicted. 

  In most cases, reporting under the “duty to warn” involves the therapist attempting to contact the identifiable target and contacting law enforcement.

  Like the “danger to self” condition, laws vary from state to state.

  It is important for the clinician to be aware of the contact numbers of local law enforcement, in addition to being versed in the “duty to warn” laws in the state(s) they practice.

  There are three main categories that these laws fall under: mandatory, permissive and no mandate. 

  The majority of states fall under the mandatory law, whereby it is required that therapists report these serious threats. 

  Failure to do so can have negative consequences for the therapist. 

  There are also states where the “duty to warn” is permitted, but is not legally mandated. 

  Finally, there are a few states that have no law in place for the “duty to warn” confidentiality exception.  

  It is important that a clinician is informed about which category their state law falls under.

  

  3. Suspected Child and Elder Abuse or Neglect

  All states require that suspected child and elder abuse or neglect be reported.  

  This makes it one of the most universally enforced limitations to confidentiality in counseling.  

  In these cases, clinicians do not have the burden to prove abuse or neglect has actually occurred. 

  Clinicians are only responsible for reporting the information witnessed or gathered that supports their suspicions. 

  There must, however, be enough significant details reported to raise reasonable suspicion of abuse or neglect. 

  State laws can vary on the nuances of what exactly defines abuse or neglect. It is very important that the nuances are clear to the clinician, so they can make assessments based on the jurisdiction of the state(s) they practice in. 

  The laws will also define where to report, what to report, and the time window in which the report must be filed.  In most cases, the report is made to a local child protective services or adult protective services agency.  

  Familiarity With the Law and Code of Ethics

  It cannot be overstated that becoming familiar with local and state therapist confidentiality laws is key to practitioners successfully navigating exceptions to confidentiality in counseling.  

  These laws form the major criteria for clinician assessments and reporting instructions.  

  The code of ethics for a therapist’s particular license will also contain important guidelines to follow. 

  It is the clinician’s obligation to be well-versed in the legal requirements and ethical expectations, regarding the limits to confidentiality in counseling. 

  

  Communication With the Client 

  Breaking counseling confidentiality can be a difficult topic to broach with a client. 

  In most cases, it is ethical to openly communicate the process to the client, unless communicating this will obviously cause significant harm to the client or others. 

  Even with effective informed consent when initiating the therapeutic relationship, there may still be a variety of responses from the client.  

  It is important that the clinician communicate what is happening with clarity, confidence, and compassion.  

  In cases that require a break in confidentiality, the clinician should be confident in their process to arrive at that determination and be able to clearly communicate, to their client, why they must breach confidentiality. 

  Understanding that this news may feel surprising or hurtful to the client, the clinician should listen with empathy and validate the client’s experience with compassion.  

  It is possible to care for the client, to attempt to maintain a positive therapeutic relationship, and still confidently follow through on the determination to break confidentiality. 

  Therapist Confidentiality Laws Are Intended to Prevent Harm

  It is helpful for clinicians to acknowledge that certain laws and systems can have imperfections, biases, and discriminatory practices. 

  Breaking counseling confidentiality and reporting a client is intended to bring safety and prevent harm. However, there can be cases where the reporting is biased, vindictive, or solely serving the practitioner’s interest of avoiding liability. Each of these can be damaging to the client and their loved ones.  

  The higher ethic of preventing harm and ensuring safety must always be considered when assessing these potential reasons for breaking client confidentiality.  

  Clinicians should always evaluate the situation at hand with care, thoughtful clinical judgment, and as much objectivity as possible. 

  As therapists we all must do our best to stay mindful of these exceptions to confidentiality in counseling.

  

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