Exploring Client Confidentiality: What Are Therapists Required to Report?

Therapist-patient privilege is a sacred trust, akin to that of a priest or doctor. When it comes to therapeutic relationships, there needs to be a certain level of trust that what you share with your mental health care provider stays with them.

However, there can be some questions about this type of relationship. Is mandatory reporting a requirement for certain situations? Can a therapist or a psychiatrist report a crime? What does it take to break confidentiality? In this article, we'll take a closer look at therapist-patient privilege and how it relates to things like past crimes, sexual abuse, self harm, and other issues that are told in strict confidence.

Please note: This article is for informational purposes only and does not replace or represent legal advice.

Privileged Relationships with Psychologists, Psychiatrists, and other Mental Health Professionals

Under United States confidentiality laws, medical and mental health professionals must abide by the privacy regulations laid out under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). There are specific regulations for psychotherapy.

In the first session, a therapist is charged with sharing confidentiality laws with the patient. They may do this verbally or in written form. The rights of a patient include the following:

• A client is permitted to access their own information and records
• Their information will only be shared with others with their own consent
• If a client poses a risk to themselves or others, or for legal reasons, information may be shared with other agencies
• A client may pursue legal action if a therapist breaks confidentiality rules

If a patient is a minor or someone who is incapacitated cognitively due to a severe mental health condition, then an appointed guardian may sign off on these rights on behalf of the patient.

When Therapists Can't Divulge What's Said in Therapy

Because therapy is such a personal thing, what you tell a therapist must remain confidential. This includes things like affairs, past crimes, and "bad behavior" that isn't necessarily criminal behavior. You can talk to a therapist about how you were abused in the past, and they will not share that information. Additionally, and with a few exceptions, a therapist can’t report a past crime you committed.

Exceptions: When a Therapist May or Must Break Confidentiality

There are a few exceptions to breaking confidentiality that we will outline here. Information from a therapy session may be shared if the therapist believes that:

• A client is showing a level of self-harm that indicates a serious risk of suicide
• Their client shows the intention of serious harm toward another person
• The client discloses their intention of committing a crime
• The client is a child or a vulnerable adult who is at risk of abuse, is being abused, or is a victim of criminal activity

A therapist may also break confidentiality if information is required as a legal obligation to determine mental state or competence in criminal cases or any other legal proceeding.

A mental health therapist is considered a mandatory reporter in certain cases under a "duty to warn" and may be subject to legal repercussions if they fail to disclose things like suicide risk, intent to harm, or risk of child abuse.

What Happens If You Confess a Crime to a Therapist?

When it comes to reporting past crimes or intent to commit crimes, it can vary from state to state. State law in certain areas can include a mandatory duty to warn or protect, while others are permissive and allow the therapist to decide which avenue to take. In some states, they do not allow a breach of confidential information at all, and therefore the duty to protect doesn't apply.

Mental health professionals' opinions differ when it comes to therapist confidentiality and the duty to report past crimes. Some believe that it is their duty to report severe self-harm, but not crimes. Some believe that any breach of confidential information can lead to individuals avoiding therapy out of fear. Other therapists may avoid working with potentially violent people because they fear that they will be sued if they fail to report the risk.

What Crimes Are Therapists Required to Report to the Police?

In places where state laws require therapists to report, they may be legally required to tell appropriate authorities when a patient poses an immediate danger to themselves or others, shares in a therapy session that they plan on committing a crime, when a child is the victim of domestic violence, or when sexual abuse is known to be taking place.

What Can a Therapist Choose to Report?

In states with a permissive duty to protect or warn, including Arizona, Oregon, Texas, and Florida, as well as in states that do not allow a therapist to share what a patient tells them, like Maine, North Dakota, and North Carolina, it's up to the therapist what they will share with police officers or other authorities. For some, a therapy session is sacrosanct, and they may feel that any breach of confidence is unethical.

Permissive disclosure allows a therapist to judge what is in the best interest of their patient when it comes to sharing information. Most states allow some level of wiggle room in the law to defer to a therapist's judgment in terms of emotional distress, intent, and overall patient well-being. Some therapists may choose to report if they believe the patient or a potential victim is in immediate danger, but in most cases, they would not choose to report.

Final Thoughts on Therapist Patient Confidentiality

Unless a therapist is practicing in a state where they have a legal duty to report, in most cases they will use their best judgment on therapeutic alliances to work in the best interest of their patient. Some may be more inclined to report crime than others, while other therapists may be more likely to report patients who seem inclined toward self-harm.

In the end, a therapist typically understands the sacred trust between therapists and their patients and will carefully weigh the circumstances before sharing information.

Confidential Therapy in NYC

If past trauma has been affecting your life and you've been afraid to share that pain, therapy can help you process your emotions and move past your life experiences.

At Williamsburg Therapy Group, we understand that visiting the past can be intimidating, and our team of doctoral-level Brooklyn psychologists offers safe and confidential guidance in the healing process.

Reach out today, and our patient coordinator will help you find the therapist who will offer the right rapport and meet your therapeutic needs.