It is crucial to the success of any counseling or psychotherapy that everything in the session remain private. You are encouraged to say anything and everything to your counselor and you can be assured that it will remain confidential. You should let your thoughts, feelings and memories flow freely and know that they will not be judged and will remain safe.
However…there are some important exceptions to confidentiality. These center on issues of life, death and abuse.
Suicide: If your counselor believes that you are at serious risk of taking your own life, he or she must take steps to protect you. Your therapist is trained to assess the seriousness of any suicidal threat and may call emergency services. Every county has a publicly-funded Mental Health Crisis Team that will respond to save the life of any individual. This may involve a trip to the emergency room for a more complete evaluation and an observation period.
Of course, your counselor understands that people often think or talk about ending their lives with no actual intention of carrying it out. Clients can get very depressed or desperate and feel that they have nowhere else to turn. Your therapist can assess the seriousness of the situation and will not call crisis every time you bring up the topic.
Please remember – suicide is a permanent solution to a temporary problem.
Homicide: If you are threatening to kill or seriously injure another person, your counselor is required to violate confidentiality to save that life. She or he may call the person, the authorities and the Mental Health Crisis Team.
Again, your therapist is trained to evaluate the seriousness of your threat. He or she will not violate your confidentiality if you are just angry, venting, fantasizing or letting off steam with no solid intention to do serious harm. You may safely discuss a wish to hurt someone who has hurt you without the intention to actually follow through.
Child Abuse: Your therapist is required, by law, to report suspected child abuse to a child abuse hotline. He or she does not have to prove it; but, only have a suspicion that it is occurring or has occurred. Your professional takes this legal mandate very seriously and often seeks consultation from supervisors or peers before making the call.
When called, a court-funded investigator will come to the home or school to evaluate the truth of the alleged abuse. Many cases are unfounded. When a case is assessed as likely to have occurred, the perpetrator will be separated from the child for further legal processing.
Child abuse includes: sexual abuse, physical abuse, severe emotional abuse and severe neglect. A child who is not being fed or is being left alone at home are examples of neglect.
It is the investigator’s responsibility to determine the seriousness and accuracy of the reported abuses – not your counselor’s. Please be aware that your counselor may be criminally prosecuted if he or she does not report suspected abuse.
Elder Abuse: Any abuse of an elderly person who is in a weak, helpless or dependent state must be reported to the authorities. Elder abuse includes physical, sexual and emotional abuse as well as severe neglect.
Elder abuse also includes financial abuse. If a caretaker is taking or confiscating an older person’s money or property without that person’s conscious permission, it must be reported. This could include and outright theft of cash, signing over bank accounts or investments, running up credit cards in the elder’s name, writing checks to oneself and other similar actions. Of course, many senior citizens are in various stages of dementia, or may forget what they said, not be thinking rationally or be easily manipulated by a loved one. These are all situations that could lead to financial abuse of an older person.
Release of Information Form: There may be times when you would want your confidential file to be released to a third party. Your counselor can release specific information to a specific person or institution with your written permission on a Release of Information form.
This may arise in legal situations like: divorces, custody conflicts, probation or parole situations. It also occurs if a judge orders a person to therapy for violations like a DUI, drug use, drunk and disorderly charges, anger management and the like. You may also desire your information to be released to another professional to coordinate your care. This may be your family doctor or psychiatrist. It may also include an organization like a school or workplace. This can all be done; but, only with your written permission.
Incidentally, in Pennsylvania, anyone over 14 years of age can sign their own release forms and oversee their own confidential files. They may even keep information from the parents or guardians.
In conclusion, your counselor or psychologist deeply respects the privacy of your personal information and will do everything possible to keep it confidential. There are a few life, death and abuse situations that legally require that confidentiality be broken. She or he takes that very seriously and will only do it for some greater good.