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What are the Limits of Confidentiality in Therapy?

Mary McMahon
Updated May 16, 2024
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Confidentiality in therapy can be revoked in some situations, including a voluntary waiver of confidentiality submitted by the patient, as well as certain legal, medical, or billing reasons. The law regarding therapist confidentiality can be vague in some regions, and people with specific concerns should ask their therapists directly for more information. Generally, all information about therapy and what happens in sessions must be kept confidential unless there is a compelling reason to do otherwise.

In a health care system where records are maintained in a single location, often electronically, therapy notes are part of a patient's medical record and can be accessed whenever the record is reviewed. These notes can include information about diagnosis, outcomes of testing, and general notes. Medical records are tightly controlled, but can be released to insurance companies and on court order, something for patients to be aware of.

Other limitations on confidentiality in therapy involve billing and payments. Third party reimbursement can only be provided if information about the diagnosis and appointment times is provided. Some insurers audit care to determine if it is covered, in which case they may request information about prescriptions and other aspects of therapy. Therapists can also release the names of their clients to debt collection agencies if the clients do not pay, although the agency is not allowed to receive information about why the patient was in therapy.

In cases where people disclose information suggesting they are a credible threat to themselves or others, the law usually requires people to break the rules regarding confidentiality in therapy to report it. Likewise, reports of abuse to people with disabilities, older adults, and children may also be subject to mandatory reporting, where the therapist must file a report if it is disclosed.

If a therapist is taken to court by a patient for malpractice, the therapist is allowed to breach confidentiality in therapy if it is part of the defense. Likewise, people introducing information about their mental status in a legal case waive the right to confidentiality by making it a factor in the case. Additionally, courts can compel the release of records about patients if they are believed to be relevant to a case, even if therapist and client both file objections.

Some places where confidentiality in therapy remain in force include couples therapy, where counselors cannot disclose the content of private sessions, and private therapy for children, where therapists cannot talk about the sessions with parents or guardians unless there is a safety concern. The law also maintains that confidentiality applies even after the therapeutic relationship is terminated.

MyLawQuestions is dedicated to providing accurate and trustworthy information. We carefully select reputable sources and employ a rigorous fact-checking process to maintain the highest standards. To learn more about our commitment to accuracy, read our editorial process.
Mary McMahon
By Mary McMahon

Ever since she began contributing to the site several years ago, Mary has embraced the exciting challenge of being a MyLawQuestions researcher and writer. Mary has a liberal arts degree from Goddard College and spends her free time reading, cooking, and exploring the great outdoors.

Discussion Comments

By Talentryto — On Sep 21, 2014

I would never feel confident about talking to a therapist or psychologist without being referred by my family doctor. Since I trust him completely, I would trust the person he refers me to.

By Rundocuri — On Sep 21, 2014

With new laws in place, patients should feel more confident than ever that the things they talk about in mental health counseling are kept private. With the exception of the disclosure of a crime, any patient who feels that his or her confidentiality has been deceived by a practitioner should contact the local governing board to see what steps should be taken next.

Mary McMahon

Mary McMahon

Ever since she began contributing to the site several years ago, Mary has embraced the exciting challenge of being a...

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