Sometimes people ask, "Is therapy confidential?" The answer? Yes! And the same is true for coaching. The law protects the relationship between a client and a mental/behavioral health professional, and information cannot be disclosed without written permission. While there are exceptions, particularly when there is suspected or disclosed abuse, injury, or harm, unless prohibited by law, all therapy is strictly confidential.
What is Confidentiality?
Client confidentiality is the requirement that therapists, psychiatrists, psychologists, and most other mental health professionals protect their client’s privacy by not revealing the contents of therapy.
For licensed mental health professionals, confidentiality is protected by state laws. Some people working in mental health who are not licensed by their state–such as phone crisis counselors or life coaches–may not be legally required to protect client confidentiality, but still generally agree not to reveal identifying information about their clients.
Confidentiality includes not just the contents of therapy, but often the fact that a client is in therapy. It is common that therapists, for example, will not acknowledge their clients if they run into them outside of therapy in an effort to protect client confidentiality. Other ways confidentiality is protected include:
Not leaving revealing information on voicemail, and seeking client permission before leaving any information at all on voicemail
Not acknowledging to outside parties that a client has an appointment
Not discussing the contents of therapy with a third party without the explicit permission of the client
Therapists who break confidentiality are accountable to state licensing boards, who can de-license the therapist.
Exceptions to Confidentiality
People working in mental health who are not legally required to maintain confidentiality may be forced to break confidentiality by outside circumstances. For example, a rape crisis counselor who is not a licensed therapist could be forced to testify against his or her client.
Licensed mental health professionals can also break confidentiality in some circumstances. The most common includes when a client is a threat to himself/herself or others, in which case a therapist must notify the person in danger or notify someone who can keep the client safe. In these circumstances, therapists often seek hospitalization for their clients. Therapists can also be forced to testify against their clients, but it is much more difficult to force a therapist to testify than it is to force a non-licensed mental health professional; laws governing therapists are much stricter about confidentiality.
Therapists also have to reveal information about treatment to insurers in order for their clients’ treatment to be covered, but they do not reveal any more information than is necessary to ensure coverage. Typically, the information revealed is limited to the diagnosis being treated and any medications required.
The confidentiality of children is a hotly contested issue. Because minors cannot consent to treatment, they do not have the strong confidentiality rights that adults have. However, this can interfere with the treatment process, so many clinicians seek the permission of their minor clients’ parents to keep therapy confidential. Even when parents do not agree to confidentiality, therapists will not typically reveal mundane discussions in therapy; instead, they will give information about broad treatment goals and progress.