Confidentiality in Therapy

Confidentiality in Therapy

You have an absolute right to confidentiality.

Most people know that psychotherapy is confidential. In fact, it is absolutely essential in order to create a sense of safety.

Can you imagine who would go if it weren't confidential?

Your therapist should discuss confidentiality early on.

This is one of the first steps in creating boundaries in the therapeutic relationship. It's also one of things you look for when you're shopping around for a psychotherapist. A competent therapist--almost by definition--has good boundaries.

If you wish your therapist to disclose any information (e.g. to your physician, naturopath or lawyer) the therapist is required to obtain your written permission. So, for instance, if you are considering going off meds, you might want your therapist to have a consultation with your physician. In this case, as your therapist, I would fax the waiver to your physician and then follow-up with a phone call.

This "written permission" principle applies even to instances when the therapist must invoice your insurance carrier directly. The "release of information" you sign in this case would outline the specifics where disclosure is being released. For instance, the form might state that only session dates and fees may be released to your insurance company.

You should know that under managed care (e.g. HMO's) it is usually required that the psychotherapist send regular reports on the treatment you are receiving.

Clinicians disguise their cases during consultation and supervision.

As part of being a competent professional, psychotherapists will seek ongoing supervision and consultation about their clients. In this case, therapists will disguise identifying information including changing the name of the client (only first names are used, for example).

There are legal limitations to the confidentiality principle.

Your therapist will also describe the legal limits of confidentiality. These limitations relate to instances where a client discloses information that leads the therapist to believe harm may come to someone.

For instance, if the therapist believes the individual may hurt himself, herself or another individual the therapist is obligated to inform the appropriate agencies or authorities. This includes instances where the therapist feels a child is, or has been, physically/sexually abused or neglected.

It is also important to understand that psychotherapists can be subpoeaned. If you undertake a lawsuit (e.g. a claim related to a motor vehicle accident) you may have waived your right to confidentiality.

Here's a good video that explains what happens in therapy and the nature of confidentiality. The discussion on confidentiality comes half way through:

Readers Comments

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I'll always return to this site

I've been browsing & bookmarked this site about a year ago. Love it! The site offers personal comfort & satisfaction as well as professional & educational properties.

No matter which road I take in life, I think I'll always return to this site. Thanks Shrinklady!

Ressa (South Carolina, USA)

Dr. Susan LaCombe Psychoshrink


You're very welcome Ressa!


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I don't want to be rejected

I keep finding new things, so I seem to be leaving lots of comments lately! I have said I know I am talking more and more to my therapist. Ridiculous as it sounds it has taken well over a year, and maybe nearing two now to even start opening up.

So, talking and telling her things yes, more and more, but actually ASKING her things - why do I have such a problem with this?

Possibly because I hate being rejected? I don't know, but I do know I don't want to be rejected by her in any way at all. So, this article and video has been invaluable to me.

Thanks Suzanne.

Marguerite (UK)

Dr. Susan LaCombe Psychoshrink


That's wonderful to hear Marguerite that you're opening up in your therapy. And to be asking questions...that's very cool.

You may already suspect this...the fear of being rejected is likely an experience from your history. Your brain has learned this response - probably early on - and now is being "on guard" for you.

That's the benefit of counseling, it allows us to feel stuff that we can work through in the moment. You see, we need a little bit of an emotion we want to change in order to rewire the neuropathic connections. So with each session, your brain is learning that's it's okay, it's safe to tell her things.

And this same process gets translated into our lives with increasing comfort within ourselves around others. Isn't that great. Amazing!

Take care,


P.S. I provided a little more of an explanation of what happens in the nervous system in your other comment on Counseling Supervision.

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