Patient Confidentiality: When Does a Counselor Have to Tell?

Counseling would not work very well without some degree of confidentiality. It’s difficult for a patient to trust their counselor with their most secret feelings if there’s no trust established and if the counselor has no repercussions for sharing the information with the world. And indeed, there are serious repercussions for counselors who break their confidentiality agreements, up to and including losing their license and spending six months in jail.

But, as you probably know, confidentiality is not absolute. In some cases, counselors can actually face legal consequences if they don’t report information, and it’s important for both professional counselors and potential patients to be aware of where that line falls. Usually, it is a counselor’s job to inform you of when your words are confidential and when they’re not, but the situations where a counselor is obligated to breach confidentiality aren’t always as obvious as they seem.

1. Suicide or the Threat of Harm

If a counselor suspects that a patient is intending to kill themselves and that the threat is real and immediate, they are required to report it. The same is true if a patient is suspected of having immediate plans to hurt or kill someone. Many people may vent their feelings of hatred and anger in a healthy way, but when it crosses the line into a legitimate threat against someone, the counselor has the right and responsibility to warn that person and the authorities. Knowing when to act can be difficult in some cases. But if a patient commits a violent crime and it is proven that the intention to commit that crime came out in counseling sessions, the counselor can face serious legal charges for failing to speak up about it.

2. Counseling and Children

Although counselors usually make every effort possible to make counseling sessions with minors confidential; they are not protected by the same laws as adults. Parents who send their children to counseling will probably expect to be regularly informed of what they say, but counselors will often refuse to disclose the majority of information, except for what they find most relevant. If the child is over 12, it is usually acceptable for them to receive the same level of confidentiality as their parents, depending on the situation. And if a counselor suspects that a child is being abused or neglected, whether, through sessions with them or their parents, they have an absolute obligation to report it to authorities.

3. Legal Cases

If a patient commits a crime, or if they are involved in another kind of investigation such as in a child custody battle, a counselor may be subpoenaed to talk about the case, and the case files could be admitted as evidence. This is true even if the investigation happens after the patient’s death. This doesn’t mean the information is free to be disclosed outside of a courtroom, just that it is being used for the specific purpose of forming a verdict.

4. Other Instances

If there is a medical emergency and counseling information can be helpful to a patient’s health, a counselor can communicate with medical doctors. Authorities with a search warrant can confiscate whatever patient information they deem necessary – and indeed, if patient information is legally required for any reason, that trumps confidentiality agreements. And if a counselor and a patient decide to confer with a family member or other mental health professional about the patient’s case, they can always sign a temporary agreement for their information to be disclosed in a specific manner.

Confidentiality is really the cornerstone of counseling. Licensed counselors are required to have the appropriate informed consent documents that outline their legal obligations and the patient’s legal rights. They could include permission for the sessions to be documented on video or in writing, or an agreement to let students or appropriate family members sit in on sessions. It all depends on the counseling environment and the patient’s specific situation. Knowing the limits of confidentiality is an important part of letting people seek help while feeling as safe as possible.