Limits of Confidentiality
In general, psychotherapy is a very private process in which information is shared only between you and your therapist. Therapy sessions can often concern delicate matters, and clients benefit from knowing that what they say will remain private and highly confidential. However, there are 6 instances in which therapists sometimes need to disclose confidential information. When this does occur, it’s the therapist’s responsibility to disclose only the minimum amount necessary for the situation:
1. If a person is a danger to themselves or others
If the therapist considers the client to be an immediate danger to his or her own physical safety or the safety of a third party, the therapist may need take necessary steps, including notifying others, in order to reduce the danger of harm for everyone involved.
2. If a person is facing an emergency medical situation
In cases of extreme medical emergency (e.g. overdosing, having a heart attack or seizure during a session), the therapist will call an ambulance or otherwise recruit appropriate healthcare providers.
3. If there is child abuse, abuse of an elder, or abuse of someone who is developmentally delayed (i.e., mentally incompetent)
In cases where there is ongoing, unreported abuse of a minor, an elder, or someone with a developmental disability, the therapist is ethically obligated to protect those individuals and may report the abuse to appropriate authorities.
4. If the court orders it
While this happens very rarely, it is possible that a court of law may subpoena documents related to therapy or order a therapist to testify in regards to what a person has talked about during therapy.
5. As part of your coordinated healthcare
In order to provide patients with the best care, Federal HIPAA regulations allow medical and mental health treatment providers, including therapists, to coordinate care and to share information about mutual patients that may be beneficial for your treatment. However, many therapists will still ask for you to sign a Release of Information before they would disclose any information to any of your other health care providers, except in cases of emergency. You may want to ask your therapist what their policy is about sharing information with your other health care providers.
6. If your insurance company requests it
If a person uses insurance to pay for therapy sessions, they will sign a form allowing the therapist to disclose certain information to the insurance company for billing purposes. Typically this information is limited to diagnosis and session dates. However, in some cases, this may also involve general information about treatment goals, etc.
In any other case, the client will have to give written permission for the therapist to share any confidential information with a third party, but for the cases explained above, no permission is needed. Legal statutes vary from state to state, and the above cases of limited confidentiality are specific to therapists practicing in Wisconsin.
If the limits of confidentiality are of concern to you, ask your therapist to provide more details about when he/she will be obligated to share your personal psychotherapy information with an outsider.