These exceptions vary from state to state, but some of the most common reasons that therapists may break confidentiality are listed below:

• If you are dangerous to yourself or to others. Your therapist is not held by confidentiality if he or she feels that you are likely to hurt yourself or someone else. However, the specifics of such “danger” are not well defined, and you may want to ask your therapist for more details.

• When there is reason to believe that children, the elderly and certain other groups have been or may be abused or neglected. All states have laws establishing some form of mandated reporting of child abuse; there may be limits on confidentiality when the abuse affects such others as the elderly or the disabled, and in cases of domestic violence.
• When there is a medical emergency. Sometimes, there may be differences over precisely which information about you can or should be disclosed, and to whom.
• When your therapist is attempting to collect on a delinquent account. If you are not paying the bills, your therapist should be able to hire a collection agency. This means revealing that you are in therapy. However, your therapist in this case can reveal only the information essential to bill collection.
• When your therapist is acting under a court order. If a judge orders your therapist to reveal information about you, this overrules confidentiality.
• When necessary for your therapist to prepare a legal defense. If you sue your therapist, confidentiality cannot prevent him or her from preparing a defense. It is unfair to sue and then say, “but you can’t talk about what you did.”
• When your therapist is consulting with other professionals. Your therapist can talk to other professionals in the same institution about you if he or she believes the advice will help improve your care. Conversations unrelated to your care are not allowed, however.
• When information is being used for teaching or research purposes. Many states allow the disclosure of confidential information for training or research, if it is presented in a way that serves a legitimate purpose and does not reveal critical information. If your therapist wants to make an audio- or videotape of you to use in presentations, you must be informed beforehand and sign a release approved by a lawyer. You always have the right to refuse.

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    Last reviewed: By John M. Grohol, Psy.D. on 22 Jun 2007