Therapists take your privacy very seriously. Only in extreme cases will they break confidentiality.

In therapy, it’s important for you to feel like you have a safe space — and much of this involves knowing there is strict therapist-client confidentiality.

You should have confidence that when you share your innermost thoughts and feelings with your therapist, that your personal information won’t leave the room.

In some situations, however, your therapist may be legally required to break confidentiality. Breaking confidentiality means sharing the minimum amount of protected health information needed to a third party, including a family member or a government organization like child protective services or the police.

These would be extreme cases where they believe that your life or another person’s life is in immediate danger.

About 10% of Americans seek mental health therapy or counseling, and therapists take your privacy very seriously.

While almost everything you share with your therapist is held in confidence, there are a few exceptions to the rule:

  • danger to self
  • danger to others
  • abuse of children (including use of child pornography in certain states), dependent, or elderly adults
  • current or future crime concerning safety of others

Do therapists have to report suicidal thoughts?

Therapists are trained to carefully navigate self-harm conversations.

It’s important for you to feel safe talking about thoughts of self-harm without the fear of getting “locked up.” If every discussion of self-harm were treated as an emergency, clients would rarely bring these issues up, potentially increasing their risk.

In short, if your therapist determines your risk of self-harm is low, then the conversation will remain confidential.

For instance, if you were to say “Sometimes I feel I’d be better off dead,” the therapist will gently explore these thoughts further to determine the level of risk.

Together, the two of you might develop a safety plan to help you monitor or manage any thoughts of suicide.

The safety plan steps might include:

  • identifying suicidal thoughts
  • using coping strategies that don’t require contacting someone else (i.e. taking a walk in nature or listening to music)
  • contacting someone you enjoy being around (not necessarily for help)
  • contacting a family member or friend to specifically ask for help (this might involve 24-hour check-ins)
  • contacting a professional or urgent care facility

If the self-harm risk appears high or imminent, and all of the steps in the safety plan have been followed, then the therapist will likely take action to get you set up with a higher level of care for your safety and well-being.

Do therapists have to report a threat to others?

If you tell your therapist that you want to harm a specific person or group of people, and the threat appears serious and/or imminent, then your therapist will report it to the police, inform the person who the serious threat is about, or both.

Do therapists have to report domestic violence?

If you’re under 18 and you’re being abused — physically, sexually, emotionally, or through neglect — the therapist is required by law to notify child protective services in the area where the abuse took place.

This law also applies to vulnerable or dependent individuals, such as older adults. For instance, if you’re age 65 or over and you’re being abused or neglected, the therapist is required to report it to authorities.

When it comes to intimate partner violence (IPV) between two adults, the answer is more complicated and depends on each individual case.

In many states, therapists are not required to report adult-on-adult assault or battery, including if the acts are between partners or spouses. Rather, the therapist might help the abused partner come up with a plan to stay safe, which may include escaping the situation.

Can therapists report crimes?

Whether a therapist reports a crime depends on if the crime was committed in the past, is ongoing, or is going to happen in the future.

In most cases, confessions of past crimes are held in confidence. For instance, if you tell your therapist that you stole a TV last year, that information is protected by confidentiality rules.

When it comes to present crimes or future crimes the client reports intending to engage in, the therapist must report it if the crime concerns others’ immediate safety.

Therapist confidentiality allows you to feel safe enough to share your private information during therapy.

Still, in extreme cases, there may be limits to full confidentiality. Some of these cases are left to the therapist’s discretion. But in other more serious situations, therapists are lawfully bound to keep the client or others safe.

In general, therapists are required to keep everything you say in confidence except for the following situations:

  • planned suicide intent
  • planned violence towards others
  • past, present, or planned child abuse
  • elderly or dependent adult abuse

In the United States, confidentiality is encoded in the Health Insurance Portability and Accountability Act (HIPAA). The HIPAA Privacy Rule is designed to offer a minimum level of protection.

Some states have even stricter laws to protect your privacy. You can contact your state’s board of psychology to ask about your confidentiality rights.

Privacy and confidentiality are also defined in Section 4 of the Ethical Principles of Psychologists and Code of Conduct, published by the American Psychological Association (APA).

This section includes the following general points:

  • Psychologists have a primary obligation to protect confidential information and should take reasonable precautions to do so.
  • Psychologists should discuss with clients the limitations of confidentiality.
  • Psychologists must gain permission by the client to record any part of the session.
  • Psychologists should only write what is necessary on reports to minimize intrusions into privacy.
  • Psychologists may disclose confidential information with the client’s permission or as mandated by law.
  • When talking with colleagues, psychologists should not disclose confidential information that reasonably could lead to the identification of a client, unless they have obtained the prior consent of the person.
  • Psychologists should not disclose in their writings, lectures, or other public media, confidential or personally identifiable information concerning their clients.

Therapists take confidentiality seriously. They understand that clients need a safe place to disclose their most private thoughts and feelings.

In almost all cases, your personal information is held in strict confidence. Only in extreme cases will your therapist need to break confidentiality to keep you or others safe.

Overall, therapy is most effective when the client feels safe. This means that the therapist will protect your confidentiality but will also try to protect you from serious self-harm.