When You Don't Know Where to Turn / A Self-Diagnosing Guide to Counseling and Therapy

by Steven J. Bartlett

"Leaks"

More frequently, confidentiality is broken due to informality rather than due to an intentional release of information. For example, if you are referred to another therapist or to a physician, the chances are that information about you will be shared by your original therapist with the new therapist or doctor. You can ask your therapist not to release information in this way, but if you do, the care you receive as a result of the referral cannot benefit from your first therapist's understanding of you. On the other hand, if you do permit your file to be shared with a new therapist or doctor, you will probably not know in advance know what his or her own policies about confidentiality are.

There is a second way that information about you may be released. Often, therapists discuss information about their clients with colleagues in an effort to provide better help for them. It is often to your definite advantage to have other therapists share their assessments and ideas with your therapist. But if you ask your therapist to refrain from discussing your case with professional colleagues, he or she will very likely agree to cooperate with you.

If you believe you have special reasons to be concerned about protecting the confidentiality of your relationship with your therapist, it will help him or her to know this, and it may be possible to request that special precautions be taken to protect your file from access by others.

Accidental or inadvertent breaks of confidentiality sometimes can also occur. For example, billings may be mailed to your address and then be opened by a spouse, child, or parent whom you may not have wanted told that you were in therapy.

Here is another example: If you enter group therapy, other members of the group are not professionally bound by rules governing confidentiality. Because they are not counseling professionals themselves, they will be less attentive to matters involving confidentiality—although most group therapists try, when a group is first formed, to get group members to agree not to disclose privileged information outside of sessions.

Exceptions

Beyond the kinds of possible breaks of confidentiality that are due to inattention, informality, and access of information about you by others, there are a number of legal exceptions to confidentiality.

Examination by court order is one. If a judge orders you to be examined by a psychiatrist or psychologist, his findings will be transmitted to the court and so be made public.

If a client reveals his or her intention and decision to commit a crime, a therapist is legally required to report this to authorities. If a patient plans to commit homicide, therapists are required by law to take whatever action is necessary to prevent the murder. In California, in addition to warning the police of the homicidal intentions of a client, therapists must also take steps to warn the intended victim, if this is possible.