Understanding Therapy Consent Forms Series

Reading over the consent for treatment is such an important step in starting therapy services. We continue our discussion today with the topic of limits to confidentiality in therapy. (Feel free to check out our previous discussions on “No Secrets” policies and the benefits of therapy.)

Most of those outside of the mental health field find confidentiality and therapists to be one in the same. These two things feel synonymous as therapists are only second to lawyers when it comes to professionals who hold secrets for their clients. However, those within the mental health field know that confidentiality is actually our second most important priority. This is due to limits of confidentiality in therapy treatment.

Certain professionals are bound to codes of law & ethics. Doctors and therapists have similar codes when it comes to confidentiality. HIPAA laws require healthcare workers to protect a client’s private health information. Unlike lawyers (who practice attorney-client privilege), healthcare workers are required to breach confidentiality when it comes to safety concerns for clients.

So what exactly are the “limits to confidentiality”? Well, for therapists the limits include four things:

1. Suspicion of child abuse (any person under 18 years of age) of any kind (physical, sexual, verbal, neglect, etc.)
2. Suspicion of elder* abuse (any person over 65 years of age) of any kind (physical, sexual, financial, verbal, neglect, etc.). *This can also be applied to those with disabilities of any age.
3. A credible threat to harm oneself
4. A credible threat to harm someone else

Therapists are obligated to act on these four things because the #1 most important priority in therapy is the safety of a client and those around them. Therapists will report these things either in the moment, if it is time sensitive, or at the very latest within 36 hours of the disclosure of these occurrences.

We ultimately report these disclosures to authority figures such as the local police or child/adult protective services in order to increase the safety of those involved. If it is a suicidal or homicidal threat, the police will be called to escort the client to a hospital setting to get psychiatric care, and/or the threatened party will be notified for their safety. If it is a safety issue concerning a child, elder, or someone who is disabled, the appropriate protective services agency will be notified so they can reach out to those involved and provide appropriate resources to keep the family safe. This is why you may be asked your address at the beginning of every teletherapy session, so if an emergency arises your therapist can send the appropriate people to assist you in your time of need.

“Limits to confidentiality” is ultimately about safety. No therapist wants to see a client in harms way, or others in harms way due to a mental health crisis. So when you are beginning therapy there is no need to be surprised by your therapist mentioning these limits at the onset of treatment.