Can A Therapist Break Confidentiality? A Mental Health Expert Weighs In

Trust is one of the foundations on which a therapeutic relationship between a patient and mental health expert is built. Dr. Brandon Santan, PhD, LPC-MHSP, NCC, BC-TMH, CCMHC, is a licensed therapist in the Chattanooga, TN area and specializes in issues of anxiety and relationship therapy. "Privacy and confidentiality are the most important aspects of therapy," he tells Health Digest in an exclusive interview. "Patients need to feel safe to share what's on their mind to fully explore, process, and heal emotions. As such, almost all information shared with a therapist can remain confidential with a few exceptions."

Dr. Santan breaks down what's known in his field as the Limits of Confidentiality, and in what scenarios they would be applicable. One such example, he says, is "if a patient directs the therapist to share information with someone and they sign a 'Release of Information' form." He goes on to outline additional logistical cases in which these limits would apply, such as in the event of a lawsuit, subpoena, or payment issues. "A therapist is legally permitted to disclose relevant information to collect fees, including the collection of overdue fees," Dr. Santan explains. The same is true for insurance claims. "Disclosure of limited Personal Health Information (PHI) will be required by health and disability insurers if the patient chooses to file a claim," he says.

Dr. Santan goes on to explain that a therapist would be able to break patient confidentiality in the event of an emergency. For example, confidentiality could be broken if "the therapist has reasonable suspicion that the patient is a danger to themselves or to others (suicidal or homicidal)," Dr. Santan states. The same is true if "the patient reports information about the abuse of a child, an elderly person, a disabled individual, or someone else who is vulnerable to abuse, neglect, or exploitation who may require protection. Therapists are mandatory reporters for these issues."

Dr. Santan further notes that therapists sometimes work alongside other practitioners to provide the best possible care for a patient. "Most therapists practice with other mental health professionals and administrative staff," he says. In these cases, a therapist may disclose a patient's private health information for billing, scheduling, or supervision or consultation purposes. "All of the mental health professionals are bound by the same rules of confidentiality, however, and all staff members are given training about protecting patient's privacy and have agreed not to release any information outside of the practice without a patient's permission."

In closing, Dr. Santan states that because confidentiality can be uniquely challenging with couples or family therapy, he has protocol in place to best address these concerns. "I have a rule in my practice that I don't keep secrets during couples and family therapy. Patients know and expect that anything shared by the individual can be disclosed to other family members."