Therapists are legally bound to maintain confidentiality, but there are specific exceptions. The standard statement you’ll often hear is: “Everything we talk about is confidential, unless: you report something that implies imminent danger to yourself or someone else; you report abuse of a minor or a vulnerable adult; or I am subpoenaed in a legal matter.” But what exactly do these exceptions mean?

Implications of sharing suicidal thoughts with me:
Suicidal thoughts are more common than many people realize and can be a normal way of coping. Sharing these thoughts with me does not automatically mean I will break confidentiality. Usually, we will discuss them, and together we will create a safety plan. I will only need to involve others if you express a concrete plan to act on these thoughts or if you have serious intent to act, and you are unwilling to collaborate on a safety plan or follow through with it.

Implications of sharing thoughts of hurting someone else with me:
Similarly, if you share thoughts about hurting someone else, those thoughts by themselves won’t lead to a breach of confidentiality. I would need to hear that you have a concrete plan or serious intent to act on these thoughts, and that you are unwilling to agree to not act on them for me to break confidentiality.

Implications of sharing about abuse of a child or vulnerable adult with me:
This one is not up to my discretion. If you disclose any abuse of a minor, even if it happened in the past, I am required by law to report it to Child Protective Services (CPS). This applies to all forms of abuse: physical, emotional, psychological, and verbal. If this situation arises, I will talk with you about it first and, if possible, we can make the call together so you can share your thoughts and ask questions of the CPS agent.

A vulnerable adult is anyone over 65 years of age or anyone over 18 who has been determined to be unable to care for themselves due to a medical or mental health condition. If I learn of any abuse of a vulnerable adult, I am legally required to report it to Adult Protective Services (APS). I will discuss this with you beforehand and ideally involve you in the reporting process if necessary.

Being subpoenaed:
This is a rare situation, but it can happen in legal matters such as custody disputes or felony charges. If a judge orders that my clinical notes are relevant to a case, I may be subpoenaed to release them. If this occurs, I will inform you. Subpoenaed records could include progress notes (brief summaries of our sessions), diagnoses, treatment summaries, treatment plans, or other documents in your client file.