What Does Confidentiality Mean in Therapy?  - Trillium Counselling

Confidentiality in therapy means your therapist cannot share what you tell them without your consent, except in specific situations set out by law. In Ontario, that duty comes from the Personal Health Information Protection Act, 2004 (PHIPA) and from the professional standards of the regulatory Colleges, including the OCSWSSW for social workers and the CRPO for registered psychotherapists. The limits — a serious risk of harm, a child who may need protection, a court order — are explained by your therapist during the informed-consent process before psychotherapy begins.

Walking into a therapist's office can be intimidating. There are lots of things to learn about how the process works and what therapy can do for you. You've probably heard that what you say in therapy is confidential, but what does that actually mean — and where does it stop? Let's walk through the basics, the exceptions, and the legal and ethical rules that sit underneath them.

What is client confidentiality?

By its nature, therapy tends to delve into private and sensitive information. It’s only natural to wonder who else will know what you share with your therapist, especially if you’ve had close relationships with people who didn’t respect your right to privacy. 

Confidentiality is a legal and ethical obligation that your therapist has in order to preserve your privacy. Some of the small details about how that works may vary by office, but there are fundamental principles that guide these decisions. What it comes down to is that your therapist cannot reveal information about you and what you talk about, except in very specific situations.

Both Ontario Colleges make this a professional standard, not a courtesy. Registered Social Workers must "hold all client information in strict confidence" and may disclose it "only with client consent or when required or allowed by law" (OCSWSSW Code of Ethics and Standards of Practice, Principle V). Registered Psychotherapists "do not collect, use, or disclose information about a client without the informed consent of the client or their authorized representative, except as permitted or required by law" (CRPO Professional Practice Standard 3.1). Both Colleges also require therapists to explain the limits of confidentiality to clients at the start of therapy.

Confidentiality is also a legal concept that applies to every regulated health professional in Ontario, including Registered Social Workers and Registered Psychotherapists. The Personal Health Information Protection Act, 2004 (PHIPA) sets the rules for the privacy of personal health information in Ontario, and requires that it be kept confidential and secure — subject to the specific exceptions described later in this article.

This means that your therapist can’t chat about your life with anyone, show their notes about you, or detail what you share in any other way, except under specific circumstances (we’ll get back to those exceptions in a minute). It is important to note that as the client, you are free to share as much or as little as you want to with others about your sessions. Confidentiality in this case refers to the barriers in place for your therapist surrounding your personal health information.

There are basic confidentiality expectations every practice must follow but they can each also have an additional set of rules. 

At Trillium, every therapist is a Registered Social Worker or a Registered Psychotherapist, so the rules described in this article come from their regulatory Colleges and from Ontario law rather than from any one practice's policy. If you are still working out what therapy involves and who you might work with, our psychotherapy page is the place to start.

In certain instances, you may wish to have your therapist share information about your sessions with someone else. If there is someone you would like your therapist to communicate with, such as a doctor, you will be asked to sign a formal release of information, giving them permission to do so.

In practice, the sensitive details you share with your therapist stay between you — unless one of the legal exceptions described below applies, or you ask for information to be shared.

Why does it matter?

It’s important for patients to feel free to discuss sensitive topics during therapy. Healing requires taking a clear-eyed look at your life. Knowing that your words won’t get back to the people in your life can help you open up about what you’ve experienced. Therapy is meant to be a shame-free zone.

Additionally, some people still experience social stigma around mental health problems. You shouldn’t have to worry that people will find out that you’re getting mental health support if you don’t want them to. Even the fact that you’re being seen in their office is something a mental health professional should not share.

Basically, confidentiality exists to protect you and give you a safe place to explore difficult experiences and emotions. You shouldn’t have to worry about other people’s opinions or judgments during such a vulnerable process. 

Will my employer or insurance companies know I am in therapy?

In Canada, the confidentiality of your therapy sessions is generally protected by privacy laws, and your employer or insurance companies should not have direct access to the details of your therapy without your explicit consent.

If you use insurance benefits provided by your employer for therapy, the information shared with the insurance company is generally limited to essential details for processing claims, ensuring that specific therapeutic content remains confidential. It’s essential to review and discuss consent forms with your therapist at the outset to understand the boundaries of confidentiality and to address any concerns about the privacy of your therapy information.

Confidentiality in Mental Health Counselling

PHIPA guidelines for confidentiality include:

Personal health information

Personal health information is identifying information about a client. It can be in verbal, written or in electronic format, and does not necessarily include the client’s name. If a client can be recognized, the information is considered personal health information; it includes information in the client health record. Information that does not allow the client to be identified is not personal health information and is not subject to PHIPA.

Consent to the collection, use, and disclosure of personal health information

Counselling centers typically do not collect or use information about a client without the informed consent of the client or the client’s authorized representative, nor does the member disclose information about a client to anyone without the written informed consent of the client or the client’s authorized representative, except where disclosure is permitted or required by law.

Circle of care and “lock box”

The terms “circle of care” and “lock box” includes other health professionals who provide care to a client, other providers in a multidisciplinary setting, and other providers to whom the member has referred a client. PHIPA allows some health providers to assume in certain circumstances that a client has provided implied consent to disclose his/her personal health information to another individual within the circle of care or to a specific health care provider. Despite this generality, however, a client may indicate that s/he does not want certain information (or any information) shared, even within that circle. In this circumstance, the practitioner must not share the information. This is called placing information in a “lock box.”

Release of client information by Registered Psychotherapists

Because of the sensitivity of what is shared in psychotherapy, the College of Registered Psychotherapists of Ontario asks its registrants to take particular care before disclosing client information to other care providers. PHIPA allows health providers, in some circumstances, to rely on a client's implied consent to share information within the circle of care. Express consent is required under PHIPA whenever information goes to someone outside the health-care system, such as an insurance company, an employer's benefits plan, or a family member (CRPO, PHIPA guidance). Social workers follow the equivalent standard under the OCSWSSW's Principle V. Each Trillium therapist's regulator and registration number are listed on their profile, which you can reach from the team section of our psychotherapy page.

This standard is not intended to prevent members from sharing client information within a care team such as those found in a hospital or agency settings, nor in an emergency situation. 

Professional discretion should be employed, and only relevant and necessary personal health information may be disclosed.

In obtaining informed consent from a client to disclose his/her information to any third party, the therapist must explain what information will be disclosed, to whom, the reasons for the disclosure, and the time-frame within which disclosure is to be made. The therapist should report back to the client following the disclosure.