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what does confidentiality in therapy mean?, list of exceptions to confidentiality in mental health therapy,

What Does Confidentiality Mean in Therapy? 

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 mean? Confidentiality, a fundamental aspect of the therapeutic relationship, is not just a legal and ethical obligation but a cornerstone in fostering trust and creating a safe space for open and honest exploration. Let’s walk through the basics of confidentiality, what the exceptions are, and understand legal and ethical considerations that underpin this crucial aspect of psychotherapy. As a Registered Psychotherapist, the commitment to confidentiality goes hand in hand with fostering a trusting and secure therapeutic relationship.

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.

According to the American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct, “Psychologists have a primary obligation and take reasonable precautions to protect confidential information obtained through or stored in any medium, recognizing that the extent and limits of confidentiality may be regulated by law or established by institutional rules or professional or scientific relationship.”

Confidentiality is also an important legal concept that applies to all other regulated health professionals, including Registered Psychotherapists. The Personal Health Information Protection Act, 2004 (PHIPA) establishes the rules relating to confidentiality and privacy of personal health information in Ontario. PHIPA requires that personal health information be kept confidential and secure.

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. 

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.

For the most part, you can be confident that the sensitive details you share with your therapist aren’t going to leave the room. 

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

Due to the nature of the psychotherapeutic relationship, the sensitivity of information shared between client and therapist, and because of the particular weight placed on the duty of confidentiality by the psychotherapy profession, this College requires a higher standard of confidentiality than is set out in PHIPA regarding the circle of care. Specifically, the College requires members to obtain written consent before disclosing information to any other party, including other health professionals. This also applies to sharing information with individuals such as the client’s spouse, or contacting any third party, such as third-party payors, insurance companies, or Employee Assistance Program for billing purposes.

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. Members providing care as part of a team should enter into written agreements with clients explaining what information will be shared with other providers in the team context.

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.

Exceptions to Confidentiality in Mental Health Therapy

Although confidentiality is important, there are situations where a therapist is compelled to share information. For example, if someone’s life is in danger, from either suicide or homicide, the authorities must be notified. Another valid reason to break confidentiality is if a vulnerable person, such as a child, someone with a disability, or an elderly person, is being abused.

The specific rules vary slightly by practice. As a client, you should receive a document outlining how your therapist handles issues of confidentiality.  Here are the situations that would be typical exceptions to releasing personal information.

1. With written consent

If we need to share information with another party, we will ask for written permission and have the client fill out and sign a “release of information consent form.” In the case of couples therapy, both partners would be required to complete the form.

2. Threats of harm

If a client is making suicidal threats toward themself or homicidal threats toward another person, we have an obligation to involve the appropriate authorities. This does not mean anyone with thoughts of harming themself or others needs to be reported, but if someone has concrete plans to hurt themselves or others, it’s vital that they get immediate intervention.

3. In the case of a sexual relationship with a healthcare professional

If a client discloses a sexual relationship with a regulated healthcare professional, we have a legal obligation to report it.

4. In cases of child abuse

Child abuse, including sexual and physical abuse and neglect, will be reported. Also, if a child is at risk in significant ways, including being exposed to domestic violence or coming in contact with known abusers, a call will be made to Family and Children Services.

5. By legal order

Occasionally, the court mandates a counsellor to disclose information, whether by testifying in court or submitting their files. This is a legal obligation that cannot be ignored.

6. In couples therapy

Although partners do not have access to each other’s information in individual therapy, couples therapy is different. Information is freely shared in couples therapy, and open communication is an important part of the process.

Trillium Counselling can give you a safe place to open up

The compassionate mental health professionals at Trillium Counselling are here to support you. If you’re interested in pursuing therapy, please contact us today to schedule an appointment. We are happy to answer any questions you have about confidentiality and how it works for you. 

*The general contents of this website are provided solely for educational and informational purposes and are not meant to provide professional medical or psychiatric advice, counselling or therapeutic services. The information provided on our website in in regards to confidentiality in counselling and mental Health settings may vary based on your region and regulations / practices, and may have been updated since the posting of this article. This article is not designed to be a full depiction of confidentiality rules / regulations / practices.  When starting therapy, it is always important review the terms of service agreement and to discuss any questions or concerns you may have regarding confidentiality with your therapist prior to beginning.*

Therapist - Devon Jorge

Devon Jorge

About The Author
Devon holds a Masters Degree in Social Work and is a Registered Social Worker MSW, RSW - Psychotherapist with more than a decade of experience. With additional postgraduate certificates including Marriage and Family Therapy from the University of Guelph, she has expertise in working with couples, individuals, and families. Devon has a strong commitment to evidence-based therapies and has received training from renowned therapists like Dr. John & Julie Gottman, specializing in Couples Counselling. She is well-versed in addressing complex issues, including affairs and PTSD events, and is an EMDRIA Certified Therapist, demonstrating proficiency in trauma-focused therapy, particularly using EMDR.

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