Are My Therapist’s Notes Really Confidential?

May 05, 2023

The success of therapy is often predicated on the trust in confidentiality. When you show up to your first session, odds are that your therapist has explained to you three situations in which they may have to breach confidentiality, and may do so without your consent. Briefly, they are: 

  1. If the therapist suspects abuse or neglect of a child, disabled person, or elderly person.
  2. If the therapist hears of imminent danger occurring to the client or someone else; and
  3. If a judge subpoenas the therapist or their notes.

Ethically, a client must be aware of these three exceptions in order for them to give their “informed consent.” What if I told you that those aren’t the only situations where your Private Health Information (PHI) MAY be disclosed to a third party? 

Certainly, a therapist may share information with outside parties if they have a written, signed agreement with the client. 

But a therapist may also share information in other situations without written consent. Specifically: 

  1. To a public health authority acting as authorized by law in response to a bioterrorism threat or public health emergency.
  2. In the following situations, the disclosure must be limited to: name and address, date and place of birth, social security number, ABO blood type and rh factor, type of injury, date and time of treatment, date and time of death, and a description of distinguishing physical characteristics. 
    • For purposes of identifying or locating a suspect, fugitive, material witness or missing person
    • About a suspected perpetrator of a crime when victim is a member of the therapist’s workforce (i.e. when a client commits a crime against a therapist)
    • To identify or apprehend an individual who has admitted participation in a violent crime (Source: U.S. Department of Health & Human Services)

There are a few other very specific instances (namely when crimes have been committed), where a therapist MAY share information, but it starts to get a bit in the weeds, and the limits on what information can be shared becomes narrowed. 

What is important to stress, is that in the above situations (1 and 2), a therapist is not REQUIRED to share PHI, but MAY disclose this information.  

Additionally, as counselors, we have an ethical duty to ”protect the confidential information of prospective and current clients. Counselors disclose information only with appropriate consent or with sound legal or ethical justification.” (Source: LPC Code of Ethics)

If you have ANY concerns about how your PHI may be used or disclosed, please speak with your therapist. 

Written By: Mike Rothschild (he/him), M.A., LPC-Associate, NCC, supervised by Michelle Hawn, LPC-S


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