In My Experience
Confidentiality is broken if there is a strong and reasonable belief that someone is in harm's way, whether my client or someone else. I have broken confidentiality to protect suicidal clients when I have known that they have the intent, a plan, and the means to significantly harm or to kill themselves. Similarly, I would break confidentiality with regard to homicidal intent that appeared credible and when I believed a client has the intent, plan, and means to significantly harm or kill someone else. I would break confidentiality to protect someone unable to protect themselves, such as a child, teen, or elder. This has taken various forms over my career and has included involving child protective services or elder protective services when the person at risk is unable to protect themselves.
For most clients, there is rarely a need to break confidentiality.
If this situation presents itself, I notify clients about my mandate to break confidentiality. With parents, I notify them, and keep the lines of communication between us open. This is not a time for us to stop talking, it is a time for us to continue talking very honestly.
Selected excerpts from the American Counseling Association Guidelines, 2005
"Counselors recognize that trust is a cornerstone of the counseling relationship. Counselors aspire to earn the trust of clients by creating an ongoing partnership, establishing and upholding appropriate boundaries, and maintaining confidentiality. Counselors communicate the parameters of confidentiality in a culturally competent manner. Counselors hold ongoing discussions with clients as to how, when, and with whom information is to be shared. Counselors respect client rights to privacy. Counselors do not share confidential information without client consent or without sound legal or ethical justification."
"In group work, counselors clearly explain the importance and parameters of confidentiality for the specific group being entered. In couples and family counseling, counselors clearly define who is considered “the client” and discuss expectations and limitations of confidentiality."
"When counseling minor clients or adult clients who lack the capacity to give voluntary, informed consent, counselors protect the confidentiality of information received in the counseling relationship as specified by federal and state laws, written policies, and applicable ethical standards. Counselors inform parents and legal guardians about the role of counselors and the confidential nature of the counseling relationship. Counselors are sensitive to the cultural diversity of families and respect the inherent rights and responsibilities of parents/guardians over the welfare of their children/charges according to law. Counselors work to establish, as appropriate, collaborative relationships with parents/guardians to best serve clients. When counseling minor clients or adult clients who lack the capacity to give voluntary consent to release confidential information, counselors seek permission from an appropriate third party to disclose information. In such instances, counselors inform clients consistent with their level of understanding and take culturally appropriate measures to safeguard client confidentiality."
Breaking Confidentiality
Confidentiality is broken if there is a strong and reasonable belief that someone is in harm's way, whether my client or someone else. I have broken confidentiality to protect suicidal clients when I have known that they have the intent, a plan, and the means to significantly harm or to kill themselves. Similarly, I would break confidentiality with regard to homicidal intent that appeared credible and when I believed a client has the intent, plan, and means to significantly harm or kill someone else. I would break confidentiality to protect someone unable to protect themselves, such as a child, teen, or elder. This has taken various forms over my career and has included involving child protective services or elder protective services when the person at risk is unable to protect themselves.
For most clients, there is rarely a need to break confidentiality.
If this situation presents itself, I notify clients about my mandate to break confidentiality. With parents, I notify them, and keep the lines of communication between us open. This is not a time for us to stop talking, it is a time for us to continue talking very honestly.
Selected excerpts from the American Counseling Association Guidelines, 2005
"Counselors recognize that trust is a cornerstone of the counseling relationship. Counselors aspire to earn the trust of clients by creating an ongoing partnership, establishing and upholding appropriate boundaries, and maintaining confidentiality. Counselors communicate the parameters of confidentiality in a culturally competent manner. Counselors hold ongoing discussions with clients as to how, when, and with whom information is to be shared. Counselors respect client rights to privacy. Counselors do not share confidential information without client consent or without sound legal or ethical justification."
"In group work, counselors clearly explain the importance and parameters of confidentiality for the specific group being entered. In couples and family counseling, counselors clearly define who is considered “the client” and discuss expectations and limitations of confidentiality."
"When counseling minor clients or adult clients who lack the capacity to give voluntary, informed consent, counselors protect the confidentiality of information received in the counseling relationship as specified by federal and state laws, written policies, and applicable ethical standards. Counselors inform parents and legal guardians about the role of counselors and the confidential nature of the counseling relationship. Counselors are sensitive to the cultural diversity of families and respect the inherent rights and responsibilities of parents/guardians over the welfare of their children/charges according to law. Counselors work to establish, as appropriate, collaborative relationships with parents/guardians to best serve clients. When counseling minor clients or adult clients who lack the capacity to give voluntary consent to release confidential information, counselors seek permission from an appropriate third party to disclose information. In such instances, counselors inform clients consistent with their level of understanding and take culturally appropriate measures to safeguard client confidentiality."
Breaking Confidentiality
- "The general requirement that counselors keep information confidential does not apply when disclosure is required to protect clients or identified others from serious and foreseeable harm or when legal requirements demand that confidential information must be revealed.
- When subpoenaed to release confidential or privileged information without a client’s permission, counselors obtain written, informed consent from the client or take steps to prohibit the disclosure or have it limited as narrowly as possible due to potential harm to the client or counseling relationship.
- To the extent possible, clients are informed before confidential information is disclosed and are involved in the disclosure decision-making process. When circumstances require the disclosure of confidential information, only essential information is revealed."