Therapy and keeping secrets

As I understand it, doctors, lawyers, priests, and therapists have privilege with regards to being able to (and required to?) keep their clients’ secrets except in the case that their client is planning to hurt somebody. So:

  1. Is it just planning to hurt someone, or is it the planning of any crime? How about knowledge that a crime has already been committed?

  2. Are they required to report potential negligence? Suppose a therapist is counseling a husband and wife, both as a couple and separately. He know the husband is having an affair. Obviously cheating by the husband could potentially result in the wife getting an std. Is the therapist required to tell the wife? Does it matter whether or not she’s also a client? What if the therapist knows that the condom broke? What if he knows that the condom broke and the other woman has an std? Has AIDS? Has AIDS but the condom didn’t break?

  3. What about other negligence? Violating safety rules in a workplace? Being careless with childcare?

Last time I checked (I can check again this wednesday), therapists were required by law to report a patient who was planning on hurting or killing another person. If I say “I’m going to kill Bob”, Doctor L is required to contact the police (provided she believes it to be a credible threat.)

There is no requirement to inform police of any past crimes I confess to.

If the therapist knows a case of child abuse or neglect, they are again required to contact the proper authorities.

People who are in positions of trust that qualify them to regularly receive confidential information are typically well versed in setting out the boundaries of what they will and will not do with the type(s) of information they are likely to receive. When you see something documented like “confidentiality and its boundaries reviewed,” this is what is meant.

In situations where this is not done for one reason or another (say someone shows up in the ER voicing a plan to kill his neighbour), there are usually laws, protocols, and acts to guide responses just like for everyone else. Some will meander about the grey areas if they feel comfortable taking calculated risks. It is likely that different types of professionals in positions of trust will resolve the issues you described somewhat differently based on their experience and the design of acts and laws in place where they are practicing.

Take the example of a father who reports to his longtime doctor that he slapped his toddler son in a sudden loss of temper last week. While the local child protection act might dictate that this uniformly be reported and investigated, this is by no means what happens in every instance – say in one instance the doctor is his psychiatrist who’s been treating him for bipolar disorder, and in another the doctor is the orthopedic surgeon who’s been treating his carpal tunnel syndrome. If he tells the same thing to a divorce lawyer vs. a construction lawyer, again – different responses.

And priests, well, they run the whole gamut of responses. Your mileage may vary.

First, it varies by state or province.

No–the client (or the client’s legal guardian) holds the privilege. Therapists (I’ll speak specifically about therapists) maintain the client’s confidentiality unless there is a legal or ethical reason confidentiality may or must be breached.

Depends on the jurisdiction, the way the law is worded there, and in some cases, the clinician’s assessment of the likelihood of the client committing harm (or other crime identified by law), the immanence of the crime, and, in some cases, whether breaching confidence is required or merely permitted (i.e., the degree to which the clinician may choose to breach or not to).

No. Some therapists who practice family therapy have a “no secrets rule” that they discuss up front, i.e., “I will not keep any secrets that you tell me in your individual sessions.”

Generally, no.

Depends on the state and the history of this kind of case in the state. It also depends on the person’s intent, e.g., did he intend to kill his wife with HIV? This is the kind of situation where consultation with an attorney familiar with both the profession that provides confidentiality and state HIV-related law is very valuable.

Safety rules: No. Careless with childcare will depend on what that jurisdiction’s definition of child abuse and neglect is, and how the therapist is required to respond.