What should one not tell/ask his/her psychiatrist, psycholog, or threapist?

How should I talk to my to therapist? What kind of questions should not be asked or what sort of happenings should not be told? Are therapists/psychiatrists/psychology tolerant to extreme things?

What is the risk of being even more hurt when I seek some kind of psychological sympathetic buttsex from the therapist to encourage myself to continue living on about my pathetic excuse of a life?

You don’t have to blow your entire wad all in the first session. Just ease into it and let information trickle out as you become more comfortable.

In general, communications with your licensed therapist should be covered under doctor-patient confidentiality, though they’re free (if not required) to rat you out if you say “I am planning to shoot up my workplace tomorrow and will kill my boss last so he has to spend the longest being afraid.” So if you have a reputable therapist I’d say talk about whatever you need talking about. If you don’t feel free to be utterly honest, you need a new therapist, and your current one should be willing to give you a referral. It’s important to be both comfortable and honest with your therapist.

I understand that therapists, at least in California, are required to tell the authorities if you admit to committing child sexual abuse, no matter how long ago it was. “Abuse” in this case, of course, meaning any sexual conduct at all with an underage young person. I don’t know about other types of (presumably secret) crimes that you might have done in the past, but I would feel safe discussing anything short of murder or the above-mentioned child sexual abuse.

Don’t ever admit to looking at underage porn as this counts as child abuse and as something they must report you for. If you have this problem and want help for it only speak in hypotheticals

According to this story about a psych worker who was fired for reporting a client’s child porn search, you are only permitted to break confidentiality if you know the name and address of the child being abused.

And if the patient discloses that information, I don’t think clever “hypothetical” phrasing is going to get them off the hook.

That’s interesting. Perhaps this is one of those things that are different from state to state. I was told by a counselor (in Oregon) who specifically looked up the law to make sure he was following it properly that he had to report any mention of someone admitting to “being in possession of” underage pornography. So I guess if you just say that you had done it in the past but don’t have any NOW, that’d be ok.

Still a risky thing to talk about with a counselor, anyhow. Definitely ask about it first I guess.

I must amend my statement: Looks like the worker in the story I linked to violated company policy, not APA guidelines.

I tried to apply for a long term disability policy once and to complete medical underwriting they required me to release all my medical records including psychotherapy notes. I thought it was an interesting position that I’d never thought of.

In other words, don’t assume that everyone has to respect your confidentiality rights as if they’re inviolable. Nothing was keeping the private insurance company from flat out refusing to write a policy if I wouldn’t release my records, and I was free to never get a disability policy written if I wanted to keep my privacy.

I’ve never seen it in writing, but the rumor at my workplace is that if the company’s health plan is paying for your therapy, the therapist is supposed to report any illegal drug use. It is a written policy that illegal drug use is grounds for immediate termination unless the employee has admitted drug use and is seeking treatment.

Do not tell your therapist you are planning to skip out on the bill.

If you feel that any kind of medications might be helpful for you, you have to be very careful and diplomatic if you want to ask about it. You could get labeled as a “drug seeker”, with unpleasant consequences.

This was discussed recently in several threads, mostly about pain medications. But it could apply to various kinds of psych medications too.

To answer a serious question with a serious but humorous answer:
No matter how many years you’ve been her patient, Do NOT ask your shrink “Oh, are you pregnant?”

Ask me how I know.

She wasn’t.

They are required by law to report to police any knowledge (or even suspicion, in some cases) of certain activities.
Child abuse and suicide are best not mentioned - the former can get you jailed; the latter committed against your will.

I will now get flamed for telling a fragile personality of the real risks of talking about certain subjects. I did not create these huge holes in the doctor-patient confidentiality - I just report them.

These laws vary by jurisdiction. A call to a local legal help line might put your mind at ease.

You’re not going to get committed just for suicidal ideation, mind you. I think you’d need to be more pro-active than that for it to lead to committal. Or, at least, that’s my experience (never been committed, but discussed suicide plenty).

You will not be committed just for saying you have suicidal ideation. Unless you to go a bad professional who doesn’t know what the hell they are doing.


I have firsthand knowledge of this.

In california involuntary three day psych commital is called a 5150. When I was in the hospital this one time I met a patient who had just been commited under involuntary. Her husband had recently passed, he was a cop. One of his friends who also was a cop called to ask how she was and she told him she missed her hisband and wished she could be with him. The friend interprwted that to mean she planned on joining him at any moment. He called for help and she said the cops and fire department shiwed up at her door. The cops placed her on a 5150 and brought her to the mental hospital. After a few days the doctor saw she really wasnt a danger to herself and she was discharged.

At your first session, you’re testing them out as much as they’re sizing you up. I didn’t talk about much of anything at all my first session with my current therapist, but she was patient and the next time I saw her we started getting into the real reasons I was there. If you’re not imminently suicidal and you feel it’s a safe place, then yes, your therapist will be able to tell you how to keep living your life, regardless of the weird shit you tell him. Don’t give up, you are worth the effort.

No doctor is going to think you’re a drug addict looking for medication if you ask if an SSRI or atypical antipsychotic is appropriate for your symptoms. This is really only an issue with medications with high likelihood of abuse/addiction, such as benzodiazepines, opiates, and stimulants.

Even then, if you are willing to accept it when the doctor explains why they don’t think that a benzo, opiate, or stimulant is an appropriate medication for your situation, it probably won’t be a problem. It’s just that some doctors are very jaded because prescription drug abuse/addiction is a HUGE, HUGE problem nowadays. Back when I was working in outpatient medicine, it was quite a routine occurence that I had to say no to a drug addict looking for opiates, benzos, and/or stimulants without any medical basis for needing them.