Confidentiality in Therapy and Treatment

By P. Casey Arrillaga, LCSW, LCDC

Confidentiality is a central theme in any type of psychotherapy, with roots going back to the earliest days of the profession. This idea became highly influential in treatment for addiction and other mental health disorders in part because of the stigma associated with these issues. Today, it is taken for granted by many people that therapy and treatment will keep strict standards of confidentiality, yet there are still some who don’t realize this is true, and so they fear seeking help. This post explores what confidentiality is, how it benefits those who get help, how it is protected by law, and what its limits are.

What We Know So Far

The idea of patient confidentiality goes back to at least the 4^th century BC when the Hippocratic Oath taken by medical providers included the idea that it would be shameful for a practitioner to disclose what they learn in the course of treating someone. This idea has been included in the earliest medical codes of ethics in England and the United States, and for centuries has been considered a foundational principle of medical treatment.

Belief in confidentiality naturally became part of the growing field of psychotherapy, because the early practitioners were medical doctors who would have taken the Hippocratic Oath. As mental health grew to include new professions, such as social work, psychology, and then professional counseling, the principle of confidentiality has been held as fundamental to that treatment.

Even lay treatments, such as Twelve Step recovery groups, consider confidentiality to be a bedrock principle. It is announced at every meeting, often as part of the opening and/or closing readings, that who is seen and what is said at the meetings is to be kept in strictest confidence.

Many people who aren’t familiar with therapy and other treatment for mental health don’t realize this, though. They can be scared that what they share with a therapist will be told to others. This is especially frightening for those who are ashamed or embarrassed about their past, their behavior, their family situation, etc. Many people have gone through trauma that they have told themselves must be kept hidden for life. Sometimes other people have reinforced this idea. Unfortunately, such a misconception can act as a barrier to getting help.

For this reason, laws have been put into place to ensure that confidentiality is kept. Mental health professionals are required to keep the secrets of their clients not only as a matter of ethics, but also as a requirement of keeping their professional license. Federal law protects all healthcare information through regulations such as HIPAA, but the need for additional protection for the confidentiality of substance-abuse clients was recognized decades earlier. Thus, federal law (called 42 CFR part 2) offers additional protection for anyone getting treatment for alcohol and other drug abuse. This was done so that when those seeking recovery from addiction understand that their confidentially will be kept, barriers can start to come down and recovery can begin.

It is important to note that there are some limitations to confidentiality. These vary by jurisdiction, but the overarching principle is that confidentiality can and even must be breached when a professional learns that their client is at high risk of suicide or that a child is being abused or in imminent danger. In some places, this is expanded to include elderly people being abused or otherwise in danger. Laws vary by state as to whether professionals have a duty to break confidentiality if they know their client is intending to kill someone else. At treatment centers, the identity of a client and other details can be given to law enforcement if a crime is committed on campus. In all such cases, only enough information to accomplish the task at hand can be revealed.

How Can We Use This Knowledge to Help People?

At Windmill, we hold confidentiality to be a bedrock principle at all times. We go to any length to protect the identity and any other detail of all our clients. If a client chooses to give permission for us to reveal information about them or their treatment to anyone else, including family members or others who may be paying for treatment, we still limit what we give out to the minimum necessary to accomplish that client’s goals. Clients have the right and ability to instantly revoke this permission at any time. We have turned away countless requests for information about our clients and will go to the mat to protect our clients and their families. All of this is to make sure our clients’ safety comes first, as well as building trust with our clients that Windmill is the safest possible environment in which to make the life-altering changes that recovery can deliver.

The Bottom Line

Confidentiality is one of the most important principles in healthcare of all kinds, and especially in caring for addiction and other mental health issues. By protecting confidentiality, we make it possible for people to enact the change they seek in their lives.

About The Author

P. Casey Arrillaga is the Team Leader for Education at Windmill Wellness Ranch, and he is the author of books including “Realistic Hope: The Family Survival Guide for Facing Alcoholism and Other Addictions”.