What Confidentiality Requirements Exist Between Counselors and Patients or Clients?

When a patient or client begins seeing a counselor, he or she needs help to cope with life problems or changes or with a mental health condition and may already feel vulnerable enough without expressing potentially embarrassing feelings to a stranger. It is essential that patients feel that they can trust their counselors to keep secrets they are told during sessions, which is why confidentiality requirements exist.

The Importance of Confidentiality

Patients going through stressful life changes, traumatic experiences or the emotional roller coaster ride of symptoms of mental illnesses may be especially unwilling to share their most private feelings with a stranger unless they know that their secrets are safe. That's why confidentiality is so important to making counseling effective. A patient who doesn't trust the counselor is unlikely to be honest about their feelings and problems, so he or she may never receive the necessary help to cope with these issues. Such a patient may be reluctant to really try any coping strategies or treatments that are recommended. Ultimately, without trust, there is little point to attempting counseling.

Upholding confidentiality and knowing when to break confidentiality is an important responsibility for counselors of all types, though different types of counselors may encounter different challenges. For example, marriage counselors may encounter couples keeping secrets from one another. Addictions counselors may be made aware of past instances of drug use. Counselors facilitating group therapy sessions must explain confidentiality rules for all group members. Confidentiality is an important part of the ethical codes of the major professional counseling organizations, according to the Zur Institute. Counselors should review confidentiality policies with patients, including restrictions to confidentiality, at the start of counseling.

When Counselors Must Break Confidentiality

Unfortunately, there are some situations in which a counselor will not be able to keep details shared in counseling sessions confidential. For example, a patient may discuss feelings of depression or anger management problems with a counselor and expect these expressions to be kept confidential. If, however, the depressed patient reveals plans to commit suicide or the patient dealing with rage control issues threatens to harm another person, the counselor has legal responsibilities to break confidentiality and alert the appropriate medical or legal authorities to prevent patients from becoming dangers to themselves or others. The same is true for patients who witness child or elder abuse. Counselors may also be required to submit records to authorities in the event that law enforcement agencies request them.

With regards to confidentiality, counselors have complex responsibilities toward their patients. On one hand, they must respect patients and keep their communications confidential when possible. On the other hand, they must make the judgment to break confidentiality when presented when a situation in which legal authorities are involved, or if the patient seems to be a threat to self or others. Though complicated, these seemingly incongruous requirements are essential for the good of the patient and those around him or her.

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