Confidentiality in Therapy and Treatment
December 9th, 2024
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 4th 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”.
