My Therapist Shared My Secrets, and Other Horror Stories
When therapists can't keep their patients' private information to themselves.
Posted Mar 19, 2018
“My therapist’s boyfriend is a friend of mine, and he told me he knows that I’m one of her patients. I’m certain she told him about me, and now I’m uncomfortable whenever I see him.”
“When I confronted my therapist about breaking my confidentiality and telling my husband what I’d said in therapy, he rationalized it by saying he had needed my husband’s help with the therapy.”
“I heard about a man who told his therapist he was thinking about shooting President Obama, and he ended up being arrested by the Secret Service and having to plead guilty to a felony.”
Whenever I first meet a new patient, I always initiate a brief and pointed conversation about confidentiality. “Everything you say to me stays here,” I tell them, “although there are three exceptions to that rule.” I then explain the three cases in which I’ll need to break confidentiality: if the patient poses a danger to his or her own life, if the patient is clearly planning to put someone else in danger, and if a child is being harmed or abused. These confidentiality-breaking situations represent my obligation, as a New York State psychologist, to protect the public from threats of which I may become aware.
New patients are often, understandably, curious and even a tiny bit concerned about my threshold for breaking confidentiality. “If I tell you that I broke the law, do you have to call the police?” they’ll ask. They may be concerned about using illegal drugs, and worried that this information will get back to their employers (or their insurance carrier). I always explain that I do not need to report prior violations of the law, or even any intention to violate the law that cannot result in immediate harm to the patient or to another person. I may well do my best to talk the patient out of his or her intention to break the law, under the assumption that such actions may be detrimental to the patient’s long-term well being, but I won’t have to call the police in those circumstances.
“My psychiatrist said to her secretary, out loud in a full reception area, that she wanted ‘all patients with PTSD to have two sessions a week, from now on,' just after I walked out of the therapy room. I felt like everyone knew she was talking about me.”
“My new therapist asked my old one to email her a case summary, but my old therapist accidentally emailed it to his entire professional listserv, instead, and hundreds of people got to read what he thought about me.”
Different states have different laws about the duty to warn — or the duty to protect — as these professional obligations have become known. In New York State, where I practice, a 2013 law requires me to report on patients whom I deem to present a “serious and imminent” danger to themselves, or to others, when psychotherapy is not enough to ensure that their harmful intentions will not be acted upon. (New York also enables the authorities to confiscate guns from people deemed dangerous by their therapists.) In return for these protections, New York State law indemnifies therapists who act in “good faith” when making reports about their patients. Twenty-eight other U.S. states, as well as Puerto Rico, currently have laws establishing a psychologist’s obligation to protect others from harm at the hands of his or her patient. (To be clear: settled law suggests that psychologists do not have a duty to warn society about nonspecific threats made by a patient, like “I’m so mad I feel like punching someone in the face.” Nor must a psychologist extrapolate from current circumstances to possible future circumstances, as in predicting that someone who owns a rifle would someday, in a fit of rage after a family dinner, shoot his in-laws with it.)
The duty to warn originated in California, in a 1976 state Supreme Court case. Back then, a university psychologist became convinced that one of his patients, Prosenjit Poddar, was pathologically attached to a woman named Tatiana Tarasoff (who did not return his interest), and might act out violently toward her. The psychologist notified the university police about Poddar, and the police interrogated Poddar but found him rational enough to release. Poddar broke off contact with his therapist, and after several months, attacked and murdered Ms. Tarasoff. Her family sued the university health center staff, as well as the police; although the case was dismissed by the trial court and the appeals court, the family appealed to the United States Supreme Court and received a ruling in their favor. According to the Supreme Court ruling, the university psychologist had a professional duty to advise Ms. Tarasoff (or her family) of the threat Mr. Poddar had made. The court ultimately stated that a therapist is obligated to use his or her professional skills to evaluate the dangers that his or her patients may pose, and to protect third parties from these dangers.
“The psychologist my mom hired is telling her about me, behind my back — and now my mom insists on coming to my therapy appointments, so she can tell the therapist her version of whatever I say.”
“My stepfather started going to therapy with my psychiatrist, in secret, just so he could hear from the therapist about whatever I’d said in therapy that week.”
Outside of this obligation to protect the public, however, psychologists are not entitled to break confidentiality at their discretion. Stories in which a patient’s information is disclosed to a third party — an acquaintance of the therapist, or someone in the client’s family — represent a breach in duty. While therapists may choose to contact a family member if the patient is a danger to himself or to others, in cases where the patient is not a minor and no other person is involved in the treatment, confidentiality is a firm rule. And if you pay for your psychotherapy with insurance, your insurer is entitled to limited information about your therapy: the dates of your sessions, the services performed (i.e. evaluation or psychotherapy), and your diagnosis. Paying out of pocket is one way to keep any such information out of the hands of insurance companies.
Your therapist may legally choose to speak about you to other professionals (i.e. psychiatrists, physicians, social workers) who are involved in your care, or to another therapist who is supervising your treatment. It is also permissible for therapists to write about their patients in books or professional literature, as long as any distinctive details are removed or sufficiently altered to mask your identity. If you’re a teenager — younger than 18 years old — your therapist may include your parents in your treatment, and may elect to disclose to them material you might otherwise wish to keep private. In such cases, therapists treating teenagers have the responsibility to inform these patients about their confidentiality policies ahead of time. Even if a therapist is legally able to communicate with a young patient’s parents about his or her treatment, doing so can still be construed as a betrayal if it takes place outside the agreed-upon boundaries of the treatment.
“I went to the school psychologist every week for six months, when I was in tenth grade. I had no idea that she was repeating everything I said to my father. Word for word.”
“My mom and stepfather sent a letter to my therapist about me, and in it they gave away a lot of things I hadn’t shared yet. My therapist wrote back and told them all kinds of things I that THEY didn’t know about me. I never went back to that therapist.”
Even so, the data on breaches of confidentiality shows a surprisingly high rate of unethical disclosure. In 1993, the New York Times reported on an 1987 survey of five hundred psychologists, of whom 62% said they had accidentally breached a patient’s confidentiality, 50% agreed that confidentiality was the ethical mandate that was easiest to violate without meaning to, and 8% admitted that they sometimes talked inappropriately about their clients by name. As recently as 2004, up to 15% of the cases looked into by the Ethics Committee of the American Psychological Association cited confidentiality as a factor; while I haven’t been able to find more recent data, the trend suggests that this problem hasn’t gone away.
If this happens to you — if you are certain that your therapist has violated your confidentiality in a way that makes you feel uncomfortable and does not have to do with your treatment, you can report him or her to the state licensing board for psychology. However, this may not be an easy decision; making a report about confidentiality violations will likely require you to speak at length, and on the record, about your therapy, which could make the experience a difficult one. There are no easy answers to the problem of confidentiality violations in psychotherapy. The best recourse might be to discuss the matter with someone you trust fully and implicitly — a friend, a family member, or even another therapist, although the difficulties inherent in such a choice may be obvious. The benefits of psychotherapy themselves rest on the promise of confidentiality, and when this trust is broken, rebuilding it can take quite some time.
Fisher, M.A. (2008). Protecting confidentiality rights : The need for an Ethical Practice Model. American Psychologist 63 (1), 1-13.
Goleman, D. (1993, April 14). What you reveal to a psychotherapist may go further. The New York Times, pp. C12-13.
Koocher, G. P. & Keith-Spiegel, P (2016). Ethics in Psychology: Professional Standards and Cases, 4th Edition.
Pope, K. & Bajt, T. R. (1988). When laws and values conflict: A dilemma for psychologists. American Psychologist 43 (10), 828.
Pope, K., Tabachnick, B.G., & Keith-Spiegel, P. (1987). Ethics of practice. The beliefs and behaviors of psychologists as therapists. American Psychologist 42(11), 993-1006.
Wachtel, M. (August 2013). What happens when a therapist breaks a client’s confidentiality? Retrieved from http://www.psychlawjournal.com.