MUE - I really feel for you So much going on all at once. So much stress!

I agree with Blue, that in most if not all states, you'd have to do a lot worse than that to be declared an unfit parent. But, if you have a reasonable amount of trust in your T, how about raising your concerns openly with him? Ask your T what sorts of things he would feel compelled to report. You could tell him that concern about that is getting in the way of your therapy because you don't know to what extent your confidentiality will be honored. T's take that very seriously, as well they should since productive therapy cannot take place without an expectation of confidentiality. Then you can discuss with him how he can help you feel supported when a lot of things happen at once and when you are already feeling stressed and vulnerable. Maybe you two can come up with an action plan that can take the place of meds or SI. And BTW, congrats on avoiding SI - that took strength under the circumstances! I'll bet you are a very good mom, MUE.

Early on in my therapy, I would still use less than optimal ways of self-soothing. I finally plucked up the courage to ask my T whether he would feel he needed to record anything I told him about in my official record, e.g. for insurance. He looked absolutely horrified, and we had the discussion I'm suggesting you and your T have. Then I realized how committed he is to protecting me and my confidentiality. He is my advocate, not the state's or the insurance company's. And he is not there to judge me. This new awareness was the beginning of my trust in our relationship, and I was able to be more forthcoming in what I told him.