Confidentiality

My friends and I were discussing patient/ psychologist confidentiality and my friend said for no reason whatsoever can a psychologist reveal anything said during a session unless you say you are going to harm yourself or others. What about PAST crimes? For instance, murder? If you killed someone in the past but no longer seemed to be a threat, would your psychologist tell authorities? We are having a huge debate on this and I am having a hard time finding anything online about this! Does anyone have any info about this?

Therapists work in the "present" so, for all they know, you could be making up the confession of murder (although I'm sure they'd probably believe you, depending on how it was discussed). But confessions to crimes not committed is fairly common like the Ramsey-Benet guy a couple months ago? It's a therapist's job to help you work with your problems, not to judge you or make your life more complicated :-) If you were having troubles with guilt, I'm sure they might suggest you turn yourself in but I can't see many murderers "confessing" to such a thing? Therapists aren't "detectives" in a police sense so they're not going to spend time checking through old newspapers or anything to see if what you say is accurate.

Maybe this will make it a little more clear?

http://pn.psychiatryonline.org/cgi/c.../full/36/12/16

Hi Joyous,

I'm not a psychotherapist, so I don't know the legal ramifications of this question. But I would think this would be an extremely problematic issue for both the therapist and the client if it were to arise in the course of therapy. My guess is that the therapist would encourage the client to turn themselves in to authorities, and confess to the murder, with such a significant crime....because if they truly did murder somebody in the past, the client has proved they can indeed be a danger to somebody else, and in a lethal way. The possibility exists that the client can repeat the behavior if they've done so previously. If the client isn't willing to turn themselves in, I would imagine the psychotherapist may need to consider the possibility of reporting the crime to authorities, even though it breaches client/patient confidentiality. But this is a highly unusual situation! In my experience, therapists work very hard indeed to maintain confidentiality with their clients, and encourage the client themselves to take care of the issue (with appropriate followup) in a situation where they might possibly have to breach confidence, so that the relationship is maintained with the best possible integrity.

Take care,
ErinBear

I asked my therapist this once and he said that he can break confidentiality for the following:

1) admission of abuse of children or the elderly
2) harming yourself or planning to harm someone else
3) patient has sex with a former therapist

We are in Texas so maybe it is a state-by-state thing?

I always thought this was hard.. what counts as harming yourself? Do you have to be actively suicidal or can it just be morbid thoughts? What about self mutilation? Drug use and alcoholism are harming yourself, but I don't think those make you lose confidentiality.. Where do they draw the line?

I think he meat suicide ideation. No I don't think SI at all impacts confidentiality.

Thanks almeda.. that was one of the reasons I was resisting telling my therapist.

I just came right out and asked my therapist. I did that because I was about to tell him about some of my sexually abusive background and was afraid he could tell someone.

But I'm 37 what was I thinking on that anyway? I say talk to your therapist and ask.

Asylumgardens
Just today I told my T that I have thoughts of self harm.He then asked if they were suicide or cutting.I said both.He then asked If I planned to follow through on suicide and I said I have thoughts but I dont have an intention of following them .Yes I think hes concerned,so is my husband,so am I for that matter......yet I walked out of that office.He must trust me.He did ask a few questions but certainly didnt overreact.I feel better sharing that.If I hadnt it would have eaten me up.
Try trusting Asylum.

regarding your specific mention of murder, assuming hypothetically of course... since there is no statute of limitations on the crime of murder he may be required by law to disclose that.

What a therapist is required to report can vary form state to state and you would need to know your state laws to answer that question. Usually telling is limited to immediate treats of self harm or harm to othes or cases of child abuse are required to be reported. I would suggest you ask you therapist what he is required to report by law and he is required to tell you.

Even with laws there still may be much discretion on the part of the therapist about reporting.

I will tell you that I confessed behavior that could have been reported but wasn't; the T saw better opportunities for healing. I will not go into detail.

I think it would be fine to ask a hypothetical question to your T or prospective T. Ask about it without saying it pertains to you and see if you get an answer you feel safe with. I do believe you will get a truthful answer to a truthful inquiry and one that you can trust and move forward with.

It can be quite a turning point even though it's scary at the time.

I don't know why, but this post upsets me. Not that I murdered anyone....but i think that this discussion belongs between T and client....

As Echoes said, there must be some room for each T's feelings, individuation and conscience here. So, know the state law is one thing but knowing, trusting T is another.

If my T thought I was in danger of seriously harming myself, imminently suicidal, then I would hope he would call my husband.....I have had suicidal ideation and SI issues in the past and he has not called anyone, because it wasn't necessary.

just a thought

I'm sorry, I did not mean to offend anyone by my post. I did not even think of it that way. This question was totally hypothetical and it was curiosity on my part about how far confidentiality between a therapist and a patient could go. I'm not seeing a therapist and so I thought of this site to shed some light on this. Thank you all for your posts.

http://www.psych.org/psych_pract/eth...nions53101.cfm This is from the American PSYCHIATRIC Association, opinions of the Ethics committee.

Section 4-E

Question: There has been a series of especially gruesome murders in a community. The similarity of the crimes strongly suggests they have been committed by the same individual, who in all likelihood is mentally ill. A forensic psychiatrist has drawn up a speculative psychological profile. Is it proper for the psychiatrist to make this profile public? If a local psychiatrist believes the profile may be that of a patient, should the psychiatrist report this to the police?

Answer: Since this profile is speculative and not representative of anyone known by the forensic psychiatrist, it is ethical to assist the police by providing them advice about the identification of the killer. If a psychiatrist believes the profile is that of one of his patients, the psychiatrist has the following options: (a) if it appears the problem is now history and future attacks will not occur, the psychiatrist should assist the patient in a decision to go to the police; (b) if there is reason to believe the attacks may continue, the psychiatrist should strongly urge the patient, perhaps with the assistance of the patient's lawyer, to go to the police; (c) if the patient refuses, it is ethical for the psychiatrist to notify the police. Section 4, Annotation 8 (APA) states:

When, in the clinical judgment of the treating psychiatrist, the risk of danger is deemed to be significant, the psychiatrist may reveal confidential information disclosed by the patient.

This is a permissive statement. In some jurisdictions, there is an obligation to report in a circumstance such as described above. (January 1977)

In my ethics class, we were taught to look for an "imminent" threat to self or others. I have a tendency towards thoughts of suicide but I have never attempted it nor have a plan. So, I would have a lower risk for suicide. If the person is of a higher risk, one could do a non-suicide pact and increase session. Pershaps the T could call the client's spouse in front of the client. If the person has a plan, past attempts, the means to do it etc, it might be advisable to recommend hospitalization and move to involuntary if the threat is "imminent." I think some states that have the word "imminent" before threat when it comes to suicide and homicide.
I don't think we discussed a previous crime like murder. I think I would first try to see if the client might try to kill again. I would be required by law to protect people if he/she was an "imminent" threat. If not, I would probably encourage the person to turn themselves in because it might help them to relieve the guilt. However, I would propably not discuss it with anyone except my clinical supervisor/client's Pdoc if in same agency. If the client is not an "imminent" threat, I don't think I could justify reporting it.