What you need to know about confidentiality: when you have it, when you don’t.
I’ve been blogging about police and first responders with Psychology Today for a couple of years. My most popular post was about cops and PTSD. On the first day of 2021, I saw a comment on that post made in response to an earlier comment left by a reader who had clearly been through a lot in his time as a cop.
“…therapists are not your friend and really could care less about you as a person. Never ever talk to them. They are liberal scumbags or they wouldn’t be in that career. Rely on close friends.”
I can only imagine the writer of this unpleasant comment has been somehow harmed by an incompetent therapist. I’m sorry for that. Just like cops, therapists range from great to ghastly. And just like cops, it isn’t fair to paint us all with the same brush.
So, how do you find a therapist you can trust if you need one? Not because you’re broken and need fixing, but because the psychological strain of working as a cop in a pandemic and a wave of anti-police sentiment may be causing you or your family problems or triggering old issues.
In a previous blog post, I wrote about the reason cops are resistant to consult a clinician. Top of the list were understandable concerns about confidentiality. So here are some things you need to know about the protections and limitations of the client/therapist relationship.
- Confidentiality is the professional and ethical duty to refrain from disclosing information from or about a client. Therapists who break confidentiality risk losing the license required to practice and open themselves up to lawsuits.
- Privilege is legal protection from being compelled to disclose communications (including records). You, the client, not the clinician, holds the privilege. We clinicians will make every attempt to honor your privilege. The 1996 Health Insurance Portability and Accountability Act (HIPPA) has fortified patient confidentiality even further.
- Exceptions to confidentiality: While there may be variations from state to state, the exceptions to confidentiality are similar to those of other mandatory reporters, like yourselves.
- Imminent threat of violence to self or others. If you are a threat to yourself or others, your therapist has a duty to warn your intended victim(s) and to inform the police. Therapists do not take this duty lightly; they won’t break confidentiality on the basis of a statement such as “I’m so mad at my wife I could kill her,” but they will ask questions to determine if you are serious. And they’ll do the same if you seem depressed or make comments about ending your life.
- If you are so gravely disabled that you can’t care for yourself.
- If you are physically, emotionally, or sexually abusing a child, an elderly person, and in some states your spouse, your therapist must report it to the police or to the appropriate protective agency. But if you reveal that you have been abused as a child—this is quite common among LEOs and very important to talk about in an atmosphere of trust and safety—your therapist is not required to report the abuse unless there is reason to believe your abuser is still harming children. If you are being abused by your mate, your therapist is not obliged to disclose this information unless your life is in danger.
- Mandatory counseling is not confidential, which is a good reason to go voluntarily before you are ordered. Many if not most clinicians will only need to report that you kept your appointments and not disclose the content of your conversations. If you are mandated, you can still get something out of your sessions, including the opportunity to save your job.
- Fitness-for-duty evaluations are never confidential because your employer, not you, is the client. You should receive a written statement from the evaluating therapist that describes the scope of the evaluation, the limits of confidentiality, what information may be disclosed to your employer, and the potential outcomes and uses of his or her report. The information reported is generally limited to the following: 1) enough information to document the presence or absence of job-related psychological problems that can be expected to interfere with your ability to do the job, and (2) a clear opinion about whether you are permanently or temporarily fit (with or without accommodations) or unfit. Details of your past and present life should not be included in the report. Fitness-for-duty evaluations are appropriate when an employee engages in observable, problematic, job-related behavior. They should never be used as punishment or as a substitute for competent supervision.
- There is no confidentiality when attending critical incident group debriefings or getting peer support. The licensed mental health professionals facilitating the debriefing can guarantee confidentiality, but they cannot guarantee that others in the group will keep what is said to themselves. A few states now provide peer supporters with confidentiality; check with your state regulations to determine how your state handles this.
- Worker’s’ Compensation Claims: In some states, when plaintiffs in a lawsuit claim damage to their mental health, they waive the confidentiality of any mental health records, past or present. Even when there is no lawsuit, if you are being treated for a work-related emotional disability, your therapist is required to provide the worker’s compensation insurance administrator with monthly reports about your progress. Your therapist should discuss this requirement with you. Some may offer to show you their report because you have a right to your files. These reports should be limited to the minimum necessary information about your progress and prognosis.
- Insurance carriers and Employee Assistance Programs (EAPs) need information to process your claim. In most instances, information is limited to a billing invoice with the dates of your sessions, services provided, your diagnosis, and the therapist’s fee. Somewhere in the fine print on your insurance policy, you will have been forewarned and given a release to sign.
- Supervision, consultation, and cocktail parties: Therapists consult with supervisors and peers. They should present “cases” without full names or identifying details. This is a form of professional development for the therapist that leads to quality assurance for you, the client. It is different from careless gossip, which is unethical and can result in censure for the therapist. Because therapists usually work behind closed doors, it is easy to hide professional deficits. A mental health professional who engages in ongoing training seeks guidance about difficult cases and operates within the confines of his or her own limitations is the therapist I want for myself and my family.