The 4 exceptions to the psychologist’s professional confidentiality

In consultation, confidentiality is very important, but there are situations in which it must be broken.

When studying psychology, professors emphasize over and over again the rules that must be followed in the context of the therapist-patient relationship. Among many of these rules are the confidentiality pact and, of course, the code of ethics reflects this set of rules.

Our patient has the right that the information he/she gives us and everything that happens in the therapeutic context is confidential, and perhaps this is what often puts us "between a rock and a hard place". And the fact is that there are situations in which the psychologists that offer therapy must break the professional secret.. Let us see which they are.

Exceptions: when to break confidentiality as a psychologist

First we must understand that professional secrecy is a very important part of the therapeutic setting. Simply letting the patient know that they can completely trust you, as their therapist, and that everything discussed and done in the session will be confidential, lays the foundation for a positive and productive therapeutic relationship.

That said, the exceptional situations that lead to breaking the psychologist's professional secrecy are the following. of the psychologist are the following.

1. Sexual and Physical Abuse

Being prepared to deal with all types of cases is something that only experience can give. But there are cases that are more difficult than others, and in students, the therapist must position him/herself beyond the framework of therapy and its objectives.

Sexual, physical and psychological abuse is quite common; the problem is that silence and fear usually dominate most of the people who suffer it. In the office, those who put the therapist in a more difficult situation are the children, since there are cases that come to the office because of suspicion of sexual abuse. In these situations, the psychologist must investigate, collect and verify whether the abuse is real or not..

When the therapist finds that such abuse is happening, it is his job to warn the parents, but what happens if the abuser is someone from the nuclear family and none of them take action? This is a very serious question, for it is here that we must break that confidentiality beyond the framework of the family. This will depend on the country in which it happens, but in most cases, the psychologist should immediately report it to other family members and to the appropriate authorities.. Take note, you should only break confidentiality beyond the family setting if none of the child's caregivers do anything to stop this situation.

2. Suicidal patients

Another very common case in the office has to do with patients suffering from depression, especially major depression. In summary, those suffering from major depressive disorder usually present certain characteristics such as sadness, hopelessness, loss of energy, loss or increase in appetite, problems falling asleep and suicidal thoughts or acts.

These patients tend to have crises if they are not undergoing adequate psychotherapy treatment and if they do not take antidepressants under the supervision of a psychiatrist. The most indicated thing is that when noticing suicidal ideas, planning or suicidal acts work with the family and prepare them to be aware of the patient..

What do you do when no family member is aware that the patient wants or plans to commit suicide? This is the moment when you should break the rule of confidentiality and inform parents, siblings or close relatives.

3. Legal proceedings

Occasionally we will see patients who are referred by a court or justice institution.. This means that, at some point, our presence in the process may be necessary, therefore, breaking the professional secrecy.

There are many situations that can reach this point, and all of them put psychologists in complex situations. That is why I suggest knowing the laws and the responsibility that we psychologists have with them, depending on the legal framework of the country.

4. In situations of risk

Any situation that puts at risk the life of the patient or other persons close to him/her (or not close if the case is serious), will oblige the psychologist or psychotherapist to break this professional (or not close if the case is serious), will force the psychologist or psychotherapist to break this professional secrecy, regardless of whether this occurs within the framework of a judicial process or not.

Remember that...

These situations are very special, and for that very reason the psychotherapist breaks the professional secrecy, in order to protect and provide the best possible service.. Otherwise the psychotherapist should not break this commitment.