Can you keep a secret? Confidentiality in psychotherapy

Confidentiality is the secret-keeping duty that arises from the establishment of the professional relationship psychologists develop with their clients. It is a duty created by the professional relationship, it is set forth in the American Psychological Association's (2002) Ethical Principles and Code of Conduct, and it is codified in many state regulations. However, the difference between confidentiality and legal privilege; how, why, and when it can be violated; and the reasons for so doing are not well understood by many practitioners. While on the surface confidentiality might seem to be an easy concept to apply to professional practice, in fact it is quite complex and filled with exceptions that frequently differ from circumstance to circumstance and from state to state. A lack of respect for and a lack of familiarity with the significance of these exceptions could have dire professional consequences. This article reviews the ethical imperative of confidentiality and then provides examples of legal cases that help to better understand its complexity. Then, we offer strategies designed to help metal health practitioners when they are confronted with questions regarding confidentiality and privilege.