Confidentiality, privileged communication, and mandated reporting
Two different duties
Confidentiality is the professional and legal duty not to disclose. Privilege is the client's evidentiary right to keep the therapist off the witness stand; in Indiana the mental health privilege in IC 34-46-3-1 extends to licensed marriage and family therapists. The holder is the client, or a guardian for a minor; only the holder waives. Exceptions include the client placing their mental condition in issue, court-ordered examinations, mandatory reports, and disclosures required in a Board investigation. HIPAA may also govern if you are a covered entity, and substance-use records may carry additional federal protection.
Mandated reporting in Indiana
- Child abuse or neglect: report immediately to the Department of Child Services hotline, 1-800-800-5556, or to local law enforcement. Good-faith reports carry immunity; knowingly failing to report is a criminal offense under IC 31-33-22-1.
- Endangered adults: report to Adult Protective Services, 1-800-992-6978, under IC 12-10-3.
- Danger to third parties: Indiana has no general statutory duty-to-warn. A therapist may disclose what is necessary to protect an identifiable person, and should document the risk assessment and the reasoning either way.
Worked example
A 15-year-old client discloses that a parent struck them with a belt, and the parent in the waiting room asks what was said. The report goes to DCS immediately; the therapist does not confirm clinical details to the parent, explains the reporting duty and safety plan at the level needed, and documents the disclosure, the report, and the time it was made.
Traps that cost marks
- Believing privilege blocks a mandated report; it does not.
- Believing a release authorizes every disclosure; releases are scope-limited.
- Forgetting that family and group sessions create multiple holders of the privilege.
- Assuming a supervisor's involvement breaches confidentiality; it is within the treatment team.