Confidentiality, Privileged Communications, and Mandatory Reporting
Domain 4 tests the limits of confidentiality and the counselor's affirmative reporting duties.
General rule
Maryland protects mental health information and recognizes a client-held privilege for licensed counselor communications. A counselor may disclose only with a valid written authorization or when a statute or regulation requires or permits disclosure. Privilege belongs to the client, not the counselor, and a subpoena alone is not a court order. When records are subpoenaed, the counselor should verify authority, seek client consent, or ask the court for protection before releasing.
Mandatory and permitted disclosures
- Child abuse or neglect must be reported to the local department of social services or law enforcement under Maryland's child abuse reporting law.
- Abuse or neglect of a vulnerable adult must be reported to Adult Protective Services.
- Disclosure may be permitted to prevent imminent serious harm, but Maryland does not give counselors a broad, unconditional 'duty to warn' statute; the counselor should follow the specific regulation and consult.
Worked example
A 15-year-old client discloses that an uncle touched her sexually and begs the counselor not to tell. The counselor explains the limits of confidentiality already in the informed-consent document and makes the report to the local DSS or law enforcement. The counselor does not investigate first and does not wait for the parents' permission.
Traps
- Promising absolute confidentiality in the first session.
- Reporting only after confirming the abuse through an internal investigation.
- Releasing the entire record to a parent merely because the client is a minor.