Confidentiality, Privileged Communications, and Exceptions
Confidentiality and privilege
- Confidentiality is the therapist's ethical and legal duty not to disclose client information without authorization; privilege is the client's evidentiary right to prevent compelled testimony or records in legal proceedings.
- Maryland's psychotherapist-patient privilege generally covers licensed MFTs. The therapist asserts it on the client's behalf unless the client waives it.
- Privilege is not absolute: waiver, court order after review, client litigation that puts mental condition at issue, and statutory exceptions can override it.
Exceptions to know
- Mandatory reporting of suspected child abuse or neglect, and abuse or neglect of a vulnerable adult.
- Imminent serious danger to the client or an identifiable other: take reasonable protective steps, such as emergency evaluation, warning the target, or notifying police, disclosing only the minimum necessary.
- Emergency medical care, Board investigations authorized by law, and disclosures required by other statutes.
- Minors: guardians usually consent, but confidentiality and disclosure limits must be explained in developmentally appropriate terms.
Worked example
A client says he has a gun and plans to shoot a named coworker at work tomorrow. The MFT may disclose the minimum information needed to protect the coworker and document the threat, rationale, and steps taken. The MFT should not tell the client's employer's entire staff or post about the threat. If the threat is vague and not imminent, the duty is to reassess and document rather than automatically disclose.
Traps
- Believing the therapist owns the privilege.
- Disclosing to family members who are paying for treatment without authorization.
- Treating every threat as a duty-to-warn case or ignoring a clear imminent threat.
- Overlooking mandatory abuse reporting.