Privacy, Protection, and Prevention: The Future of Therapist Confidentiality
“Mental health is just as important as physical health”. While this statement is incredibly popular in our modern society, there is a very select number of individuals who truly embody the concept. Therapists are one of those rare groups of people who truly see the importance of mental health and help stabilize it. The relationship between a client and their therapist is thus incredibly important and powerful… There must be a high level of trust in the therapeutic alliance for the therapy to be effective. The client must feel completely - unconditionally - supported and understood by their therapist, and this is where confidentiality comes in. A therapist must protect private details about their client at almost any cost to ensure that the client feels safe enough to confide in the therapist. The question is, where is the line that separates confidentiality from danger? To what extent is confidentiality the utmost priority? If the therapist knows that a client poses a specific and significant threat to another aspect of society, is it their duty to inform the appropriate authorities? The answer, of course, is that there must be a balance. Therapists should be allowed to break confidentiality when needed; however, the law must be able to adapt to modern scenarios, and the therapists must ensure they are not divulging personal information for false alarms or making unnecessary statements.
To begin, the most precise definition of confidentiality is that it is the legal and moral obligation of mental health professionals to protect a client’s personal information. This practice, of course, helps build trust and ensure that the client is fully truthful with their therapist. Therapists must adhere to very strict ethical codes regarding this matter, such as those set by the American Psychological Association. While the rules are restrictive, there are certain exceptions. For example, if a therapist is aware of abuse, such as elder or child abuse, they are allowed to break confidentiality. Concrete information about imminent danger to the client themselves or others is another scenario in which therapists can break confidentiality and inform law enforcement, as well as court orders or subpoenas. Nonetheless, these unrevised exceptions are much too narrow for today’s modern society. Threats of mass violence or online danger may not be explicitly uttered by the victim - only somewhat implied - and that is not enough legal basis for a therapist to take action. This can lead to many extreme cases due to the narrow nature of the law.
The case that creates the basis of the law when it comes to therapist confidentiality is Tarasoff v. Regents of the University of California, because it established the duty to protect. In 1969, a UC Berkeley student named Prosenjit Paddar confided in his therapist, Dr. Lawrence Moore, and stated that he wished to kill Tatiana Tarasoff. Dr. Moore did notify the police upon hearing this, and Paddar was detained for an involuntary psychiatric evaluation. However, Paddar was eventually released because he appeared rational. In October of the same year, he killed Tatiana Tarasoff. The Tarasoff family sued the university and therapist for Tatiana’s death, arguing that the therapist was negligent in not informing Tatiana about the danger. The trial court initially dismissed the case, and the Court of Appeals upheld that decision. The case was later taken to the Supreme Court, and the Court ruled in favor of the Tarasoff family, establishing the “duty to warn” intended victims. This specifically outlines that the intended victim must be notified through written or verbal means. However, the Court reheard the case after huge pushback from the psychiatric community, after which the “duty to protect” was established. Duty to protect allows broader intervention to protect third-party danger, protecting the client’s trust in the therapist while ensuring there is no public danger.
The Tarasoff case reveals the importance of breaking confidentiality when needed. First, of course, human life takes priority over confidentiality. As seen in Tarasoff, therapists may be the only people aware of danger. This means they carry the burden of that knowledge and must take the right steps at the right time to prevent a tragedy. On top of this, there is, of course, a therapist’s legal obligation to report any obvious signs of threats. At the same time, it must be acknowledged that a therapist must be precise and cautious if they break confidentiality. Doing so would damage the effectiveness of therapy as clients would fear their personal thoughts being reported, breaking the trust between the therapist and client. This is why therapists must be extremely meticulous in identifying true danger rather than mindlessly reporting something that may be too significant to be considered an issue. Next, it should be acknowledged that predicting violence is very difficult. No mental health professional can consistently and accurately predict the occurrence of problematic behavior, which means that they may inflate a matter that wasn’t a threat in the first place. This can raise questions regarding the overextension of the duty to warn, diminishing the effectiveness of therapy.
So, the question remains: to what extent is breaking confidentiality effective? While the laws that are in place currently - ones that enforce the importance of confidentiality while emphasizing that, in some very specific cases, it can be broken - are working, they are not fully equipped to handle modern concerns. For example, a realistic analysis of modern society must consider online threats. As therapists can only break confidentiality for a credible and identifiable threat, the possibility of online/social media dangers can easily be ignored. A client may disclose their online wrongdoings to their therapist, and, legally, the therapist may not have the obligation to utter a single word to anyone else! This shows that current laws must be adapted to match today’s growing and technological society.
In all, confidentiality in therapy is a very complicated matter. While it is undeniably important to the nature of therapy and the relationship between a patient and their therapist, it is not absolute. Sometimes, public safety outweighs the therapeutic alliance… The law, somewhat successfully, aims to create a balance between the two. Still, it must work to adapt to modern society to ensure that confidentiality remains secure while also guaranteeing protection against all sorts of threats, not just abuse and violence.
Bibliography
“Tarasoff v. Regents of the University of California .” Justia. Accessed May 31, 2026. https://law.justia.com/cases/california/supreme-court/3d/17/425.html.
“Ethical Principles of Psychologists and Code of Conduct.” American Psychological Association. Accessed May 30, 2026. https://www.apa.org/ethics/code.