Confidentiality and Therapy: What Are The Limits?
Updated: Jun 11, 2018
Dear Dr. Schultz:
My friend is a victim of sexual assault, but does not want to report it. She does not want to go through the legal process or have everyone she knows find out. I am not very good at comforting and she does not want to go to a therapist for fear of the incident being reported. Would a therapist be required to report it?
Hello, and thank you for asking this very important question. Limited as you may feel in your ability to provide her with comfort and support, your friend is indeed fortunate to have you in her corner.
It is extremely unfortunate but quite common for individuals who have experienced sexual assault or other forms of criminal victimization to be fearful of coming forward due to concerns about any further trauma which may be triggered by doing so. We can only hope that efforts to reduce the stress of reporting such victimization will persist, and that they will be successful in reducing the cost to those who are ambivalent about telling their stories and seeking justice.
The secondary level of concern that you mention, that of mandated reporting by mental health professionals, is, I am glad to tell you, much more easily allayed. Although I do not know from where in the world you write, I will proceed based on the assumption that your friend resides in the United States (and please feel free to let me know if the facts are otherwise). In the U.S., individual statutory laws and rules vary widely in regard to mandated reporting (and also in what are known as "duty to warn/protect" laws), but the following overall guidelines are typically observed by psychiatrists, psychologists, and other licensed mental health professionals.
Mental health professional are typically permitted and/or required to report to law enforcement or other relevant agencies and parties in some or all of the following circumstances:
1. When the licensed mental health professional has reasonable cause to believe that suspected child abuse has occurred, or is occurring;
2. When the licensed mental health professional becomes aware that abuse, neglect and/or exploitation of a disabled adult or elder person has occurred or is occurring;
3. When the licensed mental health professional becomes aware that a patient under their care is potentially violent and has made a clear threat of harm toward a readily identifiable intended victim; and
4. When the licensed mental health professional becomes aware that a patient under their care poses a significant and acute risk for self-harm.
Again, these are broad guidelines that are interpreted differently depending on individual state law, but all are observed to some degree by licensed mental health professional. In addition, the definition of what constitutes "abuse," "harm," and "significant risk" are varied and complex. However, these are the only circumstances in which a mental health professional is either compelled or permitted to violate the "doctor-patient" confidentiality attendant to the therapeutic relationship. Thus, disclosure by your friend that she has been the victim of a crime would not, in any case, be the grounds for required reporting by any mental health professional.
Thank you again for posing your question to me, and I hope that at least some of what I have written here has been of use to you in your efforts to support and guide your friend. Please feel free to write again to let me know how your friend reacts to this information, and/or if you have any additional questions.