What is Confidentiality, Exactly?

By Anne decore, LMFT

Confidentiality in Therapy: What You Need to Know

When you sit down with a therapist for the first time, one of the first things you’ll hear about is confidentiality. This isn’t just a formality — it’s the cornerstone of therapy. As a Licensed Marriage and Family Therapist (LMFT), I want to give you a clear picture of what confidentiality means, what the exceptions are, and what you can expect if you happen to see your therapist outside of the therapy office.

Why Confidentiality Matters

Therapy is a space where you should feel free to be open, vulnerable, and honest. Knowing that your words are private helps create the trust necessary for real healing and growth.

The AAMFT Code of Ethics (the professional ethical guidelines for marriage and family therapists) emphasizes this point clearly: “Marriage and family therapists respect and guard the confidences of each individual client.” (AAMFT, 2015, Principle II).

In other words: what you say in therapy stays in therapy.

The Limits of Confidentiality

That said, there are a few important legal and ethical exceptions — situations where your therapist, who is a mandated reporter, cannot keep something private. These limits are in place to protect safety. They include:

• Risk of harm to self: If you express intent and plan to harm yourself and your therapist believes you are in immediate danger, your therapist may need to take steps to keep you safe.

• Risk of harm to others: If you communicate a serious threat of physical violence against another person, your therapist may need to warn that person and/or notify law enforcement.

• Child abuse, elder abuse, or dependent adult abuse: If your therapist suspects or learns of abuse, neglect, or exploitation, your therapist is legally required to report it to the appropriate authorities.

These exceptions are sometimes called the “limits of confidentiality.” The AAMFT Code of Ethics makes it clear that therapists must inform clients about these limits at the start of therapy (Principle II, Section 2.2).

Outside of these situations, your privacy is protected. Your therapist won’t share what you say with your employer, spouse, friends, or family members without your written permission.

What If We See Each Other in Public?

This is a common question: “What happens if I bump into my therapist at the grocery store, gym, or a coffee shop?”

The short answer is: your therapist won’t acknowledge you first.

That might sound cold, but it’s to protect your privacy. If your therapist greeted you in public, it could unintentionally reveal that you’re in therapy. Instead, your therapist will wait for you to take the lead. If you choose to say hello, your therapist will respond warmly.

Some clients are comfortable chatting, others prefer a simple nod — it’s always your choice.

A Final Word

Confidentiality is one of the most important parts of the therapeutic relationship. Our role as therapists is to protect your privacy, help you feel safe, and be transparent about the rare times when confidentiality must be set aside for safety reasons.

If you ever have questions — about what a therapist can or cannot keep private, about what would trigger a mandated report, or about how you’d like your therapist to respond if you see each other in public — please ask. Those conversations are part of building trust, and you deserve clarity.

References:

• American Association for Marriage and Family Therapy. (2015). AAMFT Code of Ethics.