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.

Reflecting After Therapy

By Jessy Weston, amft

Therapy is a space for exploration, healing, and personal growth. While the time spent in a session can be transformative, much of the real work happens in the days between appointments. Reflection is a powerful tool to maximize the benefits of therapy and can help you deepen your self-awareness and understanding.

If you’re wondering how to make the most of your time between sessions, consider these ways to reflect and observe your experiences.

After Your Session: Pausing to Process

Take some time after your session to sit with what came up. What moments from the session stood out the most? Perhaps it was a moment of clarity, a difficult emotion, or even something that left you with more questions than answers.

Notice how you’re feeling, both emotionally and physically. Are you leaving the session feeling lighter, hopeful, or energized? Or are you feeling unsettled, exhausted, or reflective? There’s no right or wrong way to feel, but identifying your emotions and bodily sensations can help you connect more fully with your experience.

You might also reflect on whether you had any “aha” moments. Did something your therapist said click into place? Did you notice a new way of looking at a familiar pattern? These small epiphanies are worth holding onto as they can often guide you in your journey forward.

Observing Your Week Between Sessions

Therapy doesn’t stop when the session ends. The week between sessions is an opportunity to notice how the work you’re doing in therapy shows up in your daily life. As you move through your week, notice how you’re applying insights from therapy. Maybe you’re trying out a new coping strategy or challenging a negative thought pattern. Reflect on how these actions feel—are they helpful, awkward, or even challenging? It’s okay if things don’t click immediately; progress often happens in small steps. Or maybe you’re noticing moments when you feel particularly activated or calm. You can ask yourself what triggered these feelings as understanding these shifts can help you see connections between your thoughts, feelings, and behaviors.

Preparing for Your Next Session

Reflection also sets the stage for a more focused and productive therapy session. As your next session approaches, think about what you want to bring into the conversation. Is there something from the previous session that you’d like to revisit or clarify?

You might also reflect on what you’d like to prioritize going forward. Are there specific goals or themes that feel especially important right now? Therapy is a collaborative process, and your reflections can help shape its path.