This is part of our Guide to Legal and Ethical Requirements for Therapists in California.

In California, as in every state, therapists have a legal and ethical obligation to maintain confidentiality of almost everything that clients tell them in therapy. Confidentiality generally includes the very existence of the therapist-client relationship. But there are exceptions, which are described here.

When breaking confidentiality is allowed or required, the therapist is only allowed to disclose the relevant information necessary under the circumstances.

When are therapists REQUIRED to break client confidentiality?

Therapists in California are legally required to violate confidentiality of what clients tell them in the following situations:¹Note: most in this list are found in Cal Civil Code Sec 56.10(b)

• Client is imminent danger to themself²Bellah v Greenson,  81 Cal. App. 3d 614 (1978)
• Client is imminent danger to others³California Welfare and Institutions Code sections 8100 and 8105; Tarasoff v. California Board of Regents
• Client is considered “gravely disabled” because of mental illness or substance use disorder, unable to provide basic needs for food, shelter, clothing, personal safety, or necessary medical care⁴California Welfare and Institutions Code section 5008
• Therapist has reasonable suspicion that child, elder, or dependent adult abuse is occurring
• Court order or subpoena from court
• Investigation by board, commission, or admin agency
• Lawful request from arbitrator or arbitration panel
• Search warrant
• Coroner’s investigation, when client’s death is being investigated
• Request for records from client or client’s representative

When are therapists ALLOWED to break client confidentiality?

Therapists in California are allowed but not required to violate client confidentiality in the following situations:⁵Note: most in this list are found in Cal Civil Code Sec 56.10(c)

• When client poses threat to property of another (including pets)
• Communicating with other health care providers for purposes of treatment
• Determining responsibility for payment, and for payment to be made
• To billing, claims management, or other process
• To an official review group for quality control
• Licensing or accreditation body for the health care provider
• As part of coroner’s investigation when death investigated is not the client’s
• For research purposes
• To a local public health dept (e.g. contract tracing)
• Related to employment, if information comes from employment-related health care services, e.g. when client has made their mental condition the focus of a lawsuit against their employer
• When client signs release of information

Would it be an ethical violation if a therapist broke client confidentiality when they were legally allowed to but not required to?

Most therapy ethics codes allow breaking confidentiality when required or allowed by law.⁶AAMFT Code of Ethics subprinciple 2.2; ACA Code of Ethics subprinciple B.1.c; CAMFT Code of Ethics subprinciple 2.1; NASW Code of Ethics subprinciple 1.07(e)

Related

Guide to Legal and Ethical Requirements for Therapists in California

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