How to Keep Confidentiality in Psychotherapy


Secure your records. Psychological notes should be stored in a locked cabinet. Keep your office locked when you are not in the room.


Remove any identifying information when making a professional consultation. Use a client's initials, and do not disclose where a client works, his address, his phone number or any other information that could lead a colleague to identify the client. Only give information that is necessary to fulfill your purpose.


Discuss limits of confidentiality with your client before therapy begins. In cases of suspected child or elder abuse, you are mandated by law to report abuse to protective services. If your client makes a threat to harm either herself or someone else, you have a duty to protect your client and the public by contacting authorities.


Put confidentiality agreements in writing. Include information about the records you will keep during therapy, any additional agencies the records will be released to and the limits of confidentiality. You and your client must both sign this agreement prior to beginning therapy.


Prepare an additional form of consent if you plan to record your client's voice or image for your own record keeping or for learning purposes. If you will be using a recording for academic case presentations, include this information in the consent form. Clients have the right to refuse being recorded.


Clarify at the beginning of treatment what information will be shared and with whom when working under special circumstances, such as working with minor children, couples or families. Put this agreement in writing. Discuss with minor children that you cannot completely guarantee confidentiality in all circumstances.

Tips and Warnings

  • Mandated reporting laws vary from state to state. Stay updated on the laws specific to the state you practice in.
  • Psychologists who do not abide by ethical or legal guidelines may be reported to the Board of Psychology and can lose their licenses to practice.
  • Confidentiality in psychotherapy is critical in building trust with a client. It is important for psychotherapists to know what precautions are necessary to take in protecting client records. It is also necessary to know what the limitations of confidentiality are and to discuss client privacy before beginning therapy.