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How to discuss confidentiality with therapy patients

It’s key to broach the subject up front so there are no surprises later on.

December 9, 2024 • Updated on August 29, 2025

5 min read

One of the most important components of therapy is confidentiality. When your client knows their thoughts and emotions won’t be disclosed, they can feel safer and more open to being vulnerable. This transparency strengthens the therapeutic relationship and helps you better identify and enact interventions that can help your clients. 

But in certain cases where your client or another person’s safety are at risk, you may be required to breach confidentiality. It’s key to discuss this with your clients up front so there are no surprises later on. Below, learn more about how to discuss confidentiality with your clients and what your responsibilities are as a mandated reporter.

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What are the parameters of confidentiality in therapy?

Ethically, any details about your client should always be confidential, other than in a few rare exceptions where you’re required as a therapist to report a safety risk. This means you can’t disclose any information about your clients to a third party, whether your partner, a friend, or another therapist, without their consent. 

Confidentiality is something that should be discussed as soon as you start seeing a client. “This helps set clear expectations and builds trust in your therapeutic relationship,” says Maddie Tong, a licensed therapist and Headway’s senior associate of clinical education. “It's important to explain what is covered within the bounds of confidentiality, as well as the few expectations where confidentiality must be broken.”

When can a therapist break confidentiality?

As mandated reporters, there are several exceptions that may prompt a therapist to breach confidentiality, though this should happen only if it is legally or ethically required to protect a client or someone's safety. 

Mandated reporting laws are in place to protect people — specifically vulnerable persons including elderly people, children, or those living with disabilities, for example — who often cannot protect themselves from harm. Each U.S. state has its own mandated reporting requirements for therapists, along with guidance about which situations are mandatory to report and how they should be reported. 


Some of the most common mandated reporting situations involve:

  • Threat of harm (to themselves or others)
  • Physical or sexual abuse or neglect
  • Court orders (if a court issues a subpoena for records or testimony related to a patient's therapy)

The client should always be made aware of these instances from the beginning of treatment, so nothing is a surprise should you arrive at a point when reporting is necessary.

How to discuss confidentiality with your patients

Discussing confidentiality does not (and should not) be a one-time conversation. Along with including the ground rules of confidentiality in your intake paperwork, discuss the topic during your intake session. It’s important to be sure you and your client are on the same page about the main points, even if they signed confidentiality paperwork during the intake process already.

“Encourage your clients to ask questions if they have any, and keep the line of communication open,” suggests Tong. Reminding clients of the "why" behind breaching confidentiality where needed (often for their safety) is helpful in building trust and maintaining a safe, secure foundation for your work together.

How therapists should navigate confidentiality and mandated reporting

If you’re not sure how to proceed in a situation, Tong suggests reaching out to a clinical supervisor or trusted colleague for help navigating difficult decisions and next steps in supporting your client. 

Mandated reporting is a big, important responsibility, but it shouldn’t harm your therapeutic relationship. When confidentiality is a part of the conversation from the beginning of treatment, your clients should be aware that mandated reporting is in place to protect people — not to punish them or to betray their trust. 

“Our goal is to be able to best support them and their safety in an ethical way,” says Tong. “The hope is that incorporating confidentiality and the possibility of reporting into the room helps build trust and helps clients feel more secure in the relationship.”

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This content is for general informational and educational purposes only and does not constitute clinical, legal, financial, or professional advice. All decisions should be made at the discretion of the individual or organization, in consultation with qualified clinical, legal, or other appropriate professionals.

© 2026 Therapymatch, Inc. dba Headway. All rights reserved. No part of this publication may be reproduced without permission.

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