Worry about privacy keeps many people out of therapy, or keeps them from saying the thing they most need to say once they get there. People with anxiety often run through the worst case: will my employer find out, will my spouse be told, will this end up in a file somewhere? The honest answer is that confidentiality in therapy is strong, it has a few clear exceptions, and a good therapist will explain them before you need to know.
This is general information, not legal advice. If you have a specific legal concern, such as a custody case or a lawsuit, talk with an attorney as well as your therapist.
The two layers of protection
The first layer is federal. HHS explains that the HIPAA Privacy Rule gives you rights over your health information and limits who can see and receive it, whether it is electronic, written or spoken. Covered providers include most health care providers who bill electronically, and HHS names psychologists explicitly.
The second layer is Michigan law. The Public Health Code says a psychologist cannot be compelled to disclose confidential information learned from a client in their professional role, and that information may be shared with the client's consent or under a few listed laws. Michigan's Mental Health Code adds rules for privileged communications with psychiatrists and psychologists and for records held by public mental health programs and licensed facilities. Other licensed therapists, such as counselors and social workers, have their own confidentiality provisions.
What stays private
- What you say in sessions, including thoughts, feelings, fantasies, past events and things you are ashamed of
- The fact that you are in therapy at all, in most settings
- Your diagnosis and treatment details, unless you authorize their release or they go to your insurer for payment
- Information about your partner or family members that you share in your own sessions
Having thoughts of suicide, feeling intense anger, or describing intrusive thoughts that frighten you does not by itself break confidentiality. Therapists hear these things often. Saying them out loud is usually the start of getting help with them, not a trigger for a report.
The exceptions, in plain language
A serious threat to someone else
Michigan's duty-to-warn law is narrow. It applies when a patient tells their mental health professional about a threat of physical violence against a reasonably identifiable person, and the patient appears to have the intent and ability to carry it out in the foreseeable future. In that situation, the professional must act, for example by beginning hospitalization, or by trying to warn the person and notifying police. The statute also says that outside this situation, there is no general duty to warn. Venting that you could "kill" your boss in a figure-of-speech way is not what the law describes.
Suspected child abuse or neglect
Michigan's Child Protection Law names psychologists, counselors, social workers, marriage and family therapists and physicians among those who must report when they have reasonable cause to suspect child abuse or neglect. The report goes to the state's centralized intake. This applies even when the therapist's client is an adult, for example a parent describing what is happening at home.
Court proceedings
Under the Mental Health Code, privileged communications are not disclosed in court or administrative proceedings unless you waive the privilege, with listed exceptions. The main ones: you put your own mental condition at issue in a case, such as a personal injury claim; an exam was ordered by a court and you were told it would not be privileged; or you sue the professional for malpractice. A subpoena alone does not automatically open your file, and therapists commonly consult an attorney before responding to one.
Emergencies and safety
If you are in immediate danger and cannot stay safe, a therapist may contact emergency services or involve people who can help. Ask how your therapist handles this. Many will tell you that their first step is to work out a plan with you, not around you.
Family, partners and employers
HHS explains that a provider is not required to share your information with family or friends unless they are your legal personal representative. A provider may share relevant information with someone involved in your care if you agree or do not object, or, using professional judgment, if the provider believes you would not object. You can say clearly who may and may not be told. Your employer generally cannot get your therapy information from your therapist without your permission, and Your Rights at Work With Anxiety or Depression in Michigan covers what you do and do not have to disclose at work.
If you use insurance, your plan receives billing information such as dates, a diagnosis code and the type of service. It does not receive a transcript of what you said. Some people choose to pay privately for this reason; that is a personal decision with cost trade-offs.
Questions to ask at your first session
- What are the limits of confidentiality in your practice?
- Who would you contact in an emergency, and would you tell me first?
- What goes to my insurance company?
- If I bring my partner to a session, what happens to what I said privately?
- How do you handle email, texts and the video platform?
If you are considering therapy for anxiety or depression, these questions are worth asking any therapist before you begin. For what your records contain and how to see them, read Your Rights to Your Mental Health Records in Michigan.