Under which circumstance should therapists break confidentiality?

Breaking confidentiality is a crucial ethical decision for therapists, and it is generally warranted when there is an imminent risk to a client's safety or the safety of others. In the case of a risk of suicide or self-harm, therapists have an obligation to take necessary steps to protect the client. This may include breaking confidentiality to ensure that appropriate interventions can be provided, such as contacting emergency services or a healthcare provider who can offer immediate support.

The principle behind this decision is rooted in the therapist’s responsibility to ensure client well-being. When there is an identifiable threat, protecting the individual from harm overrides the usual confidentiality guidelines. This is aligned with the ethical standards set forth by clinical psychology and counseling associations, which prioritize client safety above all else.

While other scenarios, such as past childhood abuse or suspicion of substance abuse, are significant concerns warranting attention and intervention, they do not create an immediate and actionable risk situation in the same way that potential self-harm does. A client refusing to participate in therapy does not justify breaking confidentiality either, as the autonomy and decision-making of those individuals are respected within therapeutic frameworks.