Confidentiality in therapy: what stays between us and where the limits are

You’re sitting across from someone you barely know, weighing up whether to say the thing you’ve never told anyone. The thought you’re ashamed of. The event you’ve carried alone for years. The doubt about your own marriage that your partner has no inkling of. And somewhere at the back, a quiet question: where does everything I say here go? Who will hear it? What if someone finds out who shouldn’t?

That question isn’t paranoia — it’s healthy caution. You can only trust if you know what happens to what you’ve entrusted. That’s why confidentiality in psychotherapy is regulated very precisely: by professional ethics, by the rules of the field and, to a large extent, by data protection law. And that’s exactly why you deserve to have someone explain it to you honestly for once: what stays between you and your therapist, where the rare, clearly defined exceptions lie, what happens to notes, how confidentiality works when two people come to therapy — and what you’re allowed to ask your therapist about all of this.

In this piece I go through all of it in turn. No euphemisms and no small print.

Why confidentiality is the foundation, not an add-on

Therapy only works in depth — and people only go deep where it’s safe. That isn’t a platitude but a measurable fact: research on disclosure in therapy consistently shows that clients leave a great deal unsaid. Barry Farber and colleagues at Columbia University have spent decades studying what people keep back in therapy, and find that the large majority of clients at least occasionally conceal or edit something from their therapist — most often themes bound up with shame: sexuality, suicidal thoughts, a sense of failure, and also doubts about therapy itself. And the key finding: the safer and more accepted a person feels, the more they say — and the more they say, the more therapy can do.

Put the other way round: without confidentiality there’s no disclosure, without disclosure there’s no depth, and without depth there’s no change. Confidentiality is therefore not a courtesy or an administrative formality. It’s a working condition of therapy — the way sterility is a working condition of an operating theatre. I’ve written in more detail about how therapeutic change grows out of safety in the piece on why the therapeutic relationship heals.

Confidentiality has one further, less obvious function: it protects your autonomy. What you say in therapy, you say in order to understand yourself — not so that anyone can use it for you or against you. A space where you can think out loud without consequences is extraordinarily rare in adult life. Therapy is one of the last such spaces, and confidentiality is the wall that holds it up.

What confidentiality covers — more than you may think

Confidentiality doesn’t only cover the content of conversations. It covers considerably more:

• The content of sessions — everything you say, ask, describe; including what you say in passing, at the door or in an email.
• The very fact that you’re in therapy. Without your permission, a therapist confirms to no one that you’re their client — not to your partner, your parents, your employer or a friend who’s “just asking”. If we meet in the street, I won’t greet you first — not out of rudeness, but because greeting you in front of your companions would reveal that we know each other. If you greet me, of course I’ll be glad to respond.
• Your personal data — contact details, appointment times, the reason you came, everything that’s written down.
• Information about third parties you mention. What you say about your partner, parents or colleagues stays in the same room as everything else.

This obligation doesn’t apply only during therapy. It applies after it ends too — and even after a client’s death. Nor is it lifted by a therapist’s anger, curiosity or convenience: confidentiality doesn’t depend on circumstances but on professional commitment.

The basis for all this is professional ethics. The ethical codes of psychotherapy associations — in Slovenia the codes of therapy chambers and associations, and abroad, for example, the code of the American Association for Marriage and Family Therapy (AAMFT) or of the European Association for Psychotherapy — place confidentiality among the first and strictest obligations. A breach of confidentiality isn’t a “slip-up” but one of the gravest professional violations, one that can cost a therapist their licence. To this is added European data protection law (GDPR), which classes health and therapy data as especially sensitive.

Exceptions: rare, narrow and always in the service of protection

Now, honestly, about the thing many people are afraid to ask: are there situations in which a therapist may or must break confidentiality? Yes, there are. They’re rare, narrowly defined and all have the same purpose — to protect life. It matters that you know them in advance, because it’s precisely the vagueness around them that feeds mistrust.

• Immediate danger to life. If a therapist has reasonable grounds to judge that you are seriously and immediately endangering your own life or someone else’s, they may — and in certain cases must — bring in help: emergency medical services, family, the relevant authorities. The emphasis is on immediate danger: the thought “sometimes I wish I weren’t here”, familiar to many people in distress, isn’t grounds for breaking confidentiality — it’s grounds for a conversation. We therapists are trained to distinguish between pain that needs words and a crisis that needs immediate protection.
• Abuse or neglect of a child. If a therapist learns of the abuse or serious neglect of a child (or of another person unable to protect themselves), they have a legal duty to report it. This exception isn’t a matter of judgement — it’s a legal obligation on all of us, not only therapists.
• Court order. In rare cases a court can require information from a therapist. Even then the therapist discloses only what is strictly necessary, and the profession requires them to protect whatever they are permitted to protect.

That, broadly, is all. Not “a bad day”, not “an interesting case over lunch with colleagues”, not a call from your worried mother. The American psychologist Mary Alice Fisher, who developed one of the most widely used ethical models for handling confidentiality, emphasises exactly this: a client has the right to learn in advance, at the start of therapy, where the limits of confidentiality lie — so that they can decide for themselves what to entrust. A good therapist will set out those limits at the introductory session, not only once they’d become relevant. How an introductory session works in general I’ve described in the piece on the first session with a therapist.

And one more reassuring truth from practice: the vast majority of therapists break confidentiality rarely or never across an entire career. The exceptions exist to protect life in an emergency — not so that anyone can rummage through yours.

Supervision: who else “hears” your story — and how

Here I have to be personal, because it concerns my own work directly. I’m a therapist in training in marriage and family therapy, which means I work under regular supervision: at regular intervals I review my work with an experienced supervisor who watches over the quality and ethics of my practice. You’ll find more about my path and training on the My Approach page.

What does that mean for your confidentiality? In supervision we talk about the therapeutic process — about what’s happening in the work, where it gets stuck, what I could do better. Strict rules apply: the client isn’t identifiable. No name, no identifying details, nothing by which anyone could recognise you. My supervisor is also bound by exactly the same duty of confidentiality as I am — supervision doesn’t dilute confidentiality, it doubles it, since two people are now responsible for it.

Supervision is in fact an extra safeguard for you: it ensures that your therapist isn’t working alone inside their own head, but that a second pair of experienced eyes regularly reviews their work. The same goes for peer consultation and professional discussion among colleagues — always without identifying details, always in the service of the quality of your care. If you’d like to know how your care is supervised, you have every right to ask.

Notes: what a therapist writes and where it’s kept

The sight of a therapist’s notebook unsettles many people: what are they writing? As a rule, very little and very practical — themes that opened up, agreements, threads running between sessions, what to pick up next time. Notes are a therapist’s working tool, not a diary of your life, and rules apply to them too:

• They’re stored securely — in a locked space or in protected, encrypted digital form, separately from the data that would link a note to your name.
• Only the therapist has access to them. They aren’t part of any shared health record and they don’t go anywhere without your explicit consent.
• Under GDPR you have the right to know what data your therapist holds about you, and to request its deletion once your care has ended (subject to statutory retention periods).

If you ever want to know what your therapist has written — ask. The question isn’t distrustful; it’s adult. And a therapist who takes offence at such a question has told you something important about themselves.

Confidentiality for two: secrets in couples therapy

Couples and family therapy is a chapter of its own — a field I’m training in and have written about separately. When there are two people in the room, the question of confidentiality gains a new layer: what happens if one partner tells the therapist something the other doesn’t know — in an individual session, on the phone, in a message? An affair, a hidden debt, an intention to leave?

Therapists handle this through a secrets policy agreed in advance, which the couple hears at the start of the work. In practice there are two common approaches:

• A no-secrets policy: the therapist says in advance that they won’t keep individual secrets from the other partner — what one of them confides can become part of the shared work. This approach protects the therapist’s neutrality: the therapist can’t be one partner’s ally against the other.
• Limited confidentiality: the therapist protects individual disclosures in principle, but reserves the judgement that work built on the concealment of something essential can’t continue — and in that case tells the couple so without revealing the content.

Which approach is “right” matters less than the agreement being clear in advance — among those writing about this in the professional literature are Jeffrey Younggren and Eric Harris, who point out that an unclear secrets policy is one of the most common sources of ethical trouble in work with couples. Outwardly, the same holds as in individual therapy: what happens in your sessions goes nowhere — not to your mother-in-law, not to a lawyer, not into any legal dispute between you, apart from the statutory exceptions described above.

Questions you’re allowed — and would be wise — to ask your therapist

Confidentiality isn’t a subject you should have to guess about. At an introductory session (or at any point later) you can ask entirely concrete questions:

• Where are the limits of confidentiality? In what cases would you break it?
• Do you work under supervision, and how is my anonymity protected there?
• What notes do you keep, where do you store them and who has access to them?
• What happens to my data once therapy ends?
• (In couples therapy:) What is your policy on one partner’s secrets?
• How do you handle it if we meet in public?

A good therapist will answer these questions calmly, clearly and without evasion — and will probably address most of them before you ask. If you get vague answers or a sense that the question is unwelcome, that’s important information when deciding whether this is the therapist for you.

Safety you can check — and then forget about

The best thing about well-handled confidentiality is that you eventually forget about it. For the first few sessions you may still weigh your words; then the thing that makes therapy work at all happens — you start speaking for real. Only then does it become clear how much energy it has cost you to constantly manage, filter and adjust what you say to other people.

In my work I notice that the deepest shifts often begin with exactly this sentence: “I’ve never told anyone this.” Not because a secret is magical in itself — but because in that moment a person tests for the first time whether their truth can be held by someone. And when it is held, something loosens: what has been locked away for years finally gets some air.

If you too are carrying something that’s waiting for a safe space, you know where to find me — on the Contact page. And everything I’ve written above applies from the first minute of our first conversation.