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Summary
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A former therapy client asks whether a psychologist may contact their employer after receiving an email describing suicidal intent and a specific plan. The question raises both confidentiality and the professional's responsibility to respond to immediate danger.
The legacy response says confidentiality and any previously agreed information-sharing arrangements matter, and distinguishes employer contact from disclosures made to arrange urgent protection.
It describes possible exceptions when there is serious risk of self-harm but does not give blanket permission to share information, stressing that the exact circumstances influence what steps are appropriate.
Question
Reader · Identity withheldAs a former patient of a psychologist, I recently indicated to my former therapist in email that I was suicidal, every intension of killing myself with a set plan and resist any intervention. Does he/she have the right to contact my employer ? Lisa in Oregon
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Answer
Mark Vigil Dombeck, Ph.D.There are several issues at stake in the scenario you describe, each of which influences what your therapist can (or must) do.
\nThe first issue has to do with the circumstances under which you entered into therapy with this psychologist. It is important whether your employer asked you to go into therapy and paid for that therapy, or whether you initiated and entered and paid for therapy independently. This is important because it gets to the issue of who is the therapy \"client\", to whom the therapist has responsibilities towards. In situations where one person is paying for therapy and another is receiving therapy, there can sometimes be two clients, both of whom have some right to information about therapy progress. In situations where parents send their minor children to therapy, this situation happens all the time. It is less common with adults, but it can happen then as well.
\nIt is a part of a psychologists’ ethical responsibility to identify the potential for such dual client situations in advance of their occurring, and to warn all participants of the potential for information sharing in an explicit informed consent document that should occur before therapy begins. So in your case, if your employer was paying for your therapy and expects to have in return some access to information about your care, this should have been made clear to you before you began talking about your problems. In an ideal situation you should have had the opportunity to decline to allow information sharing with your employer, or at least decline to participate in therapy under the circumstances.
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A separate issue has to do with the limits of legal confidentiality in cases of suicide. Under normal circumstances, a psychologists’ therapy client enjoys a right to confidentiality such that it is illegal (as well as unethical) for a psychologist to share information about your therapy with outsiders. This protection has a few loopholes, however, and one of them is that therapists have a duty to protect their clients which trumps their duty to keep confidentiality. If your psychologist comes to believe that you are acutely at risk of harming yourself with a reasonable expectation that death may occur, he or she then has a duty to take reasonable steps to get you hospitalized, or similar acute care capable of defusing your suicidal impulse. In carrying out this duty, your therapist might call the police and alert them that you are acutely suicidal and need to be brought to the hospital, and might conceivably also contact your significant other or similar persons who could assist in helping to keep you safe. This is not a blanket permission to broadcast your status to anyone, however, and under normal circumstances, it would continue to be inappropriate to inform your employer about your suicidality.
\nThe final issue that pops into my mind has to do with the past nature of your therapy relationship with this psychologist. You are framing this therapy as having occurred in the past. You might think that because the therapy relationship is over, that this should afford you special privacy protections. I don’t think this is the case. In choosing to communicate your acute desire and intention to harm yourself to your former psychologist, you are, I believe, implicitly reactivating the therapy relationship with that psychologist (e.g., by demonstrating your acute need for care).
\nTo sum up the situation, I don’t think that in most cases I could think of that your psychologist would have any right to communicate your psychological care status to your employer without you having knowledge in advance of that fact and being obligated to warn you of this in advance of your disclosure. However, under the suicidal circumstances you’ve described, your psychologist does have an obligation to take active steps to keep you safe, which might very well include breaking confidentiality with you in order to get you hospitalized.
\nLet me close by saying that I hope you will reconsider your attitude towards suicide, which is most often not a good or reasonable solution for the problems that plague you or your family. I hope you will read our suicide article which talks about ways to cope with suicidal feelings.
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