When can a therapist break confidentiality?

In most jurisdictions: imminent risk of serious self-harm, credible risk of serious harm to identifiable others, child or elder abuse/neglect, and court orders. The specific threshold and procedure varies by country and state — know the rules for each jurisdiction where your clients are located.

Clinical Notes and Confidentiality: When You Must Break It (and How to Document It)

Confidentiality is the foundation of therapy — but there are mandatory exceptions. Here's what requires disclosure in most jurisdictions, how to document it, and what changes when you work internationally.

Confidentiality protects the therapeutic relationship — but it is not absolute. In most jurisdictions, therapists have mandatory reporting obligations that override confidentiality. Understanding these limits, and documenting your decision-making correctly when they arise, is one of the most important clinical-legal skills a therapist can have. The complexity multiplies in international practice: the reporting obligations of your client's country may differ from yours.

The standard exceptions in most jurisdictions

Situation	Typical obligation

|---|---|

Risk of serious harm to self	Duty to protect (varies by jurisdiction)
Child abuse or neglect	Mandatory reporting
Elder or dependent adult abuse	Mandatory reporting in many jurisdictions
Court order	Compelled disclosure
Supervision (within limits)	Generally permitted

These are general principles — the specific threshold and procedure varies significantly by country, state, and professional body. Know the rules in the jurisdiction(s) where your clients are located.

The duty to warn across jurisdictions

The US-based "Tarasoff duty" (duty to warn identifiable third parties of credible threats) does not exist in the same form in all countries. The UK has a different framework; EU countries vary. If you practice internationally, you may serve clients whose jurisdiction has different reporting obligations than yours. This is a conversation to have with a local legal or ethical advisor when you expand to a new client population.

How to document when you break confidentiality

Documentation when breaking confidentiality is critical. Include:

The exact concern that triggered the breach
What information was disclosed, to whom, and when
Any steps taken to notify the client (where appropriate)
The legal or ethical basis for the disclosure
Your clinical reasoning

Example documentation entry: "Client disclosed during session that they have purchased means and have a specific plan to harm [third party]. I assessed the threat as credible and imminent. Contacted [authority/person] at [time] and disclosed [specific information]. Client informed at the end of session of the contact made and the reason. See consultation note for full clinical reasoning."

The international complexity

When your client is in another country, mandatory reporting laws of their country may apply. A client in France subject to a French court order presents different obligations than a US client subject to a California court order. For therapists with internationally diverse caseloads, having a clear policy and access to international legal support is worth building into your practice infrastructure.

The bottom line

Mandatory exceptions to confidentiality are rare but exist, and your documentation when they occur must be thorough. Knowing the specific rules for each jurisdiction where your clients are located is a non-negotiable part of international practice.