Confidentiality in Therapy

By Noah Rubinstein, LMHC (he/him)

March 1, 2026

One of the most important foundations of therapy is confidentiality, which means that what you share in sessions with your therapist stays private. Therapy is meant to be a space where you can speak openly and honestly about your thoughts, feelings, experiences, and struggles, including things you may have never said out loud to anyone.

For many people, the fear of being judged, exposed, or misunderstood is one of the biggest barriers to seeking therapy. Confidentiality exists to protect you from that fear and to help create a space where trust can form.

Safety Is More Than Privacy

While confidentiality is essential, privacy alone is not what allows most people to truly open up. What matters just as much is the felt experience of being met by a therapist with genuine positive regard.

People tend to open when they sense that they are truly welcome, not evaluated, analyzed, or judged. In therapy, this is what we call unconditional positive regard. It’s the experience of being accepted as you are, even when you are struggling, crying, hurting, worrying, raging, or feeling completely hopeless. When a therapist feels genuine curiosity and compassion for you, you will feel it, and trust grows naturally.

And this is where confidentiality becomes especially important, not just emotionally, but practically.

Why Confidentiality Matters

Confidentiality allows therapy to be a place where you don’t have to edit your thoughts or protect others from your true feelings. When you trust that your privacy is respected, you are more likely to share what actually matters, not just the surface details, but the deeper thoughts and feelings that shape your inner life.

Confidentiality also allows you to explore difficult or vulnerable experiences at your own pace, trusting that what you share will not travel beyond the room. That sense of safety makes it possible to go deeper, more honestly, and more meaningfully over time.

A Commitment to Confidentiality

I take confidentiality seriously because, first and foremost, I would never want to betray another person. A trusting therapeutic relationship is crucial to a successful outcome, and without a commitment to confidentiality, it is difficult to build trust.

My intention is to provide the people I work with a space where they can talk freely and feel deeply, openly, and vulnerably about whatever is present for them.

As long as I am not legally or ethically required to break confidentiality, everything you share with me remains private. I will not disclose information about our work or about you without your direct permission, unless the legal or ethical limits of confidentiality require disclosure.

The Limits of Confidentiality

While confidentiality is a cornerstone of counseling, there are a few specific situations where therapists are legally and ethically required to break confidentiality. I know this may feel like a contradiction, but there are some things that are even more important than confidentiality, particularly protecting the health and safety of others. These limits exist to protect safety.

In general, confidentiality must be broken if:

• There is a clear and immediate risk of serious harm to you

• There is a clear and immediate risk of serious harm to someone else

• There is suspected abuse or neglect of a child, elderly person, or dependent adult

• Records or testimony are legally required by a subpoena or court order

  
  

It’s important to know that having difficult thoughts, strong emotions, or painful memories does not automatically put confidentiality at risk. Therapy is a place where you can talk openly about anger, fear, shame, grief, or distress without consequences for being human.

If any of the above limits to confidentiality were to arise, my intention would be to be transparent with you about that. Wherever possible, I would want to have a conversation with you about making a report rather than acting without your knowledge.

Breaking Confidentiality Is Rare

In all the years I’ve worked with people in therapy, I’ve only been required to break confidentiality a small handful of times. Nearly all of those situations occurred when I was working in a residential mental health treatment facility for children and involved suspected abuse.

Most people come to therapy carrying things they’ve held inside for a long time. My hope is that therapy feels like a place where you can finally release some of the weight you’ve been carrying.

If you ever have questions or concerns about confidentiality or safety in therapy, I warmly welcome those conversations.