by Alissa Klugh, MS, LPC

In my previous blog, "What to Expect in Therapy: Part One," and it's continuation, I reviewed some basics about preparation for therapy and the actual experience of therapy. This was meant to help people understand what may happen when they go to counseling for the first time and continue to attend. In this post, I wanted to share with you, one step further, in the depths of what to expect when you see a therapist regarding the hot topics of ethics, confidentiality, and privacy in a social and technological world.

Therapists tend to be pretty well-versed in this area and are expected to get updated on ethics and privacy practices in their continuing education; however, as a client, there are no classes for you to learn such things. So, here it is: from the mouth (or keyboard) of the therapist. *I should note that the information I am providing to you is not an exhaustive list, nor does it necessarily hold true in all states in the good ol' U.S.of A. I know what I've learned, thus far, in my state (PA) and things are ALWAYS changing and updating - I am always willing to learn more and update as I do, so you never know when Part Three may arise with even more information on these ethical areas. Keep in mind that within our profession of counseling, there are different classifications of types of practices within our profession, so you may see variations, there in our guiding principles.

To better understand our guiding ethical practices, a quick internet search for our codes of ethics can be found on our state sites. I know that this stuff does not get everyone excited to read, so I wanted to bring to you some brief summaries of what we follow, as clinicians practicing as licensed professionals, but put it in terms that may be easier to digest. These guidelines are always subject to change! And remember this is just one person's interpretation of them. I've also thrown in a little spin on how to handle these experiences, so that you are prepared.

Oh, and I can't forget this - remember that bit in Part One of what to expect in therapy, I mentioned that you'll have paperwork to sign and read through upon your first visit? Chances are, the information I'm sharing with you, below, is included in that paperwork in one way or another. Okay... now to the info...

  1. Privacy/Confidentiality: First and foremost: what you share is to be kept confidential. This means that your therapist is not going to walk down the street and share your story, he/she is not going to call your friends and family and share your business, and he/she certainly is not going to talk with you about what's happening out in public, when/if they run into you. With that said, you should know that here are LIMITS TO CONFIDENTIALITY. These limits are comprised of, but not limited to: if you mention that you are going to hurt yourself or someone else (they're assessing for your safety and the safety of those around you. This could lead to an involuntary hospitalization. Yes, that's a difficult thing to digest, but, again: your safety and the safety of others is always on their minds). This could also include if it is a child reporting that someone is hurting him/her. We are MANDATED REPORTERS. This means, by law, we have no choice but to report the suspected harm to the authorities. Remember - we don't like that we have to do it, just as much as the client. In fact, we'd prefer to never have to worry about any of these limits, but, the law literally binds us to share and you better believe that we're going to follow that. If someone is reporting suspected abuse, neglect, harm, injury - there is NO WAY around it for us - we have to report it. And this is honestly for the greater good of the client or the person they're reporting about. If you are unsure about the limits of confidentiality, I encourage you to speak with your therapist about it. Ask about this in your first session! Keep asking about it so that you understand what your rights are and the limits. These guidelines may vary from state-to-state, so checking in with your particular state could be helpful for your understanding.
  2. Public Encounters: I want to share this with you because this can get convoluted really quickly, and it's typically for lack of understanding/knowledge. When your therapist sees you in public, and does not say "hello" to you, it is not because he/she doesn't like you or wants to snub you; it is literally because we're not supposed to do it. Again, we want to protect your confidentiality/privacy. Now, if you approach us and say "hello," then, we may respond, but remember that, if you don't want to be put in a situation where other people know your "therapy-business" or that you attend therapy, if you say "hello" to your therapist and you're around others, you might feel the need to explain to them who your therapist is, not to mention, if your therapist is with someone else, what would you expect them to say to their friend/family? That's potentially a super awkward situation, don't you think? The best thing to do is to "think before you greet." I'm not telling you what to do and not do here, but I do want you to think about it. Let's be honest, there are some people who could care less if others knew they were in therapy, and that is their right just as much as it may be yours to keep it private. 
  3. Social Media/Technology: Okay, this is a big one these days. Social media and technology seem to be ruling the world, so we should probably touch on it. DO NOT FRIEND/FOLLOW/WHATEVER YOU CALL IT your therapist's personal page. Let me repeat: DO NOT FRIEND/FOLLOW/WHATEVER THE SOCIAL MEDIA SITE CALLS IT your therapist's personal page. There is a reason for this - your life is private, and so is theirs. Overlapping of these things is a cause for concern and a conflict of interest. Do you want your therapist knowing all about what you say and do in your social media? I doubt it, because, guess what? This could skew their view of you - that's why it's considered a conflict of interest. You should be the direct, main source of information for your therapist, not your social media connections. If you choose to go beyond this suggestion, and attempt to friend them, you can more than likely expect that your therapist will not only deny the request, but that he/she will likely block you on that social media platform. Do yourself a favor - don't neb into your therapist's personal life. That's not what therapy is all about, right? It's actually about you!
  4. Dual Relationships: This is a term that is used by people in a therapeutic setting all of the time. It's related to the previous numbers 1, 2, and 3. Therapists are not allowed to have dual relationships with their clients. This means that they should not be having any relationships with you in addition to your therapeutic relationship. What a dual relationship may look like includes, but is not limited to: buying or selling goods/services not related to your treatment, being friends with your therapist, being related to you therapist, seeing the same therapist that your child sees, dating your therapist, and so much more. Therapists are governed by a set of ethical principles that guide our practice. It is clearly stated in our guidelines that dual relationships are not allowed. If you have any further questions about dual relationships, you are welcome to ask your therapist.
  5. Gifts: Okay, so we know that there are people out there, clients included, that like to show their admiration and appreciation with gifts. Let's face it, that's incredibly nice of you, but guess what? We aren't allowed to accept them. Most ethical principles outline the amount with which we're "allowed to" accept, which tends to be a very low amount, but honestly, do yourself and your therapist a favor, and don't try to offer a gift. It'll save the therapist from having to turn it down and you from feeling upset (or even angry) that it cannot be accepted. A simple "thank you" is more than enough for most therapists I know. We appreciate you, your hard work, and your progress just as much as you do!

Do you think that you have a good handle on what to expect in therapy? I hope that this information was helpful to you. Unfortunately, I was unable to outline all of our ethical principles, here, but I wanted to at least get a little info out to you. 

Don't forget, if you have any questions about what to expect or ethical principles that your therapist is expected to follow, don't hesitate to ask them. Part of their job is to inform you!

Best of luck to you on your journey in therapy!


If you would like to schedule a session with Alissa or someone else in our practice, you can do so by calling 412-367-0575 or by clicking on our requesting an appointment option.