Therapy is often called a “safe place” to talk about anything. But, what about illegal things, like drug use, will that really stay confidential?
Talking about drug use alone in therapy, legal or illegal use, remains confidential. However, it’s important that laws vary by state. There are ways to get clarification from your therapist without disclosing information. And if you doubt your therapist, it’s probably a good indicator you need to find a new therapist.
In this article I’ll address issues surrounding confidentiality in therapy, specifically around illegal drug use.
It’s important to note that I’m a licensed therapist in California and can only speak to my knowledge about California law. I am not a lawyer and this is not legal advice. Though many, if not all U.S. states have similar laws, it’s important to know that there may be some differences.
What is confidentiality?
Confidentiality simply means that what is discussed during therapy is not be revealed to others outside of therapy. This includes not disclosing the fact someone is coming to therapy or not.
Limits to confidentiality
In California, there are generally five instances where a therapist will break confidentiality:
- You pose an immanent risk to yourself or someone else. The therapist will do what’s necessary to make sure everyone stays safe, which can include breaking confidentiality.
- There’s reasonable suspension of abuse of a child, elder, or dependent adult. This includes disclosing possessing or viewing child pornography.
- When a client gives permission to the therapist to to share information with other individuals or parties.
- When a therapist receives a court order.
- Occasionally therapists will consult with other therapists to ensure they are practicing legally, within scope, and providing quality care. In these situations, however, therapists are required to protect the identity of clients and only provide enough information necessary to answer the question.
All other times, at least in California, a therapist is required to maintain confidentiality.
Examples of your therapist’s response to drug use
Here are some examples situations involving drugs and how a therapist would likely respond:
You call your therapist under the influence and disclose you’re driving your car. In this situation, you’re posing a risk to yourself and other. Your therapist would likely report you to law enforcement as you driving under the influence could easily result in someone getting harmed or killed.
You disclose to your therapist that you drove under the influence the other night. Though this is a crime and someone could have easily gotten hurt or killed, your therapist would likely not report you and would likely need to maintain confidentiality.
You disclose to your therapist that you use cocaine everyday. A therapist would need to keep this confidential.
You disclose to your therapist that you use drugs every night and cause you to pass out around 6 pm, and you are a single parent of a 3 y.o. boy. This is a grey area as it could be seen as suspected child abuse in some or all states due to you not being able to adequately supervise your son.
You disclose to your therapist that you deal drugs and make great money at it. This is not reportable. Your therapist would be required to maintain confidentiality.
As you can see, drug use alone does not trigger a mandated report by a therapist. Only when your drug use crosses over into another area that is mandated report.
Should you disclose your drug use to your therapist?
This is completely up to you and there are some important things to consider. Your current and past drug use is critical for your therapist to accurately assess your situation and to create an appropriate treatment plan for your time together.
In general, the more a client withholds information about their lives, the more the quality of their therapy suffers.
It’s very common for clients to under report their drug and alcohol use in fear they will be judged or that their drug use will become the focus of the therapy.
This usually back fires, because the more information you hold from you therapist, the less effective your treatment will be. This means you’ll spend more time in therapy and see less of the change you’re looking for.
I don’t want my therapist to concentrate on my drug use
Though clients do occasionally ask for me to clarify if I’m require to report illegal drugs use, what I see more often is that clients aren’t wanting to change their drug use and they think by brining it up, I’ll push them to reduce or stop.
Though I will certainly offer my professional opinion about how someone’s drug use may be impacting them, I realize that I can’t make someone want what they don’t want. If a client doesn’t want to stop their drug use, that’s their choice.
So, if you’re not being completely forthcoming about drugs because you don’t want it to be the focus of therapy, I recommend telling your therapist just that: “I think it’ll be helpful for you to know that use cocaine Therapist John, but I also want you to know that I don’t want to make a change there. I want to concentrate on …”
My therapist won’t understand my drug use
If you think your therapist won’t understand or will negatively judge you because of your drug use, this is important and should be addressed.
It doesn’t necessarily mean you need to change therapists, however, it does mean you need to have a conversation about it.
I would first recommend being honest about your hesitations to disclose certain information. Tell them directly why exactly you’re hesitant.
Did you once mention that your brother does drugs and your therapist made a judgmental statement? Did your therapist once say something negative about drugs?
If so, I encourage you to tell your therapist.
You can also speak in broader terms, not even mentioning the topic of drugs: “Sometimes I’m uncomfortable to go into certain parts of my life because I’m afraid I might be negatively judged in here.”
These types of conversations are difficult to have because you’re talking directly about the relationship between you and your therapist. They are raw. And, you’re taking a risk.
It’s a risk because there’s a possibility you may offend or hurt your therapist’s feelings. Your statements might make them feel they aren’t doing their job properly.
And maybe you really like and respect your therapist. You don’t want them to think you don’t value your time together.
These are normal hesitations.
It might be helpful to remind yourself why you’re in therapy in the first place. You’re there because of you. And a good therapist knows and respects this.
A good therapist places your needs above their own needs.
By talking about the dynamic going on between you and your therapist, you’ll come out of the conversation in a better situation before. If your therapist does understand what you’re saying, you’ll likely have a helpful conversation how to adjust the dynamic to make it easier to talk about senstive areas in your life.
If you’re therapist doesn’t understand. Well, this is probably validation for your fear of being judged. You’re fear of being judged is unlikely your issue that you need to work on, but rather your therapist’s own issue they need to realize. And if that’s the case, it might be time to find a new therapist.
Therapists are interested in being your ally, and are trained not to take an investigator role in areas of reporting. And, in general, therapists don’t look forward to situations where they need to break confidentiality.
I say all this because your therapist is just as interested in making sure there aren’t any misunderstandings in issues surrounding reporting. The last thing a therapist wants is for you to disclose information that you anticipated would remain confidential.
So, if you’re concerned, simply talk to your therapist about your fear about the possibility of something you’re about ready to disclose might need to be reported. You can both talk about the pros and cons of disclosing, without disclosing just yet. If you have a good therapist, it will likely be a pleasant and productive discussion.