How can I tell a therapist that Ive done something illegal?
August 2, 2008 6:38 AM   Subscribe

How can I tell a therapist that Ive done something illegal?

I drunkenly did something that I am quite ashamed of and got me kicked out of my living situation. And could have resulted in prosecution. I feel it could be because of some long ignored issues, and I may need professional help working through it so it doesnt happen again or manifest itself dangerously in some other way.

But- I am still covered under my parent's insurance, and have the same privacy concerns mentioned here

1) How can I explain the situation to a therapist in order for them to help without worrying about possibly incriminating myself or the information later coming out somehow?

2) How can I pay for the visit(s) without my folks seeing therapist visits showing up on the insurance and asking questions?

Throwaway email:
posted by anonymous to Health & Fitness (28 answers total) 2 users marked this as a favorite
I hope others reply to you because I know I don't have a full answer. But I wanted to offer a road that I have seen work for someone else I know. They treated it as a legal question first and the lawyer recommended a therapist. IANAL, and so I was not privy to the legal conversation, but the second hand impression I got was "this is your wakeup call, you came darn close to the System coming down on you like a ton of bricks, see this therapist who I think can help you, no charge for this consult but if the System does get a hold of you, you probably won't be able to afford me, and/or your parents will be in a world of hurt". Of course, the therapy was not free but in the case I'm talking about he got help with that.

So my points:
- your concern about self-incrimination is first off a lawyer question, not an insurance, parent or therapist question.
- I suspect the lawyer would have suggestions about therapist confidentiality and insurance policies
- take my advice with a grain of salt...I just felt for the anguish you must be going through and so wanted to share this single story...other replies may be more helpful.
posted by forthright at 7:26 AM on August 2, 2008

My dad's a psychologist, and he described patient-confidentiality to me this way: if his patient killed someone, or was planning on killing someone, he would encourage that person to go to the proper authorities. But actually reporting his patient to the proper authorities was an extreme measure.

So, to answer your questions:

(1) Ask your therapist not to divulge anything you say to him/her during the sessions. They shouldn't be divulging anything anyway, but it never hurts to ask.

(2) Pay in cash. Talk to the billing person and explain that you want to pay for the session entirely in cash. Then pay them.
posted by ailouros08 at 7:29 AM on August 2, 2008

Consult a lawyer to learn about confidentiality/privilege situations in your state.
posted by Ironmouth at 7:34 AM on August 2, 2008 [1 favorite]

The way I understand it, although I am not a therapist, is that some statements/admissions made by a client to them require the therapist to contact law enforcement. I think it depends on the crime. Sounds like a lawyer is a good bet.
posted by Echidna882003 at 7:59 AM on August 2, 2008

I think you should just go to the therapist and talk about it. Getting kicked out of your living situation is not criminal prosecution.

Are you really worried that you're still going to be prosecuted? Really? Or is it possible that you just feel guilty?
posted by bingo at 8:02 AM on August 2, 2008

N^th seeing a lawyer first. Also, you could just explain to your therapist that you are worried that you may commit crimes in the future. You need not mention that you have in the past. I would suggest that you ask them to not bring up the past too much either. That way they umm.. won't, and also, they'll get the idea that even though you can't discuss it outright, you may still need to talk about how past acts are affecting you. Otherwise, you could always lie about it. But that seems like a bad idea for several reasons, like doctor/therapist-patient trust, and further extending the ramifications of your acts.

I'm no legal expert on anything, including confidentiality. But my understanding is basically like what ailouros said. Most things you say are off limits to the legal system, especially without a subpoena. If your crime is not serious, and is victimless (like drugs for example), it's very unlikely anyone would ever find out from your therapist. If it's a serious crime involving a victim (murder, rape, child abuse, assault) many therapists would probably only report it if they felt it would prevent you from doing it again. The past is the past. They can't change it by turning you in. That's not to say no therapists would turn you in. Also, if subpoenaed, they might be obligated to tell what they know (not sure on this, as with most of this paragraph, it's just my understanding). I'm not sure what obligations they would be under if subpoenaed to give information that does not directly incriminate you, but may add to the case against you (like that you have concerns about what you might do in the future). Talk to a lawyer, they'll know much more about the legal aspects, as well as about certain therapists that take confidentiality much more strictly than others.

As far as keeping your parents from being clued in, seconding paying cash. In most cities there are clinics that cater to the uninsured. They usually charge on a sliding scale. Much more affordable than paying the full cost out of pocket for most therapists.
posted by gauchodaspampas at 8:21 AM on August 2, 2008

When I've seen therapists in the past, they've described their confidentiality policies in great detail - they've all been pretty much the same in that unless you are planning to commit a crime that would harm yourself or others, they do not report anything that you've told them to anyone else.

Since this is something in the past and not something that you're likely to repeat, telling a therapist about it to work through your issues seems like a good idea. Talk to the therapist about their confidentiality policy - tell them that you have something you need to talk about that could be incriminating and you want to be sure that reporting the issue remains your choice, that they won't speak to any authorities about it without your permission.

As for insurance: I second ailouros08's recommendation to pay in cash. If you can't afford that up front, then talk to the therapist about their billing and mention that you don't want a paper trail. Therapists have all dealt with privacy issues like this, so they surely have a system that they've used before.

Good luck!
posted by grapefruitmoon at 8:23 AM on August 2, 2008

My understanding is that, aside from extreme situations, the therapist is professionally barred from ratting you out. If you killed or raped someone, for example, they may have an obligation to report it, but for comparatively minor stuff, I don't believe they can.

Might you ask the therapist, or at least their office, about confidentiality first?

I have no idea about your relationship with your family, but if you're over 18, your parents have no right to know about your treatment. Could you go on insurance but simply lie about what it is for? Things like ADHD and anxiety are "not bad" things one might see a therapist for. (Though if you're seeing a specialized therapist and their name shows up on the bill, the scope of the visit may be obvious.) The linked question did mention that he was seeking a security clearance, in which case you might not want a paper trail, but as this answer explains, it won't necessarily preclude you. (I'm not familiar with exactly what information is exchanged between therapist and government during a security clearance vetting, but I can't imagine they're allowed to discuss specifics.)
posted by fogster at 8:34 AM on August 2, 2008 [1 favorite]

(By "lie about what it is for," I meant lie to your parents, not lie to insurance/the therapist!)
posted by fogster at 8:35 AM on August 2, 2008

How can I explain the situation to a therapist in order for them to help without worrying about possibly incriminating myself or the information later coming out somehow?

IANAL and IANAD, but as far as I've ever heard, doctor-patient confidentiality is ludicrously important to everyone. Unless you're highly dangerous to other people (and I doubt that that is true), all that anyone can or will ever learn from your therapist is that you've seen them.

How can I pay for the visit(s) without my folks seeing therapist visits showing up on the insurance and asking questions?

Tell your parents you need to go to a therapist, but you don't feel comfortable telling them why. From the way your question is phrased ("still covered under my parent's insurance") it sounds like you're a college student, which presumably means you're over the age of 18. In that case, your health is *your* business, whether or not your parent's insurance still covers you. If you don't or can't tell them what's wrong with you, they've no right to know. Being up front about this fact from the beginning will allow you to get treatment at a good cost, as well as (hopefully) keeping them from prying too much.

Alternately, assuming you're in college, most all universities now have some sort of mental health facility in their student health centers. If you go in for a consultation (which is free at my university at least) and explain your situation, they may be amenable to skipping the insurance bit and having you pay a (low) fee.

However, if I were in this situation, I'd go with the limited disclosure situation to the parents. Your relationship may not be so strong, but for me, my parents are the best support I have in this world, and letting them know that I have problems has never been a bad idea.

Whatever you decide, the important thing is: if you even suspect you would like to see a therapist, you should go. First visit's free, generally, and therapy is not the shameful, shameful thing that it used to be. I wish someone had told me that a few years earlier than they did, as my life would've been a lot better.
posted by TypographicalError at 8:38 AM on August 2, 2008

Oh, I will say though: if you do go to the health center and get psychiatric help there, the privacy issues may be more pertinent. The people who work at these places are generally not for reals therapists, and they are beholden to the university. I know when I went to my student health center for help, they freaked out a little bit and sent me to an outside facility, since they are worried about culpability after the VTech things.

In any case, as other posters suggest, talk about the confidentiality at the consultation. One upshot of the student health peoples, though, is that I'm sure they are fairly familiar with hearing things like, "I got drunk and made an aggressive move on my roommate," or "I got drunk and trashed my roommate's stuff," or just generally variations on, "I got drunk and ...".
posted by TypographicalError at 8:46 AM on August 2, 2008

You also don't have to let your parents know the precise reasons for wanting to see a therapist. Tell them you're a bit under the weather, or have trouble falling asleep.
posted by limon at 10:07 AM on August 2, 2008

"...serious, imminent, foreseeable harm to client or others" is how my professional code of ethics describes when to break confidentiality; dealing with prior criminal acts is a subject not much contemplated. The more serious the activity you engaged in, the more likely it would be that a reasonable professional will break confidentiality out of concern of it happening again. It is worth noting that often times the records of your sessions with a therapist are accessible via court order - it is not the same as talking to a priest.

I would consult a lawyer first. Without knowing the seriousness of the activity you engaged in, it is difficult to predict the response of a therapist/helping professional.
posted by never used baby shoes at 10:18 AM on August 2, 2008

My dad's a psychologist, and he described patient-confidentiality to me this way: if his patient killed someone, or was planning on killing someone, he would encourage that person to go to the proper authorities. But actually reporting his patient to the proper authorities was an extreme measure.

I can't disagree more, though my sources are no more direct than ailouros08's.

My aunt and uncle are psychologists and have written about this issue for prominent psychology magazines. At least as regards California, clinicians have a significantly expanded duty to third parties as a result of the Tarasoff decisions. The California Supreme Court found that a therapist MUST warn potential victims or third parties of harm by an individual under the therapist's care, in addition to notifying the authorities.

It's a pretty complicated case but the bottom line was this: A patient under the care of a therapist threatened to kill a woman (Tatiana Tarasoff). The therapist called the campus police and had the patient detained and requested that he be committed, but the patient was released and killed Tarasoff. The courts found that the therapist had a responsibility to warn not only the police, but the intended victim(s).

More recent case law (Ewing v Golstein and Ewing v. Northridge Hospital Medical Center) has redefined the Tarasoff duty to the extent that therapists will have to consider and evaluate informations regarding potential threats that are communicated by third parties and not made by the patient directly - and warn those potential targets.

It is a messy legal landscape out there.

I have a feeling little of this pertains to you, Anon. You haven't told us directly what you did that you feel bad about, but I suspect it will not violate patient-therapist confidentiality.

Though rules are different depending on if you see a MFT (Marriage and Family Therapist), a Psychologist, a Psychiatrist, or a Social Worker, if you are in the state of California, your therapist must only report the following:

If you have hurt a child or an elderly person
If you hurt a child in the past, the child is now an adult *and* you are presently around children
If you are a danger to yourself
If you are a danger to others
Any threats that you might make
Any threats you report another making about a third party

To complicate matters further, all of this is up to the interpretation of the therapist you see. But it really sounds like you would benefit from seeing a therapist. Good luck!
posted by arnicae at 10:48 AM on August 2, 2008 [1 favorite]

Ask the therapist these questions.
posted by ikkyu2 at 10:58 AM on August 2, 2008

Geez arnicae, if you're gonna quote Tarasoff, you really should include the balancing test used to determine whether what you say is going to be confidential or not. From the opinion: Writing for the majority, Justice Mathew Tobriner said, "Confidential character of patient-psychotherapist communications must yield to the extent that disclosure is essential to avert danger to others. The protective privilege ends where the public peril begins."

At any rate, anon, none of us are your lawyer. You should seek legal advice on this; if a lawyer refers you to a specialist, the privileges of the client lawyer relationship may also be imputed to the client/specialist relationship. But you need a lawyer in your state to tell you whether this is the case.
posted by Happydaz at 11:01 AM on August 2, 2008

OK, IAAL (obviously, see handle) but IANYL. Since you identified neither the state nor the purported criminal act, you must get state-specific legal advice on your situation to determine whether 1. what you did really is a crime, 2. it's enough of a crime to be worried about this situation, and 3. if the particular therapist that you would be seeing would be bound by privilege. Not all therapists are, and the rules vary from state to state. Since you raised the question, I have to assume that you may have committed a pretty heinous crime and the stakes are high.

You should get this advice from an experienced criminal lawyer, because (s)he works with privilege issues regularly and will be up-to-date on the matter.
posted by missouri_lawyer at 11:15 AM on August 2, 2008 [1 favorite]

Ask the therapist what their ethical and moral rules are. Hypothetically at first, of course.

If the situation is that you lost control and did something bad, but under normal circumstances you wouldn't do that sort of thing, and you want to work on the issues that led to the loss of control, tell him or her that in your pre-therapy hypothetical conversation.

I speak from no authority at all, but I believe there is a difference between something that happened in the past and something that will/may happen in the future.
posted by gjc at 2:15 PM on August 2, 2008

I just finished a course of therapy, and it was made very clear that there is no patient-therapist privilege; if you tell your therapist that you committed a felony, they are required to report it.
posted by ten pounds of inedita at 2:55 PM on August 2, 2008

I dated a psychologist for a couple of years, and from what I remember her saying on the topic, they are professionally barred from reporting anything you raise in a session unless you are planning to harm yourself or someone else in the near future. That someone, e.g., killed someone in the past would not be grounds for reporting them unless it seemed obvious that they were planning to do so again. Furthermore, common practice is for a therapist to keep two sets of notes so they can hand over the "clean" set if they are ever subpoenaed. Of course, IANAL, and this may only pertain to the state she resides in (New York) and/or may be out of date and/or otherwise incorrect.

In short, therapists take confidentiality very seriously; they are there to help heal their clients, and they can't help a client who is too scared to even talk about their problems.
posted by korpios at 2:56 PM on August 2, 2008

Anon, I wouldn't goto Univ. health care; they may have different requirements. You should always interview a therapist. Ask about their training, certification and type of therapy. See how comfortable you feel. Then ask about rules of confidentiality regarding a violation of the law, and ask if they are mandated to report. It probably varies by state.

More important: you don't say what you did. If you harassed, harmed or stalked someone, they may have to report it. If you feel that there is any likelihood of you hurting someone else or yourself, then go get immediate help at the Emergency Room.

Tell your prents you need some help coping with stress. The may get all wound up. But learning to be honest is a good step towards getting out of the trouble you're in. Whatever yu did, restitution will help with the guilt, and it's the right thing to do.
posted by theora55 at 3:49 PM on August 2, 2008

I just finished a course of therapy, and it was made very clear that there is no patient-therapist privilege; if you tell your therapist that you committed a felony, they are required to report it.

Yikes! ten pounds of inedita, I have NEVER heard that. Where are you?

Generally speaking you can just ask your therapist up front. They have no reason to lie to you.

You know your therapist better than we do, obviously, but I know some damn chatty ones and they've told me things that were SERIOUSLY none of my business. Hell, they tell the barristas. It's made me very hard to trust them as a class, though obviously there is a whole spectrum of ethics out there.

Also, my classmates and I had such ludicrously terrible university therapists during grad school that we considered writing a book. Really- they were hilariously bad.

If you want full confidentiality you might consider
1) paying cash
2) using a fake name (you can tell them you're doing so)
3) go out of your immediate area (so you don't run into them at Starbucks)
posted by small_ruminant at 4:42 PM on August 2, 2008 [1 favorite]

Aarrgh, very much bad, bad, incorrect advice on this thread. The only correct answer is to ask a lawyer in your state, if you're really that worried about being prosecuted for this incident.
posted by footnote at 4:43 PM on August 2, 2008

One comment: I was under the impression that when it comes to sexual abuse of a minor, the therapist has a duty to report, and the question of whether or not he/she is likely to do it again doesn't come into play.
posted by UrineSoakedRube at 4:55 PM on August 2, 2008

Yikes! ten pounds of inedita, I have NEVER heard that. Where are you?

BC. Keep in mind that I'm talking about therapists, not doctors (psychiatrists, etc.), although the therapists I saw worked at the psychiatric outpatient clinic of Vancouver General Hospital.

The OP has not suggested that we're talking about an M.D. Any yahoo with or without a three-month community college certificate can be a therapist and even join professional associations (including getting titles like 'Registered Clinical Counselor').
posted by ten pounds of inedita at 5:33 PM on August 2, 2008

Where are you?

In short, Canada.
posted by Miko at 6:03 PM on August 2, 2008

In my history as a therapist (some 10 years ago now), my agency did abide by Tarasoff--there is a "duty to warn" the possible victims and the authorities when there is an immanent and direct threat of the client to harm self or others. We were also bound by law to report to child protective services in the case of admitted or suspected child abuse. I was a childrens' therapist predominantly, but I would have done the same in the case of suspected elder abuse.

Going to the authorities about anything outside of these circumstances was strongly discouraged by my agency, and we had a attorneys on retainer to help fight any possible subpoenas of our records. I did have individuals admit legally actionable behavior to me, which I never dreamed of reporting, and though I did not keep a second set of notes (it was hard enough keeping up with the paperwork demands without that!) my notes might not have always been as...complete as they could have been.

Ok, I guess "anyone" can hang up a shingle and call themselves a therapist, but the school where I got my Masters and the professional organizations I belonged to had a united front on this topic and it was discussed often.

Now, you might run into a therapist who doesn't quite get the whole confidential thing and feels obligated out of some personal feeling to report past crimes, but at least in my experience, that person would not be following the professional standards of the field, and might face some sort of censure for doing so.

That all said, paramount to a working relationship with a therapist is the feeling of comfort and trust with that person. If that isn't there, your therapeutic work won't get far, crime or no crime.
posted by thebrokedown at 6:57 PM on August 2, 2008 [1 favorite]

If the crime was in the past and there is nothing about the covering up or lying about the crime that will present a danger to others in the future, you should have no problems with the conversations with your therapist remaining confidential.
posted by hworth at 7:05 PM on August 2, 2008

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