3 Common Myths About Confidentiality in Counseling for First Responders

There are a lot of myths about the confidentiality and privacy of counseling in the first responder world. Some of it has been validated by poor counselors, and some of it is just hear-say.

Now, the things we will talk about today specifically relate to people in California receiving services from a mental health professional who is licensed in the state of California. If you live in a different state, the guidelines may be different for you, so make sure you get a clear understanding from a licensed professional in your state before you assume these rules apply for you.

Here are the three common myths I find myself facing when talking to new and potential clients. Let's bust these myths to break the stigma around getting help!

Myth #1: Counselors talk to people about their clients.

False. Counselors cannot discuss their clients in any way that could even potentially identify the client. 

I don’t get to come home and talk with my husband about my clients over dinner. Especially because he knows I work with first responders, and there is a chance one of them could have a run-in with him at some point during his career. Because of this, I can’t talk to him about my clients.

And the reason I can’t is because of HIPAA. 

HIPAA is a federal law that protects the information of people receiving treatment. 

If I violate this confidentiality by talking about clients, I could be reported and lose my license. I don’t want to do that because I love my job (and also I need to finish paying off my student loans).

Myth #2: If I have had thoughts of wanting to die in the past, they will put me on a 5150 and I will lose my job.

False. Absolutely FALSE.

A counselor who reports this is a threat to our profession.

We WANT people to come to us and talk about their struggles. But if they worry about past stuff impacting their job, they won’t talk to us. 

That is why we have to follow the guidelines of mandated reporting. If you are not actively suicidal, I cannot report you because you do not actually meet the criteria for a 5150 hold. 

Now, if you tell me you have been suicidal or had thoughts of wanting to die in the past, I will ask you about it. Any counselor worth their salt will ask you about it. Why? Because believe it or not, I want you to be alive at the end of the day. 

I am going to ask you if they were recent thoughts. I am going to ask you if you had come up with a plan. And then I will ask why you didn’t act on that plan. My goal is to figure out how I can keep you wanting to stay alive. 

Then, I am going to work with you on creating what we call a “safety plan”. Now, everyone calls this something different, I will call it a “survival plan”. Some people call it a “safety contract”, it just depends. But basically, what it is, you and I will collaborate and agree upon an action plan for you to take should those thoughts ever come back. Will you practice certain coping skills? Will you use distraction techniques? Will you call someone? Will you call me? How will you actually stop yourself from acting on those thoughts?

And here is the kicker for counselors that we have to do. We can’t just go, “he wouldn’t agree to the plan, so I called 911 on him.” That would be grounds for a lawsuit and I could lose my license. 

I am required by our code of ethics to take every step and action possible to AVOID calling the police on you. If I don’t exhaust all other routes of action, I have failed as a counselor and I am not competent enough to be doing my job.

So, let’s say you won’t agree to call 911 if it gets that bad. Well then, who would you call? Can you sign a release of information so I can call that person right now and make sure they would be available for you? And that they would have my number in case they felt you needed to talk to me? Would you be willing to go see your doctor to talk about medication? 

The only time I can actually breach confidentiality is if I believe you are truly a threat to yourself or others now or in the very near future. If I am afraid you will not make it alive to our next session, then we have bigger problems than confidentiality. If I think you will be safe, you have strong reasons to live for, and you have a plan to keep yourself alive, then I have no right to violate your confidentiality. 

Myth #3: My supervisors will know I am in counseling.

Not if you don’t tell them.

Seriously. Just because you are in counseling doesn’t mean I can talk to your supervisor about your issues, even if they are work related.

I do networking and connecting with command staff at different departments. I am married to a police officer. Remember myth #1? I can’t talk to them without your permission. 

And guess what? Even if you do tell them, I can’t confirm it to them without your written permission.

So let’s say you do tell your supervisor that you are seeing me for sessions. One day, I meet up with your supervisor for coffee to talk about how I can help support the department after a critical incident. If your supervisor asks how you are doing, I can neither confirm or deny that I know who you are. EVEN IF your supervisor says, “It’s okay, he told me about seeing you for counseling sessions.” I have to remind your supervisor that due to federal laws, I can’t even tell her if she is wrong and I am not seeing you. The only time I can confirm or deny this counseling relationship is with your express written permission to talk to this particular person. 

And you can also decrease their chances of knowing by not using insurance. Insurance requires a diagnosis to prove medical necessity for treatment. And that diagnosis can go on your permanent medical record, as well as the number of sessions you saw your provider. By not using insurance, you can prevent people from knowing you received treatment because there will be no records in your medical file (like if you applied for a special assignment or for a promotion and they needed to review your medical records for the process). Paying out of pocket for services decreases the chances anyone will know about your services. 

Counselors have to be super secret about your privacy and confidentiality. It is one of the most important parts of our ethics and laws. If people think we will share your deepest darkest secrets, or freak out about any little thing you tell us, then why would people ever come to counseling? 

So, we make it a priority. We make it safe and secure for you so you can feel safe and comfortable talking about the most challenging issues you face, the darkest parts of your experiences in this life. 

Because if you don’t have the right kind of help, you may find it hard to get better. Or it could even get worse.

And if you are worried about your privacy, give us a call today for a free consultation and we can help you better understand how it works and answer any questions you may have. 

Remember, it may be your battle, but you don’t have to fight it alone. 

Take care, friends!

Alisha Sweyd

If you find that this exercise or these conversations brought up some stuff you are struggling with, either individually or in your relationship, please do not hesitate to reach out to us for help. We are here to support you, and we understand that this can be a challenging issue to face. 

Photo by John Salvino on Unsplash