When Are You Required to Break Client Confidentiality?

We recently received a question wanting know about any legal requirements for massage therapists to break confidentiality with clients when they reveal things like abuse (e.g., child, elder, partner, etc.), suicide threats or attempts, mental health issues, or crimes committed. Well, my first thought was, if there are legal requirements they are probably addressed under licensure.

So, since I’m licensed in the state of Arizona, I decided to check out the Arizona State Board of Massage Therapy website for statutes and rules. I found two areas related to this subject:

In Chapter 42 of the Arizona Revised Statutes, under Article 3 Regulation:

32-4253. Disciplinary action; grounds; definitions A. The following are grounds for disciplinary action: 16. Failing to adhere to the recognized standards and ethics of the massage therapy profession.

And in Title 4 of the Arizona Administrative Code Rules, under Chapter 15 Board of Massage Therapy:

R4-15-103. Ethical Standards Pursuant to A.R.S. § 32-4203(A)(6), the Board is adopting the following ethical standards, which a licensee is required to meet: 1. When a licensee agrees to provide massage therapy to a client, the licensee shall: g. Safeguard the confidentiality of all client information unless disclosure is requested by the client in writing, medically necessary, required by law, or necessary for the protection of the public;

I know, pretty vague, but I think we can work with this because it’s about ethics.

Standards of Ethics

Under Disciplinary Action, it suggests that we have to “adhere to the recognized standards of ethics of the massage therapy profession.” So I went to a few websites to explore the codes and standards published by some of our most recognized organizations:

NCBTMB Ethical Standard III: Confidentiality

Standard III(a): protect the confidentiality of the client’s identity and information in all conversations, advertisements, and any and all other matters unless disclosure of identifiable information is requested by the client in writing, is medically necessary, or is required by law;

 AMTA Standards of Practice

3. Professional Relationships with Clients: 3.2 The Practitioner maintains appropriate professional standards of confidentiality.

ABMP Code of Ethics

7. Commitment to Confidentiality: I will keep client communication and information confidential and will not share client information without the client’s written consent, within the limits of the law. I will ensure every effort is made to respect a client’s right to privacy and provide an environment where personal health-related details cannot be overheard or seen by others.

It’s clear that I’m required to keep my interactions with clients confidential. Of course I am. But it looks like some disclosure may still be necessary, by law. The tricky part is that none of these sources define which disclosures the law may require me to make, exactly.

In The Ethics of Touch by Ben Benjamin and Cherie Sohnen-Moe, we are told: “Some reasons for breaking confidentiality include: there’s a clear and imminent danger to the client or another individual; a client discloses an intention to commit a crime; you suspect abuse or neglect of a child, an elderly person, or an incapacitated individual.” And since massage therapists have adopted many ethical standards similar psychologists over the years (due to similar one-on-one intimacy and power differentials), it makes sense that the law may require similar disclosures. Here’s what the American Psychological Association website says about confidentiality:

In some specific situations, psychologists can share information without the client’s written consent. Common exceptions are:

  • Psychologists may disclose private information without consent in order to protect the patient or the public from serious harm — if, for example, a client discusses plans to attempt suicide or harm another person.
  • Psychologists are required to report ongoing domestic violence, abuse or neglect of children, the elderly or people with disabilities. (However, if an adult discloses that he or she was abused as a child, the psychologist typically isn’t bound to report that abuse, unless there are other children continuing to be abused.)
  • Psychologists may release information if they receive a court order. That might happen if a person’s mental health came into question during legal proceedings.

That gives me a little better idea of the critical issues we are dealing with here. I’m sure the legal requirements vary from state to state, region to region, and it may even depend on whether or not a massage practitioner is considered a healthcare provider in a particular state. But, it makes sense that I may be asked to disclose confidential information under certain circumstances.

The harder question for me is, when should I report something without being asked?

On the surface it seems simple: report to the authorities if someone is in danger. Period. But what about the domestic violence victim who won’t report it herself, or the child abuse victim without any bruises or other evidence? Will I be putting these people in more danger by sending the authorities to their house if nothing can be done? It’s not fair, but too often authorities say they cannot do anything about it if the alleged victim won’t press charges or if they cannot prove anything happened. These are the realities that make ethical dilemmas so hard sometimes.

I take confidentiality seriously. But, with the privilege of providing therapeutic touch comes great responsibility, especially to those who cannot speak for themselves. So, I probably shouldn’t worry so much about what the law requires, I should probably be more concerned with what’s the right thing to do.

The Bottom Line

Whether or not it makes me uncomfortable, I am obligated by my choice of profession (and frankly, because I’m a human being), to report anything that I believe puts someone in imminent danger—whether that’s me, the client, or anyone else.

Often doing the right thing means having to make those hard choices.