When we enter the office of a psychologist or psychotherapist, we know that what we say will remain secret. And it is precisely this implicit “promise” of confidentiality that contributes to the establishment of the therapeutic alliance: knowing that you can talk about your fears, your most intimate thoughts, your vulnerabilities and your actions without the fear of being judged or exposed.
But are there any exceptions? If a person confesses to a crime, can the psychologist report it? If a woman says she is a victim of violence but does not want to go to the authorities, must the professional respect her wishes? What happens when dangers arise towards minors or the risk that someone could suffer serious harm?
The answer is far from simple. Professional secrecy represents one of the pillars of the psychological profession, but brings with it some necessary exceptions. In fact, rules of the code of ethics and provisions of the Criminal Code are intertwined around this theme, which require different attitudes depending on the case. Understanding when a confidence must remain protected by professional secrecy and when, instead, protection needs, legal obligations or duties towards the judicial authority come into play means delving into one of the most delicate and complex areas of the profession.
What is professional secrecy in the code of ethics?
Every psychologist registered in the Register is required to respect the Code of Conduct for Italian Psychologiststhe document that defines the ethical and professional principles of the category. In addition to regulating the psychologist’s duties, it establishes what protections the relationship with the patient is subject to. Professional secrecy is a guarantee of confidentiality, without which many people would not be willing to “lay themselves bare”, to speak openly about their thoughts, their suffering or their emotions.
Article 11 of Codein fact, it reads:
The psychologist is strictly bound to professional secrecy. Therefore he does not reveal news, facts or information learned as a result of his professional relationship, nor does he inform about the professional services carried out or planned (…)
This general rule has some exceptions. This means that what is told in the session cannot be disclosed to family, friends, colleagues, teachers or other people without valid legal and ethical justification (we’ll get to that!).
This principle also applies in clinical work with minors: when the patient is a minor, the parents can be provided with elements relating to the progress of the process, the therapeutic objectives and the aspects useful for taking charge, but not necessarily the detailed content of the interviews.
In general, without a protected and confidential space, the therapeutic relationship would risk losing effectiveness.
The Penal Code also protects this principle: article 622 punishes the violation of professional secrecy without just cause. This means that the unjustified violation of confidentiality can lead not only to disciplinary consequences by the Professional Order, but also criminal consequences.
Article 13: when the therapist can report the patient
If secrecy is the general rule, Article 13 of Code of Conduct identify exceptions. That is, the psychologist can derogate from the obligation of professional secrecy mainly in three cases:
- when there are situations of serious imminent danger to the life or psychophysical health of the patient or third parties;
- when there is a legal obligation, as in the cases required for a report or complaint;
- when there is demonstrable consent from the patient.
Even in these cases, however, the “strictly necessary” principle remains: the psychologist is required to communicate only the information that is essential for the purpose, without revealing more than is necessary (for example the patient’s clinical history).
This is where confusion often arises. Article 365 of the Penal Code regulates the report: this is an obligation that concerns healthcare professionals who provide assistance in situations that may present the characteristics of a crime prosecutable ex officio. The same law, however, provides for a very stringent limitation: the report is not due if it would expose the assisted person to criminal proceedings. This is a fundamental protection of the care relationship.
Let’s take a practical example. If during a session it emerges that a minor is suffering mistreatment or abuse, the psychologist may be in a position to activate the report (the priority becomes the protection of the minor).
It would be different if the patient said: “In the past, I have abused a minor”. In this case, the professional is not automatically obliged to report it: the priority is the treatment relationship and the report would expose the patient to a procedure, without the characteristics of an imminent risk.
Let us remember that the psychologist’s work is mostly clinical and is required to be more active in cases where we need to protect those in danger and to stop damage, not to reconstruct criminal responsibilities.
The complaint is instead governed by articles 361 and 362 of the Criminal Code and mainly concerns public officials and public service workers. In this case, the distinction between public and private psychologist becomes decisive.
Private psychologist and public service psychologist
The freelance psychologist who receives patients in his office is mainly bound by professional secrecy and the obligations deriving from his healthcare activity. His job is to cure, not to collaborate with justice.
The psychologist who works within public structures can instead, depending on the tasks actually carried out, take on the qualification of public service representative: this is the case of professionals who work in hospitals, clinics or in local health authorities.
This changes the picture, because if he becomes aware of officially prosecutable crimes, even past ones, he may have an obligation to report. This does not mean that the public psychologist can freely talk about what he learns from patients – professional secrecy continues to exist – the difference is that, in some circumstances, further obligations linked to the function performed may overlap.
An even different matter concerns the Office Technical Consultant (CTU) and the Party Technical Consultant (CTP), operating in the courts. In these cases we are no longer within a therapeutic relationship. The purpose of the meeting is not the treatment, but the evaluation requested by the judicial authority or by the parties involved in a proceeding. The information collected is intended to be included in a technical report and the person being assessed is informed of this purpose. For this reason the rules on confidentiality are different from those that operate in the setting clinical.
In summary, secrecy prevails in private life, barring current danger; in the public the secret remains, but obligations towards the State are added.
From the private psychologist: some concrete cases
“A few years ago I committed a robbery.” This is a past event; in general this confession remains covered by professional secrecy.
“I deal drugs”. Even the confession of an illicit activity does not automatically lead to a report by the psychologist. The professional does not carry out an investigative function and does not collect information on behalf of the judicial authority.
“Years ago I killed someone.” As serious as it is, the principle remains the same. If it is the narration of a past event, professional secrecy normally continues to operate.
“I’m planning a murder.” Here the situation changes. We are no longer talking about an event that has already happened, but about possible future damage. The presence of a concrete and current risk to the safety of other people may make further assessments and the activation of protection interventions necessary.
“I am abusing my son.” Again, the main issue is not punishing the offender, but stopping the current harm. When situations of abuse emerge, especially of minors or vulnerable people, the professional can waive secrecy to activate protection tools.
“I am a victim of violence but I don’t want to report it.” It is one of the most frequent scenarios in clinical practice. A person may say that they are the victim of mistreatment by their partner and decide not to contact the authorities. In these cases the psychologist’s task is not necessarily to replace his will. Rather, it can help the patient to understand the risk, to know the protection tools available and to build a path of protection and autonomy (provided that the psychologist does not evaluate a situation of imminent serious risk. At that point he can evaluate the complaint).
The real rule
The presence of a crime does not automatically eliminate professional secrecy. Three elements above all matter in clinical practice:
- whether the event is past or current;
- whether there is an imminent risk;
- if there are vulnerable people involved.
Aggressive thoughts, fantasies or impulses discussed in therapy do not automatically equate to an obligation to report. The psychologist intervenes only when the risk is no longer thought of, but it can translate into real harm (saying “I have suicidal thoughts” is different from saying “this evening I intend to commit suicide”).
Ultimately, the most important question is not whether a psychologist can keep a secret. The real question is when that secret should give way to someone’s protection.
