Most people assume that what they tell a therapist stays between them and their therapist, full stop. That assumption is mostly right, but not entirely. When therapists are required to break confidentiality comes down to a specific set of legal and ethical obligations that exist in every province, including Nova Scotia. The short answer: your therapist can and must disclose certain information when there is a serious risk of harm to you or someone else, when a child may be in danger, or when a court orders it. These exceptions are narrower than most people fear, but they are real, and you deserve to understand them before you walk into your first session.
Why confidentiality exists and what it actually protects
Confidentiality is not a courtesy. It is the foundation that makes therapy possible. If people feared that anything they said could be repeated to a partner, an employer, or a government agency, they would not speak honestly, and therapy without honesty is just expensive small talk.
In Nova Scotia, the privacy of your personal health information is protected under the Personal Health Information Act, S.N.S. 2010, c. 41 (PHIA), which came into force on June 1, 2013. Under PHIA, regulated health professionals in private practice are considered custodians of your information, meaning they have defined legal obligations about how they collect, use, disclose, retain, and eventually destroy what you share with them. The federal Personal Information Protection and Electronic Documents Act (PIPEDA) also applies to private psychotherapy practices in Nova Scotia, adding another layer of protection.
Beyond legislation, the Canadian Counselling and Psychotherapy Association’s 2020 Code of Ethics sets out professional conduct standards that guide registered counsellors and therapists across the country. Confidentiality is treated there not as a rule to follow grudgingly, but as a core ethical commitment rooted in respect for client dignity.
What this means practically: your therapist cannot call your boss, share your file with your spouse, or post anything about your sessions. The exceptions to this are specific, not open-ended, and a good therapist will explain them to you at the start of treatment, usually during the informed consent process in the first session.
When therapists are required to break confidentiality: the duty to warn
The most commonly discussed exception is what clinicians call the duty to warn, sometimes called the duty to protect. This applies when a client discloses a serious, credible, and imminent threat to harm an identifiable person.
The key word here is credible. A client venting “I could kill my sister sometimes” is not the same as a client describing a specific plan, a specific target, and a means to carry it out. Therapists are trained to assess the difference, and most expressions of frustration, even intense ones, do not trigger a disclosure obligation. The threshold is high because lowering it would destroy the trust that makes therapy work.
What “imminent” actually means when therapists break confidentiality
Imminence matters. A client who says they have thought about hurting someone in the abstract, with no plan and no timeline, is in a very different clinical situation than someone who describes a specific intention to act within hours or days. Therapists assess factors like access to means, history of violence, and whether the person has taken any steps toward acting. This is a clinical judgment, not a checklist, and reasonable clinicians can sometimes disagree about where a situation falls.
When the threshold is met, the therapist’s obligation is typically to take steps to protect the potential victim, which may include warning that person, contacting police, or arranging a psychiatric assessment. The specific steps depend on the situation and the clinician’s professional judgment.
Child protection reporting: a mandatory, non-negotiable obligation
This is the exception with the least grey area. In Nova Scotia, anyone who has reasonable grounds to suspect that a child is being abused or neglected is legally required to report that suspicion to child protection authorities. This obligation applies to everyone, not just therapists, but it is especially significant in a therapy context because clients sometimes disclose childhood abuse or describe situations involving children in their lives.
The standard is reasonable grounds to suspect, not certainty. A therapist does not need proof. If a client describes something that raises a genuine concern about a child’s safety, the therapist is required to report it, even if the client asks them not to, and even if the therapist believes the client’s account may be incomplete.
This is one of the hardest moments in clinical practice. A client who has finally trusted someone enough to speak about abuse in their family may feel betrayed when their therapist says they have to make a call. A skilled therapist will explain this obligation in advance, during informed consent, so it is not a surprise. They will also, where possible, involve the client in the process rather than acting entirely behind their back. But the report will happen. The child’s safety takes precedence.
One edge case worth knowing: if a client discloses that they themselves were abused as a child, and the alleged abuser is no longer in contact with children, the reporting obligation is less clear-cut and involves more clinical judgment. This is different from a situation where a child is currently at risk.
Court orders and legal proceedings: when a judge requires disclosure
Therapists can be subpoenaed. If a court issues a valid order requiring a therapist to produce records or testify, the therapist generally must comply. This comes as a surprise to many clients, particularly those involved in custody disputes, personal injury claims, or criminal proceedings where their mental health history becomes relevant.
There is an important distinction between a subpoena and a court order. A subpoena is a request; it initiates a legal process but does not automatically mean your records will be disclosed. A therapist who receives a subpoena should consult with a lawyer before releasing anything, and in some cases, a judge may review the records privately (called an in-camera review) before deciding what, if anything, is disclosed to the parties in the case.
Custody cases and therapist records: a common concern
Clients going through separation or divorce sometimes worry that their therapy records could be used against them in a custody hearing. This is a legitimate concern. If you are in this situation, it is worth discussing it directly with your therapist and, separately, with your lawyer. Therapists are not automatically required to hand over records just because one party in a legal dispute requests them. The process involves legal steps, and there are protections in place. But the protection is not absolute.
Disclosure to other health providers: when it is permitted, not required
This section addresses a common misconception: many people assume that any sharing of their information between health providers requires their explicit consent. Under PHIA, there are circumstances where a custodian may share personal health information with another health care provider involved in your care without your specific consent, if the disclosure is for the purpose of providing health care to you.
This is different from the mandatory disclosures described above. It is a permitted disclosure, not a required one, and it is meant to support continuity of care. For example, if your therapist is coordinating with your family doctor about a medication concern, they may be able to share relevant information without getting a signed release every time, depending on the circumstances.
In practice, most therapists in private practice ask for explicit consent before contacting other providers, both because it is good clinical practice and because it preserves the trust relationship. But clients should know that “permitted” and “required” are not the same thing, and that PHIA does create some space for provider-to-provider communication in the interest of your care.
If you have questions about how your information is handled, you have the right under PHIA to request a correction to your personal health information in writing, and your therapist must respond in writing within 30 days. For more general questions about how therapy works at Wholetherapy, the FAQ page covers billing, records, and what to expect.
What therapists in Nova Scotia are NOT required to disclose
The exceptions to confidentiality are real, but they are also limited. Understanding what does NOT trigger a disclosure obligation is just as important as knowing what does.
Your therapist is not required to tell anyone that you are in therapy. They are not required to share your diagnosis, your history, or anything you have discussed, simply because a family member asks, or because your employer is curious, or because someone files a complaint about you with a non-legal body. They cannot confirm or deny that you are a client without your consent.
Past illegal activity that does not involve ongoing harm to others is generally not a reporting obligation. A client who describes something they did years ago that was illegal is not automatically triggering a duty to report. The focus of mandatory disclosure is on current or imminent harm, not historical wrongdoing.
Therapists who are Registered Counselling Therapists (RCTs) or RCT-Candidates in Nova Scotia are licensed under the Counselling Therapists Act, established in 2011, and are bound by the NSCCT Standards of Practice (2021) and Code of Ethics (2020). These documents reinforce confidentiality as a professional obligation, not just a legal one. If you want to verify that a therapist is properly licensed, the NSCCT maintains a public registry.
How to talk to your therapist about confidentiality before your first session
You do not have to wait for your therapist to bring this up, though they should. Asking about confidentiality limits before or during your first session is not suspicious or adversarial. It is a reasonable thing to want to understand, and any competent therapist will welcome the question.
A few things worth asking directly:
- Under what circumstances would you be required to share information about me?
- If you ever needed to make a report, would you tell me first?
- How are my records stored, and who has access to them?
- If I am involved in a legal proceeding, what happens if my records are subpoenaed?
A therapist who gives vague or dismissive answers to these questions is a concern. The informed consent process at the start of therapy should cover confidentiality limits clearly, in plain language, not buried in a form you sign without reading.
At Wholetherapy, the informed consent process is taken seriously. Whether someone is coming in for EMDR therapy, trauma recovery, or couples work, understanding the limits of privacy is part of starting treatment with clarity rather than assumptions. If you are ready to ask these questions in person, you can contact us to book a consultation.
Frequently asked questions
Can my therapist tell my family what I said in a session?
No, not without your consent. Your therapist cannot share the content of your sessions with family members, even if those family members are paying for your therapy or are deeply concerned about you. The only exceptions are the mandatory disclosure situations described above: imminent risk of harm, child protection concerns, or a valid court order. A worried parent calling to ask how their adult child is doing will be told, at most, that the therapist cannot confirm or deny having a client by that name.
When are therapists required to break confidentiality in Nova Scotia?
In Nova Scotia, therapists are required to break confidentiality in three main situations: when there is a credible, imminent risk that a client will seriously harm an identifiable person; when there are reasonable grounds to suspect a child is being abused or neglected; and when a court issues a valid order requiring disclosure. These obligations exist under provincial law, including the Personal Health Information Act, and under professional ethics codes like the CCPA’s 2020 Code of Ethics. Outside of these situations, your therapist is legally and ethically bound to keep what you share private.
Does my therapist have to report it if I say I want to hurt myself?
Suicidal thoughts do not automatically trigger a mandatory report to authorities, but they do require your therapist to take action to keep you safe. What that action looks like depends on the seriousness and imminence of the risk. A therapist might increase session frequency, involve a crisis team, or in serious situations, facilitate a psychiatric assessment, which may involve sharing information with other providers. The goal is always to keep you safe while preserving as much of the therapeutic relationship as possible. If you are in crisis right now, please contact a crisis line or go to your nearest emergency department.
Can my therapy records be used against me in a custody case?
Potentially, yes, though the process involves legal steps and is not automatic. If a court issues a valid order, your therapist may be required to produce records or testify. However, a subpoena alone does not mean your records will be disclosed; a judge may review them privately before deciding what is shared. If you are involved in a custody dispute and are concerned about your therapy records, it is worth discussing this with both your therapist and your lawyer before the situation escalates. Many therapists will document sessions with this possibility in mind, focusing on clinically relevant information rather than personal details that could be taken out of context.
What is the difference between permitted and mandatory disclosure in therapy?
Mandatory disclosure means your therapist is legally required to share information, regardless of your wishes, such as when a child is at risk. Permitted disclosure means the law allows your therapist to share information in certain circumstances without your explicit consent, such as coordinating care with another health provider, but does not require them to. In practice, most therapists in private practice ask for your consent before contacting other providers, even when the law would permit them to proceed without it. Understanding this distinction helps you have a more informed conversation with your therapist about how your information is handled.