Therapists are legally required to report several specific situations, even though nearly everything you share in therapy is confidential. The main categories are child abuse or neglect, abuse of vulnerable adults, an imminent threat of serious harm to another person, and imminent risk of suicide. Beyond these core obligations, a few less common exceptions exist, including court orders and certain ongoing or planned crimes. The exact rules vary by state, but the broad categories are consistent across the U.S.
Child Abuse and Neglect
Every U.S. state designates therapists as mandatory reporters of child abuse and neglect. This is the most universal and well-established reporting obligation. A therapist must file a report when they know or reasonably suspect that a child under 18 has suffered, or faces a threat of suffering, any physical or mental injury, disability, or condition that indicates abuse or neglect.
“Reasonable suspicion” is a low bar on purpose. The therapist does not need proof, and they don’t need to investigate. If something a client says, whether about their own child, a neighbor’s child, or a student, raises a reasonable concern, the therapist is required to report it. In Georgia, for example, the law explicitly states that a mandated reporter must file even when the suspicion comes from a communication that would otherwise be privileged or confidential.
This covers physical abuse, sexual abuse, emotional abuse, and neglect (failing to provide adequate food, shelter, supervision, or medical care). It also covers exposure to sexually explicit material involving minors. The report goes to a child protective services agency or law enforcement, typically by phone immediately and followed by a written report within 24 to 48 hours, depending on the state.
Elder and Vulnerable Adult Abuse
Therapists are also mandatory reporters when they suspect abuse, neglect, or exploitation of older adults or incapacitated individuals. Virginia law, for instance, requires mental health providers to report “immediately upon the reporting person’s determination that there is reason to suspect” abuse, neglect, or exploitation of an adult who cannot protect themselves. If a therapist suspects an adult died as a result of abuse or neglect, they must also notify both the medical examiner and law enforcement.
The types of harm covered are broader than many people expect. Beyond physical abuse, they include financial exploitation, isolation, abandonment, and emotional suffering. In California, reporting timelines depend on severity: physical abuse causing serious bodily injury must be reported to law enforcement immediately (and in writing within two hours), while other forms of abuse such as financial exploitation, neglect, or emotional harm must be reported by phone as soon as practically possible and in writing within 24 hours.
Reporters acting in good faith are protected from civil or criminal liability, which means a therapist cannot be successfully sued for making a report that turns out to be unfounded, as long as they weren’t acting maliciously.
Threats of Harm to Others
If a client makes a credible threat to seriously harm an identifiable person, the therapist has what’s known as a “duty to protect.” This obligation traces back to a landmark 1976 California court case involving a university student who told his therapist he intended to kill a specific woman, and then did. The court ruled that therapists have a responsibility to take action when a patient poses a serious danger to someone.
Today, most states have some version of this duty written into law, though the specifics differ. Some states require the therapist to warn the intended victim directly. Others allow the therapist to choose among options: warning the victim, notifying law enforcement, or taking steps to have the client hospitalized. A few states make warning permissible rather than mandatory, giving the therapist discretion.
The key thresholds are that the threat must be serious, the danger must be imminent or reasonably foreseeable, and there is typically an identifiable potential victim. Vague expressions of anger or frustration in therapy do not trigger this obligation. Federal privacy law (HIPAA) explicitly permits disclosure of health information when a provider believes it is necessary to prevent or lessen a serious and imminent threat to a person or the public.
Risk of Suicide or Serious Self-Harm
When a client presents an imminent risk of suicide, therapists have both a clinical and legal obligation to act. This doesn’t mean that every mention of sadness or passive thoughts about death triggers a report to outside authorities. The standard of care requires the therapist to conduct a suicide assessment and take “reasonable safety and prevention steps” when a client displays suicidal ideation combined with planning behaviors.
California law, for example, protects clinicians who break confidentiality when doing so is in the best interest of protecting a client from foreseeable self-harm. A therapist might contact a family member, call emergency services, or coordinate with another provider. The legal standard does not require the therapist to predict suicide correctly. It requires them to recognize warning signs and respond appropriately when those signs are present.
Importantly, talking about past suicidal thoughts or a history of self-harm in therapy is not something your therapist is obligated to report. The trigger is imminent, actionable risk.
Past Crimes vs. Future Crimes
Many people worry about disclosing past behavior in therapy. In most cases, confessions of past crimes are protected by confidentiality. If you tell your therapist you shoplifted years ago, or got into a fight in college, that information stays between you and your therapist.
The distinction centers on timing and harm. A past crime that is finished and does not involve ongoing danger to a child or vulnerable adult generally remains confidential. But if a client discloses a crime that is ongoing, or states an intention to commit a future crime that threatens someone’s immediate safety, the therapist’s obligation to protect others overrides confidentiality. The clearest example: confessing to past drug use is protected, but telling your therapist you plan to seriously hurt someone next week is not.
There is one major exception to the “past crimes stay confidential” principle. If the past crime involved child abuse or the abuse of a vulnerable adult, and a child or vulnerable person is still at risk, the therapist is required to report it regardless of when it happened.
Court Orders and Legal Proceedings
Therapy records are generally protected by what’s called psychotherapist-patient privilege, which means they can’t simply be demanded by an attorney or handed over casually. But this protection has limits.
A subpoena alone does not automatically require a therapist to turn over your records. The American Psychological Association notes that therapists have a responsibility to assert privilege on your behalf unless you’ve explicitly waived it, a legally recognized exception exists, or a judge issues a court order. A therapist who receives a subpoena will typically try to have it modified or quashed before disclosing anything.
A court order is different. Once a judge orders disclosure and all attempts to challenge the order have failed, the therapist must comply or risk being held in contempt of court. One common scenario where this arises: if you file a lawsuit and put your own mental health at issue (for instance, claiming emotional damages in a personal injury case), most jurisdictions consider that a waiver of your therapy privilege. The opposing side can then access relevant records. A few states interpret this exception more narrowly, but it is the norm in most of the country.
How State Laws Create Variation
While the core categories of mandatory reporting are similar everywhere, the details differ meaningfully from state to state. Some states require therapists to report any known or suspected domestic violence, even between adults. Others limit mandatory reporting for adults to situations involving elders or people with disabilities. A handful of states require reporting of certain violent felonies regardless of whether a specific victim has been identified.
Reporting timelines vary as well. Some states require an immediate phone call followed by a written report within 24 hours. Others allow up to 48 hours or two working days for the written follow-up. The definition of “reasonable suspicion” is also interpreted with slightly different emphasis depending on jurisdiction, though it is universally understood to be well below the level of certainty.
Your therapist should explain the limits of confidentiality at the start of treatment, typically during the first session as part of informed consent. If you’re unsure what your state requires, asking your therapist directly is the simplest way to find out. They are ethically obligated to be transparent about it.