Under what circumstance might a therapist need to breach client confidentiality?

A therapist may need to breach client confidentiality when the client threatens to harm himself. This is because mental health professionals have an ethical and legal obligation to protect clients from self-harm and to ensure their safety. If a client explicitly expresses an intention or desire to commit suicide or engage in self-destructive behavior, the therapist must take immediate action to intervene, which may include notifying appropriate authorities or seeking emergency assistance. The priority in these circumstances is the client's safety and well-being, even if it means breaking confidentiality, which is typically a cornerstone of the therapist-client relationship.

In contrast, expressing dissatisfaction, threatening harm to others, or refusing to engage in sessions do not necessarily compel a breach of confidentiality in the same immediate and life-threatening way as self-harm threats do. Each situation must be assessed carefully, but the imminent risk associated with self-harm clearly necessitates protective measures that may override confidentiality concerns.