Therapists aren't permitted to reveal anything about their patients because they are constrained by confidentiality and ethics. But that's not always the case and sometimes they can reveal everything they know in specific circumstances. When can they tell all they know and to whom?

There is a belief among the general public that everything that is said in a therapy session remains between the therapist and the client. Currently, Johnny Depp and his ex-wife Amber Heard are embroiled in a defamation suit that Depp brought against Heard and for which he is seeking $50 million in damages.

To support his case, Depp has asked one of his therapists to come to the trial and to discuss aspects of his therapy and drug addiction treatment. This is one of the cases where a therapist may reveal whatever the client has indicated they have approved.

One thing that a patient holds, and which is theirs alone to release, is something called privilege. If a therapist is asked to reveal information, they may not do so because of confidentiality, but if the patient indicates their willingness, it means the patient has exercised their right of privilege.

Licensed therapists are held to ethical standards by both licensing boards as well as professional organizations and the standards clearly outline what is permissible and what is not. For instance, any licensed therapist may reveal and is mandated to reveal, any instance of ongoing domestic violence, abuse, neglect of children, or abuse of the elderly or people with disabilities. Should a child still be in a situation of abuse, even if the therapist does not know this for a fact but suspects it, it must be reported to authorities.

Other instances where confidentiality does not hold is in future crimes or a danger or suggestion of danger to the self or others. Anyone hinting that they are considering suicide must be taken seriously and should be referred for additional assistance at that point. In some states, the person might be involuntarily held on a psychiatric unit for a discrete period of time, often about three days.

In the case of intention to harm others, there is a classic case that involved the University of California and a student, who was in therapy with a school counselor. He indicated that he was having violent thoughts about a young woman student, Tatiana Tarasoff, who he had dated and suggested that he might want to kill her.

The actions taken by the school therapist did not result in warning the young woman or her family or other appropriate authorities and she was murdered. We now have a duty to protect and to warn intended victims of crimes.

Courts may also call a therapist to testify in a case and under certain circumstances, the therapist who refuses may be sent to jail. If a patient is involved, the therapist might request that the patient exercise their right of privilege so that the therapist might comply with the court order.

In cases of married couples, all that is needed is one member to exercise the privilege and the therapist may reveal whatever material is germane to the case. Anyone wishing to have more information on this aspect of therapeutic constraints should consult an attorney.

The defamation case of Depp heard has already indicated that Heard alleges Depp physically abused her while they were married.

The belief that everything said in a therapeutic environment is secret, therefore, is open to question and each therapist has a responsibility to inform the new patient about the boundaries of confidentiality and privilege either at the first session or in a written outline of it at that time.

No one should be expected to walk into a therapy session and feel that anything and everything that they discuss will never be provided to anyone else, even a legal authority. This is not the case and clients must be made aware of this immediately.

Therapists who are naive or foolish enough to reveal information about their patients in any setting other than a supervisory one or a legal situation can be sued for this action.