Does Therapy Threaten Your Firearm?

“Is someone going to take my firearms?” is one of the most common worries that my military, veteran, and first responder clients express. I take this question very seriously, because I appreciate how difficult it is just to go to therapy when you are concerned that asking for help could mean that you will lose your right to carry or in some other way be viewed as unfit for duty. I fully appreciate that many of my clients feel naked without a firearm, couldn’t do their job without a firearm, prioritize being able to defend themselves and their families, and also often collect firearms and other weapons purely because they appreciate the history and engineering of those pieces. So the concern about whether what they say to me stays with me is real.

Every situation and individual is unique, however the conversation I have? with clients usually follows these lines:

Cannot confirm or deny. I am ethically and legally obligated to keep your presence in therapy with me completely confidential, with a few exceptions (we will get to those!). Without your permission, I can not confirm or deny that you ever spoke to me (starting with the initial call for information), nor can I provide records or documentation of your visits to anyone (including your employer or command) unless you agree to that. HIPAA is the federal law that protects your personal health information – with heavy fines for me and my organizations if there is any disclosure, even accidentally. And, the Board of Counseling would censure or even pull my license if I failed to protect you. Substance use has an additional layer of federal protection, so even if you consented to me acknowledging that you are in therapy with me, you would have to additionally consent to me sharing anything about substances involved, including alcohol. Thanks to telehealth, we can be even more confidential, because you don’t need to be seen coming to my office. However, with telehealth, your therapist will need to know your location during a session, in case of emergency. Confidentiality like this is, by the way, part of the secret sauce of therapy – you can tell me anything, and trust I will take it to my grave.

Exceptions to confidentiality. All therapists are legally able to break confidentiality if a client threatens to kill a specific individual or individuals. Likewise, if you share details of abuse or endangerment of a child or dependent adult, we are mandated reporters to Child Protective Services or Adult Protective Services. This includes situations such as driving drunk or high with a child in the car, or in some other way exposing a minor to intoxicants. Reporting is a hard decision, and I try to discuss with clients why and how we might have to do that, and even involve clients in the reporting process. And, finally, if a client is suicidal, with intent, plan, and lethal means, we will have an immediate conversation about next steps. Sometimes, this does mean an individual is put into care for 72 hours on a TDO, in order to stabilize. My goal is to work with clients so they will go voluntarily to an emergency room for help, because their safety is my top priority – but if I have concerns that you are about to kill yourself, I will do what is needed to get you help.

Lethal Means & Safety. One of the conversations I have with clients who have thoughts of killing themselves (and in other situations) is about making lethal means in their lives safer. That means keeping firearms safely stored and unloaded (or at least, not chambered). I am an advocate for anything that will slow my clients down. Every second that it takes to get a key for a lockbox – perhaps having to locate the key underneath photographs of people who are important to them – is another second of reduced risk. Likewise, keeping medications locked up provides a similar delay and protection from overdose. Also, locking up medications is one small step we all can take towards reducing the risk that teens will experiment with substances. Many clients opt to ask a trusted friend or family member to keep their firearms or substances until their crisis is over.

My hope is that therapy could be more like an oil change than road side service -- that clients seek help before a crisis occurs, because fears such as losing the right to carry or having a mark against you for future employment or security clearance become realities when the authorities have to step in. It’s always better to have a confidential conversation with a therapist on your own terms.