Is It Confidential?

Therapy is a private process that can involve discussion of very sensitive issues; therefore, a therapist is obligated by ethical practice, rule, and law to protect the patients best interest and right to securing sensitive medical and mental health information. The Health Insurance Portability and Accountability Act (HIPAA) of 1996 provides federal protections for individually identifiable health information held by covered entities and their business associates and gives patients an array of privileges and rights with respect to that information. At the same time, the Privacy Rule does permit the disclosure of health information needed for patient care and other important purposes, but with patient's acknowledged and written consent, e.g. contacting your Primary Care Physician for medical records or making a referral on your behalf. See Site info for more details: 
Department of Health and Human Services 

Exceptions to the Rule where Confidentiality may be breached:

•  If the patient is believed to be a danger to him/herself, meaning, that there is reasonable suspicion that you are likely going to kill him/herself OR someone else.  A therapist is obligated to protect and preserve the patient or has a duty to warn law enforcement and the identified person to which he/she has threatened serious harm or death.
  
• As a mandate reporter, a therapist will report suspected child abuse, to an elderly person, or a disabled person, as required by law.
  
• A court can compel a therapist to testify or a judge may subpoena records about what is discussed in therapy.  This is not often done, but most ethics codes state that therapists are required to follow court orders.
• If you are paying for therapy using a managed care entities or 3rd party funding, insurance companies can request information about your therapy  and are aware of your treatment diagnosis, if there is a treatment plan in place, and often require demonstration of treatment progress, by way of progress updates.