But, although most therapists are not currently trained this way, an exacerbation of a serious mental illness (e.g., psychotic decompensation) is good cause to breach confidentiality so that you can speak with others who care about your patient. If the limits of confidentiality are clear up front (“If you become sick and it affects your good judgment, I will need to inform your family to get their help”), there is no ethical dilemma.
