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I'm not sure about the US law but I'm fairly sure confidentiality has its limits with certain crimes in New Zealand.

Telling a priest you shoplift - he can't turn you in. Telling a priest you murder children - he has to turn you in. I think they may have to follow the duty to warn and the duty to protect.

http://en.wikipedia.org/wiki/Duty_to_warn
http://en.wikipedia.org/wiki/Duty_to_protect

I think that is how it works anyway.