Are the things you tell your therapist really private?

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When you leave your psychotherapist’s office after an especially personal session, it’s comforting to know that everything you discussed remains within those four walls. But will it really? Just how bound to confidentiality is your therapist? Can they be legally coerced into revealing what you’ve talked about in private?

Privacy is what makes therapy work

“Psychologists understand that for people to feel comfortable talking about private and revealing information, they need a safe place to talk about whatever they’d like, without fear of that information leaving the room,” states the website of the American Psychological Association (APA). Psychologist Ali Mandelblatt of Lighthouse Health Group, LLC in Florida, backs up that claim, saying, “a client can tell his therapist his deeply held secrets knowing they will not leave the therapy room.”

There are, however, times when a therapist must breach a patient’s confidentiality and release personal information into the more public realm.

RelatedCan you photo be published without your consent?

As a professional, Mandelblatt cannot provide accurate information about confidentiality until she first determines who her client is and why he or she is seeking treatment. “Is the client voluntarily seeking treatment or is she court-ordered to treatment?’

In the first case, most of the information disclosed by the client would remain confidential. In the second case, however, the information the client discloses is not confidential. “Court-ordered treatment provides that the therapist report back to the Court in terms of the client’s progress and/or lack thereof,” explains Mandelblatt.

Laws are in place to support your privacy…

The Health Insurance Portability and Accountability Act (HIPAA) lays out national standards to protect the personal health information—including information about psychotherapy and mental health—of an individual.

Each state has its own standards above and beyond the level of protection provided by the HIPAA Privacy Rule. You can find out what laws and protections exist for you by contacting your state’s board of psychology. The contact information for each state’s board can be found at The Association of State and Provincial Psychology Boards.

…but there are exceptions

When you first visit a psychotherapist (psychologist, psychiatrist, or social worker), you should be provided with written information that details how your personal information will be handled. Exceptions to your privacy protection should be made clear. In the following instances, according to the APA, your therapist can share information without your written consent:

  • Psychotherapists may disclose private information without consent in order to protect the patient or the public from serious harm; for example, if you reveal a plan or intent to commit suicide or to harm or kill someone else.
  • Psychotherapists are required to report ongoing domestic violence, abuse, or neglect of children, the elderly, or people with disabilities. If, however, an adult discloses that they were abused as a child, the therapist is not necessarily bound to report that abuse, unless there are other children who are continuing to be abused.
  • Psychotherapists may release information if they receive a court order; for instance, if your records are subpoenaed in a legal case regarding your mental health, or if the treatment is court-ordered, as Mandelblatt indicates above.

“It should be noted even though these disclosures are ‘allowed,’ a client may still bring a complaint about the psychologist to the Board of Psychology,” adds Mandelblatt. “Confidentiality and breaches of confidentiality can often place a psychologist in a difficult situation legally, professionally, and ethically. Rapport may be ruined between the client and the psychologist after this breach, leading to a termination of the therapeutic relationship.”

Disclosure with consent

Your therapist may ask if they can share your personal information with other healthcare professionals when coordinated care is in order. This, too, is a policy that should be mentioned at your initial visit. Ultimately, you get to decide whether or not you’re okay with it.

“As a therapist and a forensic psychologist, it is initially my duty to help my clients understand confidentiality and the limits of confidentiality,” says Mandelblatt. “By doing this, I give my clients an opportunity to understand how the information they disclose to me can or may be used.”

As the patient, you are free to disclose as much or as little as you desire about your therapy sessions. You can tell family, friends, coworkers – anyone. Choosing to do so does not give permission to the therapist to do the same. “Psychologists are ethically bound to protect your privacy,” reads the APA website, “regardless of what information you choose to share with others.”

How much does your insurance company need to know?

Your health insurance company (or Medicare or Medicaid, if applicable) may need access to some of your personal information in order to pay for your treatment. In turn, the insurance company (or government program) is bound by the same HIPAA regulations that apply to your therapist. For example, the health insurance company may not share information about your treatment with your employer, even if your coverage is through that employer.

If you are uncomfortable with your insurance company having access to your private health records, you can circumvent it by paying out-of-pocket for your treatment.

Minors get slightly less privacy

This area, in particular, is one in which states differ. Typically, a parent or guardian is involved when a child under the age of 18 receives psychotherapy services. That involvement may be as limited as having an early discussion about what types of information everyone—the therapist, minor, and parents—agree should be shared. The APA website states that it is common for parents to agree to be informed only if their child is engaged in risky activities.

What happens when a child is over the age of 18 but still covered by their parents’ insurance? If the insurance is used to pay for the treatment, then the parents will receive an Explanation of Benefits (EOB) from the insurance company describing the services the child has received. The EOB will not reveal what was discussed during sessions with the therapist, only that the visits were made.

Bottom line: A professional psychotherapist will abide by the rules and laws that protect your privacy. And he or she will use those laws to protect you further – by breaking that confidence when necessary. Use the resources available to you to make sure your therapist is licensed and in good standing. And, if you feel that your privacy has been breached, seek help from an attorney to protect your rights.

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