Entries in confidentiality (1)


How Confidential is Therapy Anyway?

Confidentiality is an exquisitely important issue for clients and clinicians alike. And it's no wonder. In therapy, clients should feel comfortable exploring some very private thoughts, feelings, and experiences. Often, therapy is the only place people can talk comfortably about some fairly private matters. For example, an individual with OCD (obsessive compulsive disorder) may be plagued with fears that he or she believes are irrational but still can't get a handle on them. Someone with depression may have thoughts of harming themselves. Sharing these thoughts and feelings with someone, even a caring professional, can be difficult. The last thing you want to worry about is whether your private concerns will become public information.

Psychologists have long prioritized the privacy of patient information. The American Psychologial Association has established the Ethical Principles of Psychologists and Code of Conduct which each member is obliged to follow. Regarding your privacy, psychologists are required to keep your information confidential (with some exceptions noted below) and to discuss confidentiality and its limits with each and every patient at the outset of therapy. In California, state law requires that clinical psychologists follow the APA ethics code and its provisions around privacy. At the national level there is a law passed by Congress in 1996 called HIPAA, the Health Insurance Portability and Accountability Act. It is a complex piece of legislation that, in part, has very specific rules for managing patient data. These rules apply to the entirety of your health record. If you have seen any health care professional in the last several years, you have received their Notice of Privacy Practices which explains to you how your health information may be used and how it is protected. Though the notice is long and likely very dry reading, I encourage you to read it in its entirety since it is important for you to understand. Because of the potential for extra sensitive information in therapy records, the safeguards to protect their privacy extend even further than those for your regular medical record.

Consultation, Collaboration and Care: Sharing Information with your Permission

There are times when it makes good sense for your psychologist to share information with others. In planning your treatment, it is often helpful for your therapist to consult with your other health care providers or significant people in your life. This type of consultation requires your permission. With your written or verbal permission, your therapist can talk with others in order to provide you with high quality care. Your permission may be revoked at any time. And, you have a right to request that some specific information not be shared. For example: "Hey, doc, when you talk to my husband next week, I'd rather you not tell him about my current problems at work."

Hopefully, when your therapist requests to speak with another individual about your care, the rationale is clear and understandable. If it's not, you have every right to get clarification.

If you are a patient in a hospital or clinic, there is often a "blanket" release of information form such that any of your providers in that setting are able to consult with one another on your care.  

There are times when it is helpful for your therapist to consult with professional colleagues to assist with treatment. Your therapist is able to do this without your permission as long as there is no identifiable information provided to the consultant. That means that your name and any other identifying information is not conveyed.

Breaking Confidentiality: Sharing Private Information without your Permission

There are exceptions to the privacy and confidentiality of psychotherapy. Though this list is not exhaustive, these are likely the most common reasons why a psychologist might disclose your private information without your permission:

  • If your psychologist determines that you pose a danger to yourself or someone else, he or she may be required by law to break confidentiality to protect you and/or the public.
  • If there is a child, older adult, or dependent adult at risk for experiencing abuse, your psychologist is mandated to report that to the appropriate authorities.
  • If you are involved in a lawsuit, your records may be subpoenaed.
  • If you are in a life threatening medical situation, your therapist may supply pertinent information (about medication, for example).

The exceptions to confidentiality are very rare. Any breaches in confidentiality are taken extremely seriously by professional psychologists.

What Should I Do If My Privacy Has Been Unjustly Breached?

If you believe your confidentiality has been compromised, I would encourage you to speak with your clinician directly. You also have the option of contacting the Department of Health and Human Services (Office for Civil Rights, 200 Independence Ave., S.W., Washington, D.C. 20201) which oversees HIPAA violations.

Privacy Matters

Privacy is an essential ingredient in effective psychotherapy. You should feel confident that your treatment provider values your information and guards it closely. Though there are times when some confidential information may be shared, by and large, you have control over the content and the recipient. Even in the rare circumstance when your confidentiality is breached without your permission, psychologists typically share only the most relevant information.