Some people never going to therapy because they are not confident that their therapy sessions would be confidential.
This is a common concern, and an important one.
Will people know the content of my therapy? So is therapy confidential? Yes, therapy is kept confidential in general.
There are very tight privacy laws regarding what you disclose to your therapist, but, there are a couple major exceptions that it is advisable for all clients to be aware of.
Understanding the principles of confidentiality and that therapy information is highly confidential can help you feel comfortable sharing. These privacy protections are meant to help you heal and also ensure safety in the face of a very high risk of harm. When you know the rules, you can feel more confident and in control at the beginning of your journey into mental health.
Understanding Therapy Confidentiality: The Foundation
Therapist confidentiality is foundational to good mental health care. In its most basic form confidentiality is the assurance that no confidential communications made in the course of therapy can be revealed to anyone else without the client’s written consent.
And this confidentiality covers more than just what you say; it also protects your presence, your diagnosis, your treatment plan – and indeed even the fact that you are in therapy at all.
This is crucial to the therapeutic relationship. Most individuals would not feel comfortable divulging the personal information essential to treatment if there were no guarantees that that information was confidential.
Consider attempting to have a conversation about your greatest fear, a traumatic experience, your mother’s addiction, your marital challenges; but imagine attempting to have these conversations while fearing that someone will disclose the information to your family, your boss, your insurance broker.
Legal Framework Protecting Your Privacy
The major federal safeguard of your mental health information is the HIPAA privacy rule.
In fact, this law makes it very clear how your private information must be treated by healthcare professionals, including therapists. HIPAA stipulates that “patient information” including the fact that you are receiving treatment cannot be disclosed to anyone without your permission, except in certain very limited cases.
Most states have even more stringent laws, which provide additional safeguards over and above the minimum federal requirements set forth by HIPAA. In particular, such state confidentiality laws often have broader protections for mental health treatment acknowledging the sensitive nature of psychological information. You can contact your state’s board of psychology for more information on privacy protections in your area.
When Therapists Must Break Confidentiality
Though therapy is confidential there are some exceptions that require therapists by law to disclose information that is disclosed in sessions. Part of understanding confidentiality is knowing those limits so you can decide what you feel comfortable talking about and when.
Immediate Danger Situations
The law requires therapists to breach confidentiality when there is an imminent and serious threat of harm. Not every instance of suicidal ideation falls into this category, but when there is a plan, intent, or means to follow-through. They want to protect you and everyone else.
Confidentiality can be disclosed if:
- You have a detailed plan or intent to actually hurt yourself.
- You have the ability to execute that plan.
- You threaten significant injury to another person.
- You are perceived as an immediate threat by professional assessment.
In these situations, your therapist might call emergency services, involve family members, or call the police to ensure safety.
Mandatory Reporting Requirements
Therapists are also “mandatory reporters” and required to call in any suspicion of abuse in a child, elder, or dependent adult regardless of the circumstances or persons involved.
These laws exist to protect vulnerable individuals from harm and though reporting may impact the therapeutic relationship many therapists will discuss the process with you prior to if it occurring.
Confidentiality is broken when:
- The therapist has reason to suspect the occurrence of child abuse, either currently or historically.
- There is evidence of the abuse or neglect of an elder or a dependent adult.
- Reporting ongoing domestic violence is consistent with the therapist’s judgment or is supported by state law.
Most therapists will use their judgment to decide when reporting is appropriate and discuss what this entails with you if it becomes necessary.
Special Considerations in Different Treatment Settings
Individual vs. Group Therapy
Confidentiality has a different meaning in the context of groups than it does in the context of individual therapy.
Those participating in group therapy must commit to protecting the confidentiality of other group members’ disclosures. Of course, therapists cannot ensure that everyone in the group will respect these confidentiality guidelines, thus presenting another privacy threat.
Insurance and Privacy
By utilizing your health insurance for mental health treatment, you are providing your insurance company with some information about your care.
It usually contains your diagnosis, dates of treatment, and occasionally brief summaries of treatment. But, again, insurance companies are also protected by the privacy rule protections of HIPAA and cannot disclose this information to employers or any other unauthorized individuals.
If privacy is of utmost importance, you might consider paying out-of-pocket for therapy services. This method, referred to as “self-pay” approach, entails that there will be no documentation of your mental health treatment within your insurance company.
Technology and Modern Privacy
The advent of telehealth and online therapy platforms has introduced additional privacy concerns. The best therapists conduct virtual sessions with safe, HIPAA-compliant technology, but you should educate yourself about the technology being used and what the limits of privacy are.
Be cautious of therapy apps or websites that are ambiguous or vague about their privacy policies. Some apps might disclose data to third parties or use your information for marketing purposes – something that would be considered unethical and unacceptable in face-to-face therapy.
Your Rights and Responsibilities
- Accessing Your Records: You can obtain copies of your records from therapy.
- Corrections to Therapy Records: You may request corrections to information in your records that you do not believe is accurate.
- File A Complaint: If you feel your privacy has been violated you have the right to file a complaint.
- Confidences: You may address any concerns regarding levels of confidentiality with your therapist at any time.
- Transparency with Therapists: Most therapists are quite willing to discuss this and will share their policies regarding confidentiality and its legal limitations.
By knowing and claiming your rights, spaces to heal can be safer, more collaborative places.
Final Thoughts
The tenet of confidentiality is what builds trust in any therapeutic setting. There are of course significant legal and ethical exceptions, but therapy is a context in which you can talk openly without concern for censure or exposure.
Your strengths and healing can be better supported if you at least have a sense of your rights and when confidentiality potentially does not apply.
If you have further concerns regarding confidentiality or privacy, Odyssey Counseling would like to help answer any of your questions. Our caring therapists understand the need for a safe and respectful space in which your issues are heard and sheltered.
Please reach out to us for a private consultation to begin the journey towards your mental wellness.
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