Rehab Cell

Physical Medicine and Rehabilitation

Confidentiality in Therapy?


Hey everybody, today we’re going to talk
about confidentiality in therapy. What are your rights? Now before I jump into today’s video, I
just wanna remind you to turn on notifications. I’ve been hearing from
many of you that you’re not getting notified that my videos are getting
released on the Mondays and Thursdays that I release, so if you go to my home-
channel page you can click that little bell button to make sure that you don’t
miss out. But now let’s jump into today’s topic. Before I talk about all the
different caveats of confidentiality in therapy, I want you to know that your
privacy in confidentiality is taken extremely seriously. Even in school it was
something that we were harped on, and like we had intense testing, not to mention my
licensing exam, so know that it is important in therapy for you to feel safe
and we as clinicians understand that. And so part of it is holding your
confidentiality, knowing anything you say in therapy for the most part is held
in confidence and won’t be told to anyone else. But I’m gonna walk you through any
of the reasons that we might break your confidentiality, and what happens if we’re
over 18, under 18, so lets get into it. The first is that when you come to your
first appointment – I’m just looking at my notes so I make sure I run through these –
when you come to your first appointment at a therapist’s office, they will have paper
work out. And one of those is informed consent. And this will talk about all
their privacy policies, & confidentiality, the limitations of it, so make sure you
read that. And you can actually ask for a copy. They should really give you one – I
always offer up another one for my clients to take home and read and keep,
but make sure that you’re informed. Make sure you read through that so you fully
understand their privacy practices. And if you have any questions, you can always ask
them. Like “Hey, are you gonna tell my parents X, Y, Z?” So that you know where
you stand before you divulge any information that you don’t want others to
know. Now like I said, almost all things are held in confidence, but there are some
reasons that we have to break confidentiality. And I know many of you
can probably already guess these, but the first is if you’ve signed a release. Like
if you are my client and you’re seeing a psychiatrist, I’m gonna have you sign a
release so I can talk to that psychiatrist. I personally always let my
clients know what I’m gonna talk to them about, and I double check with them that
that’s ok. Because I want you to know that it’s because I want to help you that I’m
doing this. And I want to make sure that you’re comfortable with everything I’m
sharing. And if your therapist doesn’t do this, you can always ask. “Hey, I signed
that release for you to talk to my EMDR therapist, what are you two gonna talk
about?” So therefore you know what information’s gonna be shared and you can
feel comfortable with it. The second is, and this is one I’ve talked about a lot,
is danger to self or others. If we worry that you are extremely suicidal and we’ve
gone through the certain steps – like I’ve told you, there are certain steps we’re
supposed to take, like talking to you about it, creating a safety plan, doing 24
hour check ins, um letting you know that we’re gonna be calling a close friend
or family member who can check in on you to make sure that you’re safe before we
then maybe put you on a 5150 hold and place you in the hospital for your own
safety. And the other is if you’re homicidal. If you’ve talked to us about
someone – we know the person, you have the means, you’re talking about when you’re
gonna do it – and we feel the threat is imminent, we may have to call the police
and make sure that that person is kept safe. So those are kind of the danger to
self or others and why we would have to break the confidentiality. The third is
abuse. We’ve talked about this a lot but if you’re under 18 and someone is abusing
you, I am legally mandated to report it, meaning I’m gonna have to break your
confidentiality and share what I know with CPS, um meaning Child Protective Services,
or whatever service there is in your area to make sure that you are kept safe. And
abuse can be a lot of different things. I think a lot of people don’t understand the
fact that abuse isn’t just physical – it can be physical – it can be sexual abuse,
it can be emotional abuse, and even neglect. Neglect is one people don’t talk
about a lot. But if they don’t – like lets say a parent doesn’t take you to the
hospital or the doctor when you’re sick, that’s neglectful. Or if you have – you
should’ve gotten stitches and they didn’t do it or they’re not feeding you – there
can be a lot of different ways that parents can neglect their children. Or
just leaving children at home alone- I’ve had to call some of those in when I worked
at a clinic downtown because my client was 8 years old and was left at home for days
on end to kind of fend for herself and that isn’t okay, and that’s something
that I have to report. And abuse also covers adults like dependent adults
and elders. And that means – dependent adult means that even though we’re over
the age of 18 we’re not able to care for ourselves and we depend on someone
else to do things for us. So if they abuse us or neglect us in any way I have to
report that as well. And also elderly abuse- if you’re over the age of 65 and
someone is neglecting you or taking your money and not buying the things that you
need, not taking you to the doctor – any of those things, physical abuse, emotional
abuse, any of that – I have to report that as well. And the fourth and final reason
that I would have to break confidentiality is if I receive a court
order. I, luckily, knock on wood, have not had to do this in my private practice.
However, if your mental health or mental illness is brought into question during
legal proceedings, then I can receive a court order and be forced to come to court
to share a little bit about what we’re working on as it relates to that legal
case. This I’ve heard from other colleagues of mine, that this has happened
a lot in divorce cases, this can happen when someone is quote-unquote made legally
insane like if they’ve committed a crime, but luckily like I’ve said, I haven’t had
to deal with it, but that would be another reason that I would have to break
confidentiality. Now I’m gonna talk about some of the most commonly asked question
about confidentiality. And I’m gonna link in the description to an APA meaning
American Psychological Association to a link and article that they put together
that I thought was really great that kind of breaks it all down. So if you want more
information, click that link. But the first question that I wanna answer is “Do
insurance companies see all of my information. Does my therapist give them
all of the stuff that we’re working on in therapy?” And the answer is no. They do
however see diagnoses as you know we have to use the DSM codes and ICD10 codes to
get reimbursed from insurance. It’s not important that you know what those
acronyms mean, it pretty much just means that if you struggle with Major Depressive
Disorder, your insurance company will know about it. And they also will know to what
level of severity, and potentially portions of treatment planning. But
they’re not gonna know everything that you say in session, they’re just gonna know
what they need to know to make sure that you can get coverage. And the second
question is “Will my employer learn about what happens when I go to therapy and get
my mental health records?” And the short answer is no. Your employer is not gonna
get any of that information. Um, through insurance companies they don’t share
anything with employers, however if your employer does offer an EAP – an
employee assistance program which pays for therapy, and usually makes it free for
you for a certain number of sessions, they may have the therapist fill out a really
short questionnaire. But trust me, its very simple, it doesn’t share much, all
that they’re really asking in the questionnaires – at least from my
experience – is can you still do your job. And the most common question I get is
“I’m under 18. Are my parents gonna know everything about therapy?” Now, every
state has different rules and regulations around the age that you can go
to therapy without parental consent. And like I’ve said before, um, I think in
California the age is 13, but some are 12, some 14, it’s always around that age. But
in order for us to see you without parental consent, that means that you
have to be able to pay for it yourself, you have to be able to participate in
therapy fully, meaning just like you’re developmentally there where you can
actually get something out of therapy, and there also has to be a real reason for not
including your parents. And I know a lot of you are scared that “hey they’re gonna
tell my parents about self injury” or “they’re gonna tell my parents that I have
suicidal thoughts.” The one thing that I would encourage you to do, because each
person’s gonna be different, and legally, we can tell your parents whatever we deem
appropriate, and I want you to understand that. That it’s therapist to therapist on
what we really feel we need to tell parents. But overall, we are going to
share things that we think could put you in danger. That meaning suicidal
thoughts, which, if a therapist doesn’t fully understand self injury, they could
put that in that category. Also drugs and alcohol, a lot of therapists will
always tell parents about that, because it can put us in really risky
situations if we’re underage. How are we getting the substance that we’re using.
Are we putting ourselves in kind of dangerous, sketchy situations to get it?
It’s possible. And the third is sexual promiscuity. I know that a lot of
clinicians will share with parents because it can be really dangerous. We can get a
STD or become pregnant and those are things that can be really frightening and
dangerous for us and so therefore they will break your confidentiality and
tell your parent. But the thing that I would encourage you -if you’re under 18,
you’re seeing a therapist- like I said at the beginning, ask them about their
privacy policies. Ask them what they’re gonna share with your parents. Make sure
that you let them know you want to talk about it before they tell your parent.
Have a conversation because I find – as long as we’re talking about it and
communicating about it, there won’t be any surprises, and we won’t come home to a
bomb being dropped where our parents are like “oh, I heard you’ve been having
sex with your boyfriend” and you’re like “oh my god”. So talking to your therapist
first, understanding where they lay on different issues and what they’re gonna
share and not share is really important so that you can go to therapy, be honest
and open, and get the most help. Another important topic to discuss is
if you’re over 18, therefore you’re legally an adult, but you’re on your
parents’ insurance. What are they gonna find out? Are they gonna send things in
the mail? I’ve had clients literally run to the mailbox every time the mailman
comes to ensure that no information is given to their parents. And the truth of
it is, at least in the States, if you’re on their insurance, they’re going to get
what is called an EOB, an explanation of benefits, at the end of roughly each month
and it’s usually like two weeks into the next month when they finally send these
out, but they come to your parents house, or whoever’s address is on the insurance
form, to explain why things were covered or not and what was covered et. cetera.
Its not a bill, its just an explanation of benefits. And those EOB’s will go to the
person who pays the premium for that insurance. And lastly, a privacy thing
that I don’t think gets talked about enough and that’s something that either
will happen on accident and then we’ll have to talk about it or I personally
try to bring it up with my clients is “What if you see me in public?”
Frightening, right?! But if you live in a small town, even in a big city, you might
run into your therapist at the grocery store. You might run into them at a
concert. Who knows. You might be at a children’s event, a ballet or something,
and there they are. What do you do? As the client- this is what’s important to
remember – as a client you hold your confidentiality. Meaning I will never take
action to break that. You have to say hi to me first. The reason for that is
because what if I come up to you and I’m like “Oh hey Sarah, so good to see you.”
If you have friends around you, or anyone around you, they might be like
“oh how do you know her, who is she?” Then there are questions that you have
to answer and that puts you in the position where maybe you don’t know that
person that well and you don’t wanna tell them you’re in therapy – or whatever. So I
will never approach you. However, as a client, you can definitely approach me
and you can say Hi and I can say Hi. Because that’s you letting me know that
you’re okay with people in public knowing that we know each other. I think that’s
important to note because often this happens when we haven’t talked about it
and all of a sudden we’re like “oh my god, oh my god.” Like I’ve heard from a
lot of you that you like hid from them cause you’re like “Shit. I don’t know what
to do. What am I supposed to say?” So that’s where we stand on that. I hope you
found that helpful. I know there are so many questions about confidentiality and
what are our rights, but know that overall you hold the confidentiality, and we as
clinicians take that very very seriously. That’s why, truthfully, I share the least
amount of information that I can at all times, unless it’s something that you want
me to share, or unless we’ve talked about it and we think it’s really important to
your treatment. And overall, if you have any questions or concerns about it, ask
your therapist. It’s okay, it’s your confidentiality and your privacy, and we
take it very very seriously. And please share this video. I know a lot of people
have questions about it and don’t really understand. So hopefully this helped clear
it up. If you have any other further questions, let me know in the comments.
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can continue breaking through the stigma of mental illness. And if you’re new to
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see you next time. Bye! Subtitles by the Amara.org community

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