Protecting your privacy: Understanding confidentiality

Psychotherapy is most effective when you can be open and honest. If you've never seen a psychologist before, you may have some questions about privacy.

Will the things I discuss in therapy be kept private?

Confidentiality is a respected part of psychology's code of ethics. Psychologists understand that for people to feel comfortable talking about private and revealing information, they need a safe place to talk about anything they'd like, without fear of that information leaving the room. They take your privacy very seriously.

Laws are also in place to protect your privacy. The Health Insurance Portability and Accountability Act (HIPAA) contains a privacy rule that creates national standards to protect individuals' medical records and personal health information, including information about psychotherapy and mental health.

The HIPAA Privacy Rule is designed to be a minimum level of protection. Some states have even stricter laws in place to protect your personal health information. You can contact your state's board of psychology to find out its laws and protections.

At your first visit, a psychologist should give you written information explaining privacy policies and how your personal information will be handled. This information will explain that in some cases, there are exceptions to the privacy rule, as described below.

When can a psychologist share my private information without my consent?

In some specific situations, psychologists can share information without the client's written consent. Common exceptions are:

• Psychologists may disclose private information without consent in order to protect the patient or the public from serious harm — if, for example, a client discusses plans to attempt suicide or harm another person.
• Psychologists are required to report ongoing domestic violence, abuse or neglect of children, the elderly or people with disabilities. (However, if an adult discloses that he or she was abused as a child, the psychologist typically isn't bound to report that abuse, unless there are other children continuing to be abused.)
• Psychologists may release information if they receive a court order. That might happen if a person's mental health came into question during legal proceedings.

Will insurance companies see my records?

Psychologists will share certain information about your diagnosis and treatment with the health insurance company or government program (like Medicare or Medicaid) that is paying for your treatment so that the company or program can determine what care is covered. The health insurance company or program is also bound by HIPPA to keep that information confidential. However, if you choose to pay out of pocket for services, and you choose to not ask your insurance provider for reimbursement, your insurance may not be aware that you are seeing a psychologist.

Similarly, your psychologist may ask for your consent to share information, or discuss your care, with your other health care professionals to coordinate your care.

Will my employer know I saw a psychotherapist if I use my company's insurance?

Employers don't receive information about the health services an employee receives, even if he or she uses company insurance.

Some companies offer employee assistance programs (EAPs), which offer mental health services to employees. Usually, the company simply provides the service but doesn't receive information about how each employee uses it. However, if you have any questions about privacy and your organization's EAP, talk to a human resources representative for more details.

I'm under 18. Will the psychologist tell my parents what we talk about?

Different states have different ages at which young people can seek mental health services without informing parents. In most cases, a parent is involved when a minor receives psychotherapy services.

Psychologists want young people to feel comfortable sharing their feelings, and are careful to respect their privacy. Often, at the first psychotherapy visit, the child, parent and psychologist will sit down together to discuss ground rules for privacy. That way both parents and children know exactly what types of information the psychologist might share with parents, and what he or she will keep private. For example, it is common for parents to agree to be informed only if their minor child is engaged in risky activities.

I'm older than 18, but still use my parents' insurance. What do I need to know about privacy?

Many college counseling centers don't require insurance. In those cases, students should be able to receive mental health services without their parents' knowledge, if they wish.

When a person receives services using medical insurance, the insurance company sends a statement called an Explanation of Benefits (EOB) that explains which services were used and paid for. If you use your parents' insurance for psychotherapy services, your parents may receive an EOB that outlines the services you used. However, they will not be able to access your records or find out what you discussed during your sessions with a psychologist.

What information can I share about my psychotherapy treatment?

Privacy is your right as a patient or client. If you choose to tell your friends or family that you're seeing a psychologist, you are free to do so. How much information you decide to share is up to you. Psychologists are ethically bound to protect your privacy regardless of what information you choose to share with others. For example, psychologists typically won't connect with clients on social media sites, even if the client initiated the request.

Sometimes, psychologists find it helpful to discuss your concerns or behaviors with other people in your life. A psychologist may want to interview your spouse to better understand what's going on in your home, for example. If a child is having trouble at school, the psychologist may want to interview the child's teachers. But whether you involve others is completely up to you. Psychologists generally can't contact anyone else without your written consent.

If you have specific concerns about confidentiality or what information a psychologist is legally required to disclose, discuss it with your psychologist. He or she will be happy to help you understand your rights.

Thanks to Angela Londoño-McConnell, PhD, and Stacey Larson, PsyD, JD, for their contributions to this article.