Is Therapy Private?
When a prospective client first contacts me about therapy one of the first things I do is to send out a copy of my HIPPA (Health Insurance Portability and Accountability Act) Privacy Notice and a couple of pages (oh-so-poshly called my "Statement of Practice") that describe my clinical practice. The Privacy notice, as of April 2003, is a "must have" in any clinical practice and therapists are legally required to present one to their clients. I have one of the best written privacy notices EVER because my spouse was HIPAA Compliance officer at a major hospital a while ago, and made sure that I dotted my i's and crossed my t's! I know of many therapists who don't provide one for their clients, and are treading on a legal minefield as a result. Essentially what this notice says is (1) how information about you, the client, can be used and (2) how you, the client, can access your personal information. On my particular privacy notice there is a handy-dandy tear off sheet on the back. Most client dutifully tear off the sheet, sign it and return it to me where it is filed away for posterity, proof that I gave them the document. Only one client has ever had a conversation with me about privacy, thus proving that they actually read the privacy notice! As boring as it is, I wish more clients would take the time to read. It's frequently taken for granted and shouldn't be.
The very first session with a new client, I have a checklist of things I review with them. First one on the list is the limit to confidentiality. Here's where I inform my client that if they plan on beating up the wife, abusing their kid (or any other kid for that matter), wacking the next door neighbor, slow-poisoning an ex-boyfriend or killing themselves, I am duty bound to warn the appropriate authorities. This is the meaning of the phrase "mandated reporter," and there is no therapist in the USA who can circumvent this. The law is the law.
When all is said and done, most people, and by people I mean clients, can see the wisdom in this arrangement; after all most of us want to protect children, and most of us understand that people need to be protected from those few poor souls who want to hurt, maim or otherwise disrupt our lives in painful ways, even if this does mean revealing our confidential records. So, I typically explain that I would in most cases attempt to contact and talk with the client first, before making the call if I am about to break what I consider to be a sacred trust between therapist and client (their privacy) they deserve to hear it straight from the horse's mouth.
So, here's the irony for me in giving out this darned Privacy notice. Here I am, doing everything I can to provide a safe environment in which people can unload and unburden themselves of their deepest, darkest pain and yet I am required to hand out this blurb that essentially says that people have less rights than they think they have (if they were to think about it for more than 3 seconds that is!) In point of fact, clients who self-pay for therapy and don't rely on their insurance (and these clients account for 99.9% of my client base) have many more protections than clients who use their health insurance to cover their mental health costs. Health Insurance companies place great premium on being able to have access to mental health providers' files. In fact, they have the right to review ALL clinical files, even those of clients who are not members of their insurance plan, if they consider or suspect that the therapist is providing improved coverage and better standard of care to self-pay clients.
I was talking with my friend Kelly about privacy and confidentiality this week, and told her about this blog, and about the philosophical dilemma I am in each time I hand out the privacy notice. Kelly and I have spent endless hours discussing organizational psychology and the importance of a shared vision and mission in working with groups of people in collaborative efforts. Kelly works in a senior position at an urban multi-service center working with poor and homeless people and I used to be director of a large agency that covered five cities, and the mission of the agency (which also focused on poor and working poor people) was the central organizing principle for me with every facet of the work I did. This applied whether I was supervising staff, directing the various projects I implemented, or even down to the way I related to the people who delivered sandwiches to our agency site at lunch time. So, during this particular conversation Kelly told me the following:
"I was doing orientation this week with a new hire and told her what the mission statement of our agency is. Then I said that the mission statement for most people and organizations in the country is to make as much money as possible in the least amount of time. So if violating privacy makes money then that is what they do. I explained to her that mission statements are about what comes first over all else. At our agency the dignity of the guests comes first over everything else, including money, property, staff, etc. For you, your clients come first. Perhaps you could write your mission statement or a blog about what that would be... and how important it is to determine the mission of any person or organization that you deal with, so that you know where you stand with them, first or secondary to something else."
Hearing this from Kelly was like having a light bulb go on over my head. I have been short of a mission statement, a simple phrase that is my current organizing principle that comes first and foremost above all else! So here it is.
Jassy Timberlake's central organizing principle as a psychotherapist is to provide a safe, welcoming and supportive environment in which any information shared is regarded as sacred and private and not to be revealed unless severe physical or emotional harm to another human being would result.
Yep, that about sums it up.
The very first session with a new client, I have a checklist of things I review with them. First one on the list is the limit to confidentiality. Here's where I inform my client that if they plan on beating up the wife, abusing their kid (or any other kid for that matter), wacking the next door neighbor, slow-poisoning an ex-boyfriend or killing themselves, I am duty bound to warn the appropriate authorities. This is the meaning of the phrase "mandated reporter," and there is no therapist in the USA who can circumvent this. The law is the law.
When all is said and done, most people, and by people I mean clients, can see the wisdom in this arrangement; after all most of us want to protect children, and most of us understand that people need to be protected from those few poor souls who want to hurt, maim or otherwise disrupt our lives in painful ways, even if this does mean revealing our confidential records. So, I typically explain that I would in most cases attempt to contact and talk with the client first, before making the call if I am about to break what I consider to be a sacred trust between therapist and client (their privacy) they deserve to hear it straight from the horse's mouth.
So, here's the irony for me in giving out this darned Privacy notice. Here I am, doing everything I can to provide a safe environment in which people can unload and unburden themselves of their deepest, darkest pain and yet I am required to hand out this blurb that essentially says that people have less rights than they think they have (if they were to think about it for more than 3 seconds that is!) In point of fact, clients who self-pay for therapy and don't rely on their insurance (and these clients account for 99.9% of my client base) have many more protections than clients who use their health insurance to cover their mental health costs. Health Insurance companies place great premium on being able to have access to mental health providers' files. In fact, they have the right to review ALL clinical files, even those of clients who are not members of their insurance plan, if they consider or suspect that the therapist is providing improved coverage and better standard of care to self-pay clients.
I was talking with my friend Kelly about privacy and confidentiality this week, and told her about this blog, and about the philosophical dilemma I am in each time I hand out the privacy notice. Kelly and I have spent endless hours discussing organizational psychology and the importance of a shared vision and mission in working with groups of people in collaborative efforts. Kelly works in a senior position at an urban multi-service center working with poor and homeless people and I used to be director of a large agency that covered five cities, and the mission of the agency (which also focused on poor and working poor people) was the central organizing principle for me with every facet of the work I did. This applied whether I was supervising staff, directing the various projects I implemented, or even down to the way I related to the people who delivered sandwiches to our agency site at lunch time. So, during this particular conversation Kelly told me the following:
"I was doing orientation this week with a new hire and told her what the mission statement of our agency is. Then I said that the mission statement for most people and organizations in the country is to make as much money as possible in the least amount of time. So if violating privacy makes money then that is what they do. I explained to her that mission statements are about what comes first over all else. At our agency the dignity of the guests comes first over everything else, including money, property, staff, etc. For you, your clients come first. Perhaps you could write your mission statement or a blog about what that would be... and how important it is to determine the mission of any person or organization that you deal with, so that you know where you stand with them, first or secondary to something else."
Hearing this from Kelly was like having a light bulb go on over my head. I have been short of a mission statement, a simple phrase that is my current organizing principle that comes first and foremost above all else! So here it is.
Jassy Timberlake's central organizing principle as a psychotherapist is to provide a safe, welcoming and supportive environment in which any information shared is regarded as sacred and private and not to be revealed unless severe physical or emotional harm to another human being would result.
Yep, that about sums it up.
posted by Jassy @ 7:47 PM
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