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. But today's video, as all videos, is
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