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Is Counseling Always Kept Confidential?

Confidential counseling is one of the reasons why many people seek the services of licensed professionals. A confidential relationship with a counselor creates a safe space. When a client knows that within reason, all things that they say are kept private, they will feel far more comfortable sharing personal details of their life.  As explained below, there are only a few scenarios that require a therapist or psychologist to share confidential counseling information.

Why Confidentiality Matters

Client confidentiality is a fundamental part of therapeutic psychology’s code of ethics. These psychologists understand that clients must first feel safe to talk about anything they want before they feel comfortable talking about very personal and revealing information. Psychologists strive to create safe and respectful environments that encourage clients to speak without fear of their private information ever leaving the room. In the world of psychology, client privacy goes hand in hand with job security.

There are laws are in place to protect health care privacy. The Health Insurance Portability and Accountability Act (HIPAA) contains a very clear privacy rule that creates national standards that protect individuals’ medical records and personal health information. HIPAA mandates that health care organizations must keep all files containing client information locked up and away from public access. Failure to comply with HIPAA regulations can result in serious fines from the Department of Health and Human Services’ (HHS) Office for Civil Rights. Individuals can also sue the health care organization if their private information is illegally disclosed.

Exceptions to the Law

The HIPAA privacy rule provides a minimum level of protection, but many states have even stricter laws in place to protect personal health information. Every state’s board of psychology will publish their own laws and protections. During the first visit, psychologists generally give their new patients handouts that explain privacy policies and how personal information is handled, accessed and stored. These documents will always explain that there are a few exceptions to the privacy rule when a psychologist can or must share private information without their client’s consent.

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First, psychologists are mandatory reporters of abuse and neglect to children, elderly and people with disabilities. They must also report ongoing domestic violence situations. Adults who disclose that they were abused as a child will not require a disclosure, unless there are other children presently being abused by the perpetrator. Psychologists must release private information if they receive a court order, such as a subpoena, which may happen if a defendant’s mental health comes under question during legal proceedings. Psychologists may disclose private information without consent in order to ensure public safety, such as when a client discusses their plans to attempt suicide.

Who Can Legally Access the Records?

Psychologists must share certain pieces of information about diagnoses and treatments with the health insurance provider, such as a private company or a government program like Medicaid and Medicare. These programs must know basic information for billing purposes, such as when to determine what care is covered. Health insurance companies and programs are similarly bound by HIPAA rules to keep medical information confidential.

Depending on the client’s needs, some psychologist may ask permission to share information or discuss treatment plans with external professionals and health care professionals. This includes social workers, school counselors and primary care physicians. Employers do not receive information about health services an employee receives because this information is kept confidential through the insurance company. Most HR professionals who coordinate benefits will have access to insurance billing reports that list basic information, but they are also bound by the HIPAA rules. Confidential counseling is a key to providing engaging and supportive therapeutic services.

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