Everything you need to know about confidentiality
Counseling will work to the degree that you are confident my office is a safe place to bring up sensitive matters, but you will have to take some risks. The things we talk about are confidential. I will not repeat the things we discuss in a way that can be traced back and identified with you. There are some limits and challenges to confidentiality, though. You need to know what they are.
Sometimes the counselor can interfere with the counseling being a safe place. You will not be honest with me if you think I will judge, preach, blame, chew you out, abuse, or criticize you. But I will respond to what you say to me. I would not be human if I did not have a reaction. It would seem weird if I just sat there.
The most frequent complaint I’ve heard from clients about other counselors is that they just sit there, inscrutable, and don’t offer any help. I don’t have this problem, but I am always mindful of giving you the space to talk about what you need to talk about without imposing my own values.
My office has a parking lot in the back, so it would be hard for anyone to see your car by my building. You can enter through the back, so no one is likely to see you go in. When you step into my waiting room, there will be no one waiting to see other counselors. The radio will be playing and there will be a white noise machine by my door to mask sounds coming from my office. I’ve tested it. Unless people are screaming, it’s impossible for anyone to hear what we talk about in my office. My files are locked and you will not see any private information on my computer screen or on my desk.
In the Community
I will not say hi to you if I see you out in the community. I don’t want you to have to explain to anyone you’re with how you know me if you are not comfortable in doing so. If you are comfortable, then go ahead and approach me.
The Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule provides consumers with important privacy rights and protections with respect to their health information, including important controls over how their health information is used and disclosed by health plans and health care providers. If you would like to read a government document discussing these rights, click here. If you don’t want to read it, I don’t blame you in the least.
If you choose to use insurance to pay for your sessions, you or I will have to give them some information. If I’m an in-network provider, I will send a claim after each session telling them that you saw me, the date and duration of the session, the type of therapy provided, and a diagnosis code. They seldom ask for anything more, unless we are trying to get approval for more sessions.
If I’m out-of-network, you will have to send them that information if you want to reimbursed. After each session, I will email you a receipt, called a superbill, that contains that information. You pass it on to them.
If you are in the military
If you are in the military and are seeing me through the insurance the military provides to you, like Tricare or Military One source, then I am under obligation to report family maltreatment (spouse, child, elder abuse), threats of harm to self or others, substance abuse, and illegal activities. I have to make the report to the insurance company and they report to your commanding officer.
So, you can see, that, as long as you use that particular insurance, you do not have the same confidentiality rights as a civilian would.
If you don’t pay your bill
Payment is due at the time of service. If you fail to pay, there is a $5 late fee. If months go by and you still don’t pay, then I refer the bill to a collection agency. They will have your name, demographic information, dates of service, and charges, but I will not pass clinical information onto them.
Release of information
You may want me to pass on information to others. I frequently have clients who are required to attend counseling or get an evaluation by probation, parole, the courts, a parent, or a spouse. If that’s the case, then I’ll ask you to sign a release that states I have permission to share information with others.
I have found that having to report to the authorities may affect the things you will talk to me about. It can be hard to be honest. For that reason, I give them the minimum amount of information they need.
If others are involved in your treatment
If you are seeing someone else, like a doctor, for medication, for instance; it is generally best if I work together with that person. This may necessitate that I share information with them about you. If that’s the case, I will ask you to sign a release. If there is particular information you don’t want me to include, tell me what that is and we will discuss whether I can exclude it.
If you’ve just come from another facility and I need information from them, I might ask you for permission to contact them. If that’s OK, then sign a release.
In an emergency, then no one in the health care field waits around for releases to be obtained before information is shared that is vital to your safety. If I get a call from an emergency room, for example, I will give them whatever information they need to assess and treat you effectively.
If you’re coming to see me with your spouse or other family member to improve your relationship, most of the time you will be meeting me with them. If there is something you would like to talk about without your family member present, whatever the reason, then please ask to see me individually.
When I work with couples in marriage counseling, I will often set up individual sessions so we can talk privately. I don’t do this because I believe it’s best to have secrets from your spouse; I do it so it can be easier for you to talk. I will regard the things you tell me as confidential and will not repeat them to your spouse when I see them individually or with you.
I, and most other counselors, will not meet with couples for marriage counseling when there is an ongoing threat of domestic violence. It may seem that marriage counseling would make sense in cases like that, but the situation is often not safe enough for marriage counseling. I don’t want you to bring up something up in my office, thinking it’s a safe place, and pay for it when you get home. When there is domestic violence, I will work with one or both people individually on whatever issues are relevant.
If I learn in our conversations that you are planning harm to yourself or others, I am obligated to take action towards safety. This may mean that I get you to the hospital. It may mean I call the police. It may mean that I warn the person threatened. If you have physically or sexually abused a child and are that child’s caretaker, I will have to report this so it can be investigated.
You may have heard that the Safe Act in New York requires that mental health professionals report any client to the authorities who possesses a gun and is likely engage in conduct that puts people or themselves at risk. The authorities would then revoke that person’s permit to possess a firearm.
That is true, but, when they wrote the law, they defined mental health professionals as psychologists, psychiatrists, registered nurses, and social workers. In their haste, they left out licensed mental health counselors and certified alcohol and substance abuse counselors, which is what I am. This leaves me in a very ambiguous position. On one hand, the intent of the law was clearly to include me and my colleagues, on the other hand, they could have, and didn’t.
The way I have settled this for myself is to do what I have always done. If I learn you are planning harm to yourself or others, I take action towards safety. This may mean that I get you to the hospital. It may mean I call the police. Confidentiality is important, but saving lives is more important.
Theoretically, a judge can order me to testify or submit my records to court. However, in twenty-five years, I have only had one subpoena to do this and, in that case, I evoked privileged communication and the request was withdrawn. I would do the same if it ever happened again.
Consultation and Training
Being able to consult with and learn from other professionals is vital to me as a therapist. Every two weeks I host a peer supervision group with colleagues. I sometimes work with an intern who sees me for supervision. I also attend training and conferences where cases are discussed. If I ever bring up your case in those settings, I will not share identifying information.
I do a lot of writing. I have a blog: Madness 101, in which I post twice a week. Currently, I’m working on three books: a self help book about relationships and two novels. Under a pseudonym, I also have written a blog of fiction called The Narrative Imperative.
Certainly, my work as a therapist enters into the things I write about. I seldom write case studies. I don’t like them aesthetically, and I also wouldn’t want my clients shocked to find themselves written up in entirety as an example. If I ever am interested in writing about your case in detail, I will get your permission first.
My fictional work is sometimes inspired by my own experiences and stories I’ve heard, but it is still fiction. Any resemblance to actual people and events is purely coincidental.
I’m not on Twitter. Call me a dinosaur, but I don’t tweet.
I’m on Facebook, but, if you’re a client and send me a friend request, I will decline. Not because I don’t like you, it’s just that it crosses boundaries into the personal. If you are already one of my Facebook friends, I will refer you to someone else for counseling. I won’t ask you to like my business Facebook page, because I haven’t created one. I don’t believe it really helps any business but Facebook.
LinkedIn is a different matter. I have a page on LinkedIn and, because it deals with my professional life, I will accept invitations to connect there. However, please don’t expect me to endorse you for a skill I know nothing about.
Electronic Medical Record
I keep your records electronically on an encrypted cloud server provided by TherapyAppointment.com. I use this software for online appointment scheduling, appointment reminders, charting, emailing, billing, insurance claims, and business management. I selected TherapyAppointment.com because it is HIPAA and HITECH compliant. I believe it is more secure than keeping paper records. Click here to read a government assessment of the security of electronic medical records.
I also selected TherapyAppointment.com because it enables me to involve you in every aspect of your treatment. You can look up, schedule or change appointments, view and download account balances, pay your bill online, and exchange secure, encrypted messages with me. I send you a summary after each session to remind you what we talked about.
Any messages I send through this service self destructs after two weeks, like in Mission Impossible. You will have to cut and paste if you want to save it.
To take advantage of this, you will need to set up a patient portal and keep your password safe. If we have never met and have not yet set up an appointment, then you can click here to register as a new client. If we have met any time since December 2013 or have an appointment in the future, then I already registered you. Click here to log in. Call me at 585-732-1970 if you don’t know your username or password.
Phone and Texts
You may call or text me at 585-732-1970. This is my cell number, both business and personal. If I don’t pick up it’s because it’s not a good time to talk. If you leave me a voice mail message or text, I will try to get back to you by 9 pm at the latest.
I work by myself in a private practice and it is impossible for me to always be available for emergencies. If you’re in crisis, nearly anywhere, you can get help by calling 911. If you’re in the Rochester area, dial 211 to call Lifeline at any time.
You can email me at firstname.lastname@example.org, but it is not an encrypted form of communication, so I prefer to use the email service provided in the patient portal.
Feedback and Complaints
The best way for me to get better at counseling is to get accurate, constructive feedback from my clients. I try to do this in a way that doesn’t overwhelm you with surveys or detract from the reason you see me. Please let me know, by email or when we meet, any reactions you have to our sessions or the summaries I send, positive or negative. This feedback helps me improve.
I try to follow the ethics guidelines set forth by the American Counseling Association and the New York State Office of Alcoholism and Substance Abuse Services. Click on the links if you want to read them.
I am licensed by New York State as a Mental Health Counselor (LMHC) and a Certified Alcohol and Substance Abuse Counselor (CASAC). (Click on the links to verify) You can contact those offices if you have a complaint.
So, that’s it. I’ve tried to think of everything to enable you to trust me. If you still have trouble trusting, that’s not unusual. Maybe you were hurt in the past. Tell me about it and we will work through it together.