Confidentiality in Therapy     (Recently revised)


  One hallmark of psychotherapy in our culture is the presumption of client confidentiality.  It is an important part of the therapeutic relationship that the therapist will maintain to the utmost the privacy of any therapeutic communication.

  In addition to professional ethics, the laws of the State of Michigan protect this.

  I keep a written record of treatment and conditions, this record itself is considered confidential in accord with Michigan law regulating privileged communication, except when:

  - legal constraints apply

  - when a compelling need arises based on substantial probability of personal harm to the client(s) or others, or in cases of a life-threatening emergency,

  - when an insurance carrier asks to review the records to verify the services billed to it have been rendered, and/or

  - when the client has signed an appropriate form for the release of information.


  I am very careful about the storage and protection of client files. And it is also my policy that files in which there has been no client activity for a period of ten years, may be removed and safely destroyed.

A note about Insurance and confidentiality

  When you wish us to submit a claim for payment to an insurance company, or any other third party payee, you will be asked to sign a release of information form that allows me to share with them certain information about you. This information generally consists of a diagnosis and a record of service dates and settings, as well as progress notes and evaluatory information.  At a practical level, this shared information cannot be considered as absolutely confidential. Also, whereas this information used to be primarily paper information, now it is being requested in electronic format, and involving a more extensive amount of clinical information.  

  I used to consider this risk to be minor, but in our current age of rapidly increasing healthcare security breaches, my level of concern has been increasing for effective confidentiality whenever insurance coverage is used. Realize this involves your own psychological diagnosis and treatment records. Once such information enters electronic format (which is mandatory these days), it lasts forever, independent of actual accuracy.

[On a personal level, I can have some comfort that if I were to end up in an ER while visiting family in San Francisco, my (now electronic) medical records from Michigan could be available in 2½ minutes.  But to have my lifetime psychologocal information so readily available gives me pause.]

  For this reason, I have long had clients who opt not to be involved in the use of their insurance benefits, so that the confidentiality of the client/therapist relationship is more absolute. For professional, ethical and philosophical reasons I increasingly take this matter seriously.

  As of June, 2015, I have generally decllined to bill insurance for any new clients.  I notice I can be much more efficient and creative without this burden, and the reduction in 'back room accounting' work has already added to my own quality of life.  

A note about confidentiality with Minor clients

  When a client is of minor age, that is (in Michigan) under the age of 18 years, therapy can only be undertaken with the written consent of a legal parent or guardian. The parent or guardian also has a right to confidential information about the minor client.

  As a matter of policy and practice, I inform a minor client that "I will not keep secrets" between him or her and their legal parent or guardian. However, I will tell the minor client that before I would reveal significant confidential-type information, I'll inform the minor client ahead of time (if possible). With many minor clients, it's very important that much of what they share is considered "private" - which is much of the value of "being in therapy." However this "privacy" is not an absolute right, and I will use my discretion as to what is appropriate and useful to share with the legal parent or guardian.

© William K. McDonald

ed, August 1, 2015