Paranoid about counseling and privacy

Originally Published: July 18, 2008
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Alice,

Is a therapist ever allowed to use/share my information without my knowing (for publications, case studies, etc.), provided he/she conceals my identity or otherwise makes me "untraceable"? I'm worried about becoming "material."

Thanks.

Dear Reader,

As you may be aware, the rules about healthcare and privacy can be very complicated and confusing. Laws and rules vary from state to state, and currently there are no national standards or laws when it comes to regulating the confidentiality of mental or general health issues. The good news is that most states have some laws in place that protect the confidentiality of mental health records and information. These regulations may be specific to mental health, or might be included within the guidelines that protect general health information.

There are situations where confidentiality might be broken, such as voluntary consent by the person who is seeking counseling or treatment, releasing information to another health care provider, or giving information to insurance companies for billing and payment purposes and to guardians if the patient is underage. These disclosures are made on a need-to-know basis. Other instances where information might be released is if it is suspected that a child is being abused or if someone's life is might be threatened or in danger.

When it comes to research purposes, most states allow healthcare information to be used in publications or for studies without consent from the individual. This is the case if it is impractical or not possible to get consent and if the study or purpose for getting information has already been approved by the appropriate governing body. The American Psychological Association's (APA) ethics code allows for disclosure of patients' information in publications and other works only if the identifying information has been disguised, the individual or organization has given consent, or there is a legal reason or obligation for providing this information. Although the ethics code is not an enforceable law, the APA is the largest association of psychologists in the world, and all of its members are expected to take the code into consideration in their practice.

At Columbia, both Counseling and Psychological Services and Primary Care Medical Services have strict standards regarding medical and healthcare information of their patients. The information is never a part of one's educational record (i.e. transcripts, report cards) and cannot be accessed by the faculty of the school. If a student wants or needs his or her information to be released, then written consent must be given beforehand. Again, the rare exceptions to this right to privacy are if the provider feels that a minor is being abused or if someone's life is in danger. Check out Health Services' confidentiality policy for more information, as well as who to contact if you have questions.

Because you say you are worried about your privacy being breached, you might want to have a discussion with your therapist about your concerns. This will hopefully ensure that both of you stay as well informed as possible about your needs and expectations, as well as her or his intentions and obligations.

Alice