Confidentiality is a central tenet of psychotherapy. It is a critical component of the therapeutic relationship that fosters trust and creates a safe environment for clients to explore their innermost thoughts and feelings. However, there are limits to confidentiality in psychotherapy. While therapists are bound by strict ethical codes and laws that protect their clients’ privacy, they are also mandated to break confidentiality under certain circumstances.

4 Main Reasons for Breaking Confidentiality

First and foremost, therapists are required by law to break confidentiality if they believe their clients pose an imminent danger to themselves or others. This is known as the “duty to warn” or “duty to protect.” If a therapist has reason to believe that their client intends to harm themselves or someone else, they are legally obligated to take steps to prevent harm from occurring. This may involve contacting the authorities, hospitalizing the client, or notifying potential victims of the threat.

Second, therapists may be required to break confidentiality if they receive a court order or subpoena to release client information. In some cases, clients may be involved in legal proceedings, and their therapy records may be relevant to the case. In such situations, therapists may be required to release information that is pertinent to the case.

Third, therapists may be required to break confidentiality if they suspect child abuse or neglect. In Oklahoma all adults are considered to be mandated reporters, which means they are legally obligated to report any suspected cases of child abuse or neglect to the appropriate authorities. This duty extends beyond their clients to any child they have reason to believe is being abused or neglected.

Fourth, therapists may be required to break confidentiality if their elderly clients are at risk of being exploited or abused by another person. For example, if a client is being exploited by a caregiver or intimate partner, a therapist may need to report the abuse to protect the client’s safety.

Health Insurance

When a client uses their healthcare insurance to pay for psychotherapy, the therapist is required to provide information about the client’s treatment to the insurance company. This information typically includes a diagnosis, treatment plan, and progress notes. This is necessary to process insurance claims and to ensure that therapy is medically necessary and appropriate.

This sharing of information, however, means that the client’s confidentiality may be compromised. Insurance companies are bound by laws that protect the privacy of clients’ health information, such as the Health Insurance Portability and Accountability Act (HIPAA). However, even with these protections in place, there is still a risk that the client’s health information may be accessed by unauthorized individuals, such as insurance company employees who do not have a direct role in processing the client’s claims.

Another way that using healthcare insurance may limit psychotherapy confidentiality is through the use of pre-authorization and utilization review processes. Some insurance companies require therapists to obtain pre-authorization for therapy sessions, which involves providing information about the client’s diagnosis, treatment plan, and expected outcomes. The insurance company may also conduct a utilization review, which involves reviewing the client’s treatment progress and determining whether further therapy is medically necessary. These processes may lead to additional sharing of the client’s confidential information with the insurance company.

In addition to these concerns, clients may also be concerned about the stigma associated with mental health treatment. If a client’s health information is accessed by unauthorized individuals, it may lead to discrimination or negative perceptions about the client’s mental health.

Health Information Exchange

The Oklahoma Health Information Exchange (OKHIE) may impact psychotherapy confidentiality through the sharing of mental health information between healthcare providers. When a client receives psychotherapy services, their therapist is required to keep their health information confidential, including information related to their mental health. Clients may choose to NOT have your psychotherapy/counseling information uploaded to the OKHIE. This way the OKHIE will never know you are – or have been – in counseling.

Bowden McElroy and Associates, LLC (BMA Counseling) has chosen NOT to participate in the OKHIE.

However, if the client also receives healthcare services from physicians who prescribe medications and participate in OKHIE, their mental health diagnosis may be accessible to other providers through the exchange.

While OKHIE is designed to maintain the privacy and security of patient health information, there is always a risk of data breaches or unauthorized access to sensitive information. The sharing of mental health information between healthcare providers may result in stigma or discrimination against individuals with mental health conditions.

It is worth noting that there are some protections in place to minimize the impact of OKHIE on psychotherapy confidentiality. For example, therapists are required to obtain written consent from their clients before sharing any health information with OKHIE. Clients also have the right to limit the information shared through OKHIE or to opt-out of the service entirely.

Clients should be aware of the risks and work with their therapist and prescribing physician to minimize the sharing of their mental health information through OKHIE, if that is a concern for them. Ultimately, the decision to participate in OKHIE is a personal one that should be based on the individual’s needs and priorities.

In conclusion, while confidentiality is a critical component of psychotherapy, there are limits to its protection. Therapists are required to break confidentiality under certain circumstances to protect the safety and well-being of their clients and others. As such, it is important for clients to understand these limits and the circumstances under which their therapist may be required to breach confidentiality. This knowledge can help clients feel more comfortable and confident in their therapy sessions and ultimately lead to better outcomes. Also, while using healthcare insurance to pay for psychotherapy can be a useful way to manage costs, it may also limit confidentiality. Clients should be aware of the risks and work with their therapist and prescribing physician to minimize the sharing of confidential information with both their insurance company and the Oklahoma Health Information Exchange.


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