By law, licensed therapists are required to maintain confidentiality and keep your records private, as they are considered part of your medical record. You may sign a Release of Information authorization in order to have your therapist share your medical record or talk to another party (such as another therapist, doctor, psychiatrist, or school counselor). You may also request to have a summary of your treatment.
Confidentiality is an essential part of the therapy process. One goal of the space is to be accepting and unconditionally loving, with the ability for anything to be shared without fear of judgment or external repercussions. A client needs to know that they can trust that what they say will not be used against them. The starting point of growth honesty. Honesty can be impeded by fear of information being shared, which is why confidentiality is so important. Please see my note below about the caveat to confidentiality being harm.
Some churches or Christian organizations will offer pastoral counseling or pastoral care and their counselors or pastors may not be licensed therapists. If this is the case, their confidentiality standards are not governed by state laws. If you want to work with someone who is not licensed, I recommend you discuss their confidentiality guidelines with them.
Therapists must receive supervision during their first years of clinical practice (but after completing a master's or doctoral degree). During this time the therapist will meet with a licensed therapist to talk about client cases in order to learn. This supervisor is also legally required to maintain HIPAA confidentiality and the supervisee refrains from sharing any identifying information in order to maintain anonymity of the clients in discussion. Most states require these supervision hours (an average of 100-200 hours) in order to obtain full licensure.
Some therapists who have completed their supervision and gained full licensure decide to meet with other therapists for peer supervision in order to learn and gain more skills. Again, these other therapists are also legally required to maintain HIPAA confidentiality and the therapists all refrains from sharing any identifying information in order to maintain anonymity of the clients in discussion.
Some therapists take notes during sessions. Each therapist determines whether or not these notes will be part of your public file or their own private notes. I personally take notes in order to best pay attention and then I keep these notes as private. I write down a key word or phrase in my progress summary that is part of the public file. My main goal is to ensure that I am fully engaged, have relevant information handy should I want to refer to it (such as stories, names, or goals), and maintain confidentiality.
Public Notes and Private Notes
Therapists may separate a file into two sections: public and private. Public Notes are those which can be shared with a client, shared with another professional (therapist, doctor, or school official with a signed Release of Information), or subpoenaed (though most clinicians work to avoid a subpoena as this not only jeopardizes trust in the therapy space, but also because clinicians are not experts in legal matters).
Private Notes are for the therapist’s use only and are intended to help the therapist in their treatment with the client. Information from these notes may be shared on an as-needed basis with other professionals during confidential case consultations, which are for the benefit of the client. Overall, these notes are mostly used for the therapist’s own treatment planning.
The one caveat: Harm.
The therapist may be legally required to break confidentiality because a licensed mental health professional is considered a mandated reporter. A mandated reporter is someone required by law because of their professional position to report to law enforcement or Child Protective Services (CPS) that physical, sexual, or emotional abuse or neglect has or is occurring. Harm can occur in one of three ways:
The client is harming themselves (self-harm; such as cutting, use or abuse of drugs or alcohol, or inflicting physical pain on one's self)
Someone else is harming the client
The client is harming someone else
There are laws that govern when, how, and to whom reporting should occur. My personal policy is that, if at all possible, I discuss with the client before any reporting occurs. I also discuss my confidentiality policy, and the limits due to harm, with my clients at the start of therapy.
