Your therapy will include talking over very private things with me. To some extent my ability to help you will depend on how open you can be about yourself – your ideas, feelings, and actions. So that you can feel free to talk openly with a psychologist and so that your right to privacy is protected, the law makes it a psychologist’s duty to keep patient information confidential. This means that, generally, I cannot discuss your case with anyone or send out information about you without your permission.
If you ever want me to share information with someone else (for example, your physician), I ask that you sign a written authorization form that meets certain legal requirements imposed by HIPAA. We will talk about this before you sign the consent. There are other situations that require only that you provide written, advance consent. Your signature on this Agreement provides consent for those activities, as follows:
If you are under eighteen years of age, please be aware that the law may provide your parents the right to examine your treatment records. It is my policy to request an agreement from parents that they agree to give up access to your records. If they agree, I will provide them only with general information about our work together, unless I feel there is a high risk that you will seriously harm yourself or someone else. In this case, I will notify them of my concern. However, before giving them any information, I will, if possible, discuss the matter with you.
Exceptions to Confidentiality
If you threaten to harm someone else, I am required under the law to take steps to inform the intended victim and appropriate law enforcement agencies.
If you threaten to cause severe harm to yourself, I am permitted to reveal information to others if I believe it is necessary to prevent the threatened harm.
If you reveal or I have reasonable suspicion that any child, elderly person, or incompetent person was or is being abused or neglected, the law requires that I report this to the appropriate county agency.
If a court of law orders me to release information, I am required to provide that specific information to the court.
If you have been referred to me by a court of law for therapy or testing, the results of the treatment or tests ordered may have to be revealed to the court.
If you are or become involved in any kind of lawsuit or administrative procedure (such as worker’s compensation), where the issue of your mental health is involved, you may not be able to keep your records or therapy private in court.
If you see me in couples, group, or family therapy, I ask that each member of the therapy promise to keep whatever happens in treatment confidential. However, I cannot guarantee that others will keep this agreement.
In order to provide you the best treatment I can, there will be times when I may seek consultation from another licensed mental health professional. In these consultations, I make every effort to avoid revealing your identity. The consultant is also legally bound to keep the information confidential, although the exceptions to confidentiality apply to them as well. Similarly, when I am away or unavailable, my practice is covered by a licensed therapist. I may inform the on-call therapist about your situation to facilitate your getting appropriate support should you need it in my absence.