therapy and confidentiality.

Hello Doctor:

As an adult child of an alchoholic, I have been wanting to seek a therapist for a while now, because there are several emotional
problems from the past I need to work on which are keeping me in great pain.
However, despite "knowing" that therapy is supposed to remain confidential, in today's time of insurance practices--my insurance would cover a therapist--is that guaranteed. I understand that to seek more sessions, a therapist would have to give some info to the insurance company. However, I see in the movies about legal situations where a client's mental health record is used etc...dont know if this is fiction or can happen.

Could you please let me know under what conditions and to what extent can discussions and dignoses of a therapist be revealed tosomeone?  And what about insurance companies--to what extent are they absolutely prohibited from releasing information,and
what is the scope of the information they may get from a therapist to approve sessions. I guess this question may sound a little paranoid but I have this fear that if I am ever in a legal situation--you know divorce or professional problems--someone might be able to use my attending therapy and my therapist's file on me, to discredit me.

I would feel much better about going to therapy if I knew thatinformation could NEVER be disclosed by therapist or insurance company and would be more relaxed about revealing myself to a therapist; otherwise I worry about how something i may say may end up haunting me later. This  worry defeats the purpose of the therapy as it would get between me and a potential therapist.(i realize of course the stipulation about "if you are a danger to self or others"--but that's not what i mean here. also, are insurance companies prohibited by law to provide any information about mental health?

My insurance is covered by my employer--I dont know how all the billing etc gets done, but I worry whether my employment's benefit office may get bills or whatever.

[Roger Gould, M.D.]

This is a very complicated situation right now because the privacy laws are being debated in congress and by the current administration. Traditionally everything said to a therapist is legally protected as confidentiality and only a court can compel him or her to testify without your explicit consent, and only under dire or emergency kind of situations. You are well protected in that regard.

Your employer is not entitled to know anything about your case at all from the insurance company other than the fact that you are using benefits and their is a legitimate need.  That may vary with insurance company in some small, but maybe important details so you need to check with the insurance company directly about that and what their policy is about sharing information with anybody.  By and large  you are protected by many laws here to  but check to make sure that there is not some idiosyncracy in your state.  The insurance company is entitled to a diagnosis, a prognosis, and progress reports; but not to any confidential disclosures or discussions.

In practice most therapist will protect your privacy 100%. You should also discuss this with the therapist to make sure.