hello. My main fear preventing me from going to therapy is the therapist telling/sharing my information i give with others in my real which then affects me negativly in any way.
I know there's like atleast some rule to not tell strangers less your fired, but I also worry for parents or schools or goverment etc. Conservative parent doesn't believe in mental health(normal ppl or r-word and nothing else) and I generally have had bad experiences with social workers telling the things I tell them to others. I fear how I might be treated or how freely info like me being autistic might spread or be used. Do you know how much therapists usually share what they find with such people/organisations?
Obligatory “therapist but not your therapist” disclaimer, then the answer is: it depends. In the U.S. therapists are bound by HIPAA, although recent moves with the federal government may impact how HIPAA works going forward at-present it means that people cannot share “PHI” or personal health information unless you permit them to do so. This is impacted by multiple variables - for example, at one of the sites I worked at we made parents sign a confidentiality agreement before treating their kids to avoid having to disclose information to parents as the legal guardians of a child (and by extension their PHI). Our contracts permitted us to work with parents if a child was going to engage in behavior that could reasonably endanger them, such as meeting an internet stranger for sex or using powerful drugs. At that site I only ever involved parents in a child patient’s care twice - once with a child’s permission to discuss an ongoing stressor in their life, and the other after a child expressed serious suicidal ideation and I needed dad to know to safely secure his firearms.
I also worked at a site that provided forensic evaluations for kids going into the Juvenile justice system. In those cases we often could not disclose information to parents but were obligated to disclose information to the courts. This was always disclosed beforehand and almost always worked in the patient’s favor, but sometimes kids would confess to crimes they had plead “not guilty” to and that would get sent to the judge overseeing their case. In forensic cases we were not allowed to share information about the person receiving the assessment with them or their caregivers as our client was legally considered to be the Arizona Office of Corrections.
With adult patients, my work with patients who had committed sex offenses had some unusual aspects related to confidentiality. Patients were not permitted to choose to seek treatment, and often refusal to see treatment was considered a violation of parole, so many patients were being treated against their will and with limited confidentiality due to the nature of their probation arrangements, which permitted us to share information with probation officers if needed. It also gave probation officers access to therapy documentation, which was an additionally confounding factor. But these were factors which were known to patients prior to engaging in treatment, so while it is ethically dubious it was still allowed.
In general, therapy patients who are adults and not involved with the legal system in some way are protected by HIPAA, where information cannot be shared barring extreme circumstances (imminent risk of danger to self/others) unless the information is de-identified (meaning the information used cannot be so specific as to identify you to others.) Some states have extended these same protections to minors, although not all of them have. A good general rule of thumb to use is “If the state lost the civil war, it does not protect the confidentiality of minors by default.”
HIPAA protections do not mean information cannot be shared - it does mean, however, that if it is shared you can stand to win a lawsuit against the provider in question depending on the details of how it was shared. I hope this helps! Feel free to ask more questions in the comments or to DM me if you so desire :-)
