My T had an accountant but I am sure that was wholly giving the person my check each week and that was it, had nothing to do with my sessions or file (I was a whole file drawer in her home she said). I don't think the accountant even had any sort of indication on how much I was supposed to pay/did/did not pay, etc. but just received the money and accounted for it :-) If I had not paid "correctly" my T would have addressed that with me so my therapy was not really connected I don't think (as in, if I had cancelled a session too late I would still have had to pay her for that week, even though there was no session :-)

Depending on my relationship with my T and who their billing person was, whether I was aware of them, etc. would matter to me more than that someone had read my T's (someone else/other than "Me") writing about me. I did not use insurance or anything so my paying was very transparent, no forms to fill out, etc. I do not think I would care that someone read my file/knew I was anxious or depressed or had two heads If I had a T through work or something like that and it was a small busines, etc. and there was a chance of "gossip" of any sort I might feel less comfortable or if I had to meet/talk to the billing person and did not know them well, that might bother me. I remember my poor stepsister went to a cocktail party in the 1960's and her OB/GYN was there, LOL. THAT would make me uncomfortable.