I do understand your adamant protection of your privacy. I feel the same way. But because I want privacy doesn't mean that I get to tell other people not to follow the law. What I can do is learn how to protect my privacy and still get the help I need. When a health professional (therapist, psychiatrist or primary doc) ask me a question that I want to stay private and off the record, I don't answer it or answer it in a way that maintains my privacy. For my mental health services, I go to a private therapist who has no office staff. She keeps her own records and does her own billing. This keeps the flow of information contained. But even with her, I tell her what I don't want to discuss or "get into". That's my right and she honors it.

Like you, however, I'm not in the position to pay out of pocket for services. I have to use my insurance. That makes it difficult because when I use the insurance, the insurance company is entitled to certain information: my diagnosis and my treatment plan. I've talked this over with my therapist and she it really up front with me about how brief her case notes are and what she puts down as a diagnosis (dysthymia). She's never had an insurance company call her and question her about treatment plan and/or session issues and she told me that she'd let me know if she ever got that kind of call. She was even willing to make sure she didn't call back to "chat" with them unless I was present for the call. It's a matter of finding the right treatment provider and willing to negotiate how treatment will be delivered.

I will say, however, that there is no way around the legal issues regarding the therapists need to report suicidal/homicidal or abuse issues. I know enough not to try to even negotiate that issue. If I have bad thoughts that I don't want someone reporting to anyone, I keep them to myself. It isn't fair for me to put the other person in a difficult legal position regarding their safety or others safety. You have the right to not discuss issues that you wish to keep private.

And as for the confidentiality breaches, I'd definitely talk to a law advocate to discuss whether or not you have the right proof to pursue a breach in confidentiality laws. You're entirely right when you talk about how vigilant one has to be to protect their privacy rights. Hope things work out for you.