[SenatorPenguin8081]

I've always had a problem with one thing in therapy--- privacy.

I haven't seen my T in awhile, but I'm planning on going back in a month or so. He's always respected my privacy as much as possible, and doesn't usually take any notes while in session (who knows if he writes anything down afterwards), but he does have this standardized form he fills out primarily legal and insurance purposes (I've read some of them, which are still more than I'd like to share with the world at large). Now that I'll be paying out of pocket, he won't have to submit anything to the insurance company, which I feel better about, but still...

I'm a little freaked out by what can happen with this stuff. I'm afraid of office staff even. I was pretty used to it before, but since I've had a break of several months since I last saw him I'm on my paranoid privacy kick again.

Anyone else struggle with this issue?
How do you contend with it in a healthy way, keeping things in perspective?

[jilliebeanmn]

I figure if I trust my T with my darkest, deepest secrets, I can trust him to protect my privacy. I let it go at that.

[splitimage]

It's not really an issue for me, even though my T writes down everything I say, because of confidentiality laws. My T absolutely can not discuss me, other than in very general terms unless I sign a release. The only exceptions to this is if she believes I'm an immediate danger to self or others or if she was ever suppoenned to testify in court in a case involving me (extremely unlikely). Same thing with all medical Dr's. They can't disclose anything without written consent. When my pdoc wanted to talk to my addictions Dr, this past summer, I had to fill out a ton of forms.

The only exception to this is if you're IP or have a team treating you as an outpatient. Then the care providers can talk between themselves and share notes about your care, but they can't disclose to anyone outside the institution.

[SenatorPenguin8081]

Originally Posted by splitimage

It's not really an issue for me, even though my T writes down everything I say, because of confidentiality laws. My T absolutely can not discuss me, other than in very general terms unless I sign a release. The only exceptions to this is if she believes I'm an immediate danger to self or others or if she was ever suppoenned to testify in court in a case involving me (extremely unlikely). Same thing with all medical Dr's. They can't disclose anything without written consent. When my pdoc wanted to talk to my addictions Dr, this past summer, I had to fill out a ton of forms.

The only exception to this is if you're IP or have a team treating you as an outpatient. Then the care providers can talk between themselves and share notes about your care, but they can't disclose to anyone outside the institution.

I wish I had your trust about it. The reality is that laws are broken all the time though, and yes, doctors and therapists are capable of negligence, breaking the law, and general lack of common sense.

My past is the reason why I have such fears, even though they are likely out of proportion to what would/could actually happen. My T almost part of a court case that I was a party of, which, THANKFULLY-- never saw light of day. But it was that close...I'd be so pithy scared if I was ever inpatient!

Will they talk to your other providers about prescription drug abuse if they think you are harming yourself?

[skeksi]

I've always wondered how much information my T has to give my insurance company. I don't really want to deal with the answer if I hate it, so I don't ask.

T did speak to my psychiatrist at the beginning of my treatment, at my request. He said he thought it would be more helpful to me to hear him summarize (and explain) what he wrote, so that's what we did instead of me just reading it. I assumed it was written in clinical language and he knew I'd be bothered by that.

[(JD)]

I'm not an authority on this at all but I do know that anything T writes down and puts in a file for your treatment is supoenable. The only thing the secretary should be hearing and typing is the basic report for insurance reimbursement. They don't need any details. They get their code numbers, and whether patient is progressing, etc.

In the USA we now have HIPAA ... and what people don't understand is that doesn't protect the patient in the least. It protects the doctor! It allows the doctor to send out your information (because you have to sign the agreement before they see you) and once they send it, they are no longer liable! The third party who receives the information is never liable for what happens to your information. So they can toss it out with the cat litter if they want for anyone to find.

Yes, it might ruin their reputation for a while if found in the trash...but

However, all reputable psychologists and therapists up on their CEUs etc know full well what is happening in the arena and take advice from the legal experts on how to best protect their patient's and themselves.

Discuss it with T if you have any questions, and get it off your mind early. Sometimes just the questioning will nudge a less than meticulous doctor into sharpness!

[ECHOES]

I also pay out of pocket and one thing that I absolutely love about it is that my therapy is just between my T and I. She took notes once after asking, and it was for a course she was taking. She also will write down dreams but that is different and is about wanting to capture every detail and in the order that I tell it, because dreams are important in analysis. I don't mind at all and in fact I kind of like it, as if it is THIS important, so it needs to be written down.

Especially now in the big push for electronic medical records, computerized records that follow you for life, like your credit report, I am glad that I bypass the nosy insurance company whose motives are not my well-being.

[SenatorPenguin8081]

Originally Posted by (JD)

I'm not an authority on this at all but I do know that anything T writes down and puts in a file for your treatment is supoenable. The only thing the secretary should be hearing and typing is the basic report for insurance reimbursement. They don't need any details. They get their code numbers, and whether patient is progressing, etc.

In the USA we now have HIPAA ... and what people don't understand is that doesn't protect the patient in the least. It protects the doctor! It allows the doctor to send out your information (because you have to sign the agreement before they see you) and once they send it, they are no longer liable! The third party who receives the information is never liable for what happens to your information. So they can toss it out with the cat litter if they want for anyone to find.

Yes, it might ruin their reputation for a while if found in the trash...but

However, all reputable psychologists and therapists up on their CEUs etc know full well what is happening in the arena and take advice from the legal experts on how to best protect their patient's and themselves.

Discuss it with T if you have any questions, and get it off your mind early. Sometimes just the questioning will nudge a less than meticulous doctor into sharpness!

Absolutely right about the subpoena part, having gone through that and ALMOST having to make it public information to the court because I was at one time a part of a court case that was dismissed (thank God!). My T was very blunt about what he would and wouldn't share with the court though. He could legally deny them access to certain material and force the other side to petition the court citing irrelevance etc., which he was prepared to do. Thankfully I never found out what would have happened!!!

Your right--- HIPAA sucks. I'm not a fan. Our laws don't do much for us in some situations. That's why it's so important to have a really good T.

[SenatorPenguin8081]

Originally Posted by ECHOES

I also pay out of pocket and one thing that I absolutely love about it is that my therapy is just between my T and I. She took notes once after asking, and it was for a course she was taking. She also will write down dreams but that is different and is about wanting to capture every detail and in the order that I tell it, because dreams are important in analysis. I don't mind at all and in fact I kind of like it, as if it is THIS important, so it needs to be written down.

Especially now in the big push for electronic medical records, computerized records that follow you for life, like your credit report, I am glad that I bypass the nosy insurance company whose motives are not my well-being.

Darn right Echoes--- I personally believe EMRs are Orwellian hell! I've seen them misused before and I don't care for the direction we are taking. Our laws are not protecting the patients privacy and furthermore, we don't have the protection in place to prevent misuse and theft of our personal details that will follow you around your ENTIRE life. Just ask GOOGLE what could happen...

Especially in this era of Copy and Paste--- accuracy will be lost, more so than ever before.

I hate the price of privacy Echoes, I really do, but it is worth it to keep the damn insurance company minions out of my private life. I do not want to become a part of that "aggregate data" collection sample again.

[sunrise]

I don't think my T keeps notes. Insurance is not part of our relationship. Last time I was there, I asked him to write something up for me and email it to me. He agreed but said he would not email it. He would write it and give me a hard copy. I don't think he will keep a copy on his hard drive, just print it for me, then delete it. That was the implication. There have been a couple of times he asked if he could speak to someone else about me and my family and I had to sign a release for him to do this. But no written documents were exchanged.

I am really glad he doesn't keep notes. I saw my family doctor's file on me and there are all sorts of inaccuracies there and stuff I wish wasn't there. It is hard to get it corrected once it is in their computer system. Even when I tell them something is incorrect, I find it is still there when I visit next.

[SenatorPenguin8081]

Originally Posted by sunrise

I don't think my T keeps notes. Insurance is not part of our relationship. Last time I was there, I asked him to write something up for me and email it to me. He agreed but said he would not email it. He would write it and give me a hard copy. I don't think he will keep a copy on his hard drive, just print it for me, then delete it. That was the implication. There have been a couple of times he asked if he could speak to someone else about me and my family and I had to sign a release for him to do this. But no written documents were exchanged.

I am really glad he doesn't keep notes. I saw my family doctor's file on me and there are all sorts of inaccuracies there and stuff I wish wasn't there. It is hard to get it corrected once it is in their computer system. Even when I tell them something is incorrect, I find it is still there when I visit next.

Yep, I've ran into similar experiences with my regular physicians, and it was some pretty personal, and inaccurate stuff in my files. Some of it was downright unprofessional. I'm not worried about my T as much as I am about who the data goes to and who possibly has access to it after it leaves his hands-- if it leaves his hands. Even my T is human and prone to error because of his hubris.

What I really hate is possibly needing accommodations for my ADHD for classes because I'm not doing very well right now and the medication isn't really working... I'm going to solicit my T's input on this. When I did it before the only thing that helped was the extra test time, but my problem is primarily studying, not test taking. The supports I've had experience in the past with at my old university were really just in name only; they really didn't take any true action to help-- but they sure requested a lot of detailed personal data and reports from my T and psych doc in order to provide me with that empty "support". I am not optimistic about my new school either.

Sickens me. Annoys me. Frustrates me. I am more than that fubared file they have on me. I dont know I just feel sorta messed up guys, and vulnerable--- and I don't want personal stuff about me getting out to people.

[sunrise]

Originally Posted by SenatorPenguin8081

The supports I've had experience in the past with at my old university were really just in name only; they really didn't take any true action to help

SP, what supports would you like the university to provide? I have ADHD too and would love to have some supports but can't think of much of anything I could ask for that would be something the university could provide. (I have not requested accommodation at my school.) If you have ideas, I would love to hear them. At my university, you can get extra time for a test or an isolated and quiet spot to take the test. I really appreciate the latter option, as all of the people clacking noisily on their laptops in the class can be very distracting to me. I asked my professor informally if she could ask that those with laptops sit on one side of the room so there can be a laptop free zone on the other side, but she wouldn't do it. I have had some professors do that and have found it really helpful so I didn't think I was asking for anything outrageous. I didn't want to tell her I would like this because of ADHD. I don't like to share my health information with professors.

Originally Posted by SenatorPenguin8081

I dont know I just feel sorta messed up guys, and vulnerable--- and I don't want personal stuff about me getting out to people.

I don't like it either, so I try to limit the spread whenever I can. I don't readily give release for my health care providers to discuss me with anyone else unless there is clear benefit, and I don't use insurance for mental health. As far as my insurance is concerned, I have never sought services for mental health. I guess we do the best we can and then just try not to worry ourselves too much.

[WikidPissah]

i don't trust...period. My attorney requested all medical records for a court cast that I have coming up. I signed the forms, stupidly thinking he would just be looking into the injury I sustained in an auto accident. Now he has my whole history, and the opposing lawyer has asked for it. I can decline to sign the forms for the opposing lawyer, but that doesn't change the fact that my attorney has the records.

Also, I have had the same Pdoc for 5 years. When I first saw him I was also seeing a T in his group. That didn't work out and I ended up with another T outside of the group. This other T wanted me to get some psych testing done, and with my permission called pdoc. The next time I saw pdoc he told me he had discussed the situation with my former T, the one in his office whom I hadn't seen in over a year.

Point is, humans talk, they say things, let things slip. T's and pdoc's are human, and more than likely they are gonna say something at some point...to a spouse, a secretary, a colleague....someone.

[SenatorPenguin8081]

Originally Posted by sunrise

SP, what supports would you like the university to provide? I have ADHD too and would love to have some supports but can't think of much of anything I could ask for that would be something the university could provide. (I have not requested accommodation at my school.) If you have ideas, I would love to hear them. At my university, you can get extra time for a test or an isolated and quiet spot to take the test. I really appreciate the latter option, as all of the people clacking noisily on their laptops in the class can be very distracting to me. I asked my professor informally if she could ask that those with laptops sit on one side of the room so there can be a laptop free zone on the other side, but she wouldn't do it. I have had some professors do that and have found it really helpful so I didn't think I was asking for anything outrageous. I didn't want to tell her I would like this because of ADHD. I don't like to share my health information with professors.
I don't like it either, so I try to limit the spread whenever I can. I don't readily give release for my health care providers to discuss me with anyone else unless there is clear benefit, and I don't use insurance for mental health. As far as my insurance is concerned, I have never sought services for mental health. I guess we do the best we can and then just try not to worry ourselves too much.

I would appreciate 1 on 1 study help, maybe help with homework--with someone who is familiar with the symptoms and behaviors of ADHD and knows how to get around them. Extra test time in a private/semi-private area, fine-- lovely, whatever, but that doesn't help me in the interim period. I feel as though I have no self control sometimes and I don't do what I am supposed to do hardly ever.

The only problem with out of pocket is that out of pocket therapy is exceptionally high most of the time. The practitioners who take sliding scale are limited and you need to be careful when selecting a T. I really want to go back to my old T, which I'm planning on, but I think I need to see someone here in my local area sooner than I can get into my regular T's office.

Right now for instance I'm a good month behind on my classes. I really need to be working on my classwork today, but I can't seem to focus and I feel resigned to my mediocrity. This really sucks.

Oh yeah-- when I first filed the paperwork with my current pdoc, the rude office staff person made me sign a release of information form-- really unprofessional. I'm going to go back and change that ASAP. That's not their right nor is it mandatory for proper treatment to sign a blanket ROI. He was really rude when I confronted him on it, but since he wouldn't deal with it I'm just going to go back and deal with someone else.

[sunrise]

Originally Posted by SenatorPenguin8081

I feel as though I have no self control sometimes and I don't do what I am supposed to do hardly ever.... I really need to be working on my classwork today, but I can't seem to focus....

There are therapists who are ADHD specialists who try to help with behavioral techniques with problems like these. I know there are also some good books out there with behavioral strategies so I'm not sure if the T provides more than one can get on one's own through books. Perhaps the regular meetings help troubleshoot, keep one on track, and provide encouragement. My T recommended an ADHD T if I wanted to go that route, but I chose not to. The ADHD T also offered a group format. My own T has ADHD so he has had some good strategies to recommend based on personal experience. My PNP, who prescribes for me, also has had good suggestions. I don't always implement what they have suggested, though. I have good intentions but poor follow-through.

Originally Posted by SenatorPenguin8081

The only problem with out of pocket is that out of pocket therapy is exceptionally high most of the time.

Unfortunately, my insurance doesn't reimburse for my T, so it's not a choice (if I want to continue seeing him). But it has turned out to have the advantage of privacy.

Originally Posted by SenatorPenguin8081

I really want to go back to my old T, which I'm planning on, but I think I need to see someone here in my local area sooner than I can get into my regular T's office.

Since you're thinking of finding a new or a second T, you could look for one with an ADHD specialty.

Good luck.

[SenatorPenguin8081]

Originally Posted by sunrise

There are therapists who are ADHD specialists who try to help with behavioral techniques with problems like these. I know there are also some good books out there with behavioral strategies so I'm not sure if the T provides more than one can get on one's own through books. Perhaps the regular meetings help troubleshoot, keep one on track, and provide encouragement. My T recommended an ADHD T if I wanted to go that route, but I chose not to. The ADHD T also offered a group format. My own T has ADHD so he has had some good strategies to recommend based on personal experience. My PNP, who prescribes for me, also has had good suggestions. I don't always implement what they have suggested, though. I have good intentions but poor follow-through.

Unfortunately, my insurance doesn't reimburse for my T, so it's not a choice (if I want to continue seeing him). But it has turned out to have the advantage of privacy.

Since you're thinking of finding a new or a second T, you could look for one with an ADHD specialty.

Good luck.

Thanks.
My T likes to specialize in ADHD in adults as well as the other things he does, but I haven't delved into it that much (primarily because I was dealing with anxiety/depression and the ADHD meds were working at the time).

I don't know. I don't want to trust another T, but I'm not sure it would hurt me any if I tried it, at least in the interim.

[Perna]

I try to ignore "society" and "the world at large" because they're kind of meaningless, wholly invented concepts? I can't know who "they" are or what "they" know so I just try to keep my focus on immediate or things relevant to my actual life as I'm living it and deal with anything else as it comes up. My imagination is too good and I'd drive myself paranoid if I let myself.

But I also do the opposite and realize that almost all my stuff is out there in the world; anyone can go to a library with Cris Cross directories and find I own my house and what its address is. They can look up my phone number, find I've been in therapy and for what (because I've said what on various boards where I have used my name too) and someone really anxious to get to know "all" about me could. . . BUT, I am not what is written about me!

THE MAP IS NOT THE TERRITORY

[ECHOES]

Perna, you are also retired and not seeing employment

[Christina86]

I'd always assume that notes are being taken, even if they're not being taken in session with a client. It's for legal reasons (like if there is a subpoena, or in instances where there is suspected child abuse, or harm to self and/or others... having a record is very important), and how in the world would I expect a T to remember all the details of my life if they didn't actually take some notes, even after a session?

(I should also say I'm biased in that I'm taking a class as part of my diploma and we've got an entire course on record keeping and confidentiality, so I'm seeing it from both perspectives, as a client of a therapist and as a person who will eventually be working in the helping profession).

[SenatorPenguin8081]

Originally Posted by Christina86

I'd always assume that notes are being taken, even if they're not being taken in session with a client. It's for legal reasons (like if there is a subpoena, or in instances where there is suspected child abuse, or harm to self and/or others... having a record is very important), and how in the world would I expect a T to remember all the details of my life if they didn't actually take some notes, even after a session?

(I should also say I'm biased in that I'm taking a class as part of my diploma and we've got an entire course on record keeping and confidentiality, so I'm seeing it from both perspectives, as a client of a therapist and as a person who will eventually be working in the helping profession).

If the person taking the notes does a good job and respects the patient and their privacy, this wouldn't be AS much of a problem.

The problem is that not everyone is built equally--some T's have poor skills in various areas and this can be harmful to the patient. Hopefully one gets a good T and doesn't run into this problem. I have a really good T, but I'm scared to see another one here because of my history of bad T's and bad pdocs.