Ruptures....what to do..........what to think of it?

A lot of the threads have been about ruptures with our Ts. I'm so sad that there are SO many of us going through these ruptures with our Ts. I haven't posted much as I am going through another rupture with T and it is hurting me so much that I can't even sleep much. I don't think I've seen a thread that is similar to the rupture I'm currently going through with my T. Any input would be great. What I really would like to know is what would you guys do? Or what do you all think of this situation?

Ok, when I first saw T (which was Dec 2010), she went over what the "limitation of confidentiality" were with me. She said that the one way she would share what I tell her with someone else was if I threaten to kill/hurt someone or was going to harm myself. She said she would have to notify the police. The only exception for the initial assessment was that the neurologist would just read what is shared initially then he would shred it. I'm seeing a neurologist because I get really bad headaches. So I started therapy with the mindset that I had someplace safe to talk about what was in my heart. I slowly let T in. My walls kept coming down and then "transference" happened.

I was having such a hard time grieving Dad this past Fall/Winter. I was SO ready to go into great detail with how it was to witness what happened to Dad and then something horrible happened at the end of November. When I saw my OT, out of the blue, she pulled up my T's notes and started reading an entry T had made from a session because she asked how my appointment went with T and I didn't feel like sharing. I was SO shocked to find out that OT could see and read what I have told T. I was SO hurt from that. A place that I thought was SO safe was not safe at all. What a fool I've been. I couldn't bring what happened up with T until session on Friday because I didn't want to deal with it and I feel like I'm punishing T for something that she didn't purposely do. I tried to avoid the hurt and it backfired on me and got worse.

Therapy this year as been tough. Since the moment I knew that whoever I saw would know what I'm disclosing to T, I started "filtering" what I tell T. What I mean by this is I just haven't been telling her things with much details at all and I feel I have wasted a lot of time. T recognized that I seemed and appeared "nervous and not able to relax" in the room with her. I used that to open up to her about what happened in November with OT. T then went on to explained to me that the "limitations of confidentiality" had changed back in July 2011 when the clinic switched over to a new software which allowed any provider that sees me to view all the notes from each other. I questioned why I wasn't told this. T acknowledged that she didn't tell me this and apologized. Despite her apology, the hurt still lingers. I feel like my trust in her has been shattered.

How do T and I recover from this? Would we be able to move foward from this? That I just don't know. If I didn't feel a connection to her, I would walk away and not think twice. It's not that easy to walk away now. I've shared SO much with her. I feel SO violated. I would like to work through this hurt with T but I fear getting hurt again.

T said "I would like for my patients to feel that they can share anything with me." Hm.......well that's really hard when I know that other providers can see whatever the heck it is I tell her.

FYI, T is not under any supervision.

I would have never found out about it if my OT didn't open up T's notes and start reading them to me. I wish SO badly that OT would have not done that. Things were just SO much better when I didn't know. I could have just went on believing that there is a person I could go to and pour my heart out and learn how to cope with things, then move on with life. Therapy is hell.

I want to get better. I want to work on my issues that's why I finally brought up what it was that was preventing me from going "deeper" with T. That was my intention of why I finally brought this incident up. I want to stop hurting. I usually run from ruptures or try to make it all better by myself but why does this rupture feel like it will take both parties to work through it? I'm not good at handling conflicts. Maybe something good/useful will come out of this. Maybe I will learn something from it that I can apply it to my RL. Sigh.....

Where do I go from here? I don't want to lose T. Just not yet. There is SO much left to do. Why did this have to happen?

Wow Yang. You have every reason to be hurt and angry. That would freak me out. I don't believe any apology would be enough for sharing my crap with others without my consent. You deserve confidentiality. I don't know how I would handle that, but I just want to validate your feelings.

yang,

first of all i am so so sorry this happened and that you are in such pain over it.

i honestly have no wise words on this. I think something like this would totally affect the trust i would have in a space that is supposed to be safe. i couldn't work like that.

is there a way for you to have your therapist block access of your information to other providers - deny permission? (in writing)

the only other thing i can think of IS to keep taking about it because it clearly is in the way of any other work you are trying to do - and figure out a way to move forward.

I hope you can work this out. Remember that your T did not share your information with someone else. The clinic bought new software that allowed all providers to see each others notes. Your T cannot prevent others from seeing your info because that is the clinic policy.

I can understand your hurt - I would be too. But this is not the same as if she promised you your info would be private and then broke that promise. Yes, it would have been better if she had told you rather than you having the shock (and it must have been quite a shock) of another person reading the notes to you!!

I can also understand that your T probably did not think to announce to each of her patients, "Hey guys, just wanted to let you know that all providers here can see my notes, so please continue opening up to me like you always have."

Talk it out with her. Listen to her point of view, and by all means tell her how this makes you feel. This may have triggered something from your past that is making it really difficult to get over. Talk about it as much as you need to until you can either let it go or leave.

How is this even legal?

I understand your hurt. I would be too. I want to say that I wouldn't put up with the lack of confidentiality, but I know I would struggle leaving my T.

It is very important to recognize that if you don't feel safe sharing and filter yourself, then you aren't really getting help from therapy.

I hope you can work things out.

I am sorry, I may have missed something. What is "OT" ? I am thinking that you are not in the States as this can easily be prevented on Electronic Medical Records.

And I had to change my mood from "happy" to "irritated" after reading this.

OT, in Canada is occupational therapist

Thanks for clearing that up. Sadly, I cannot comment on the Canadian HealthCare system. I think I can safely say that in the US and with confidentiality laws, things like that should not happen. As a Family Practitioner I never see any notes from a mental health provider other than, " Thank you for referring Dr. Freud. I appreciate your confidence in my ability to manage your patients. " That's it . If we need specifics the patient can sign a Release of Records but we usually do not do that unless some emergency occurs.

Thank you all for your input and validating my feelings. What really hurt me was that T admitted that the limitation of confidentiality changed in July and it didn't cross her mind to tell me because "I mention it just at the initial visit." What I just can't seem to comprehend is if the rules of confidentiality had change, shouldn't she have informed all of her existing patients of this? All the clinic had to do was send out letters or do what they needed to do to let the patients know. I wonder what the other patients at the clinic would think and feel about this. Especially the ones that are in the same boat as me.

Actually, I am in the states and the records at the clinic are all electronic. I feel like things are just SO messed up. I feel like telling T the next time I see her that she should consider telling her patients that saw her before July what the change in confidentiality is. It will either rock the boat for some and maybe save others from heartbreak. The choice is hers to make. I just hope no one else will have to find out the same way I did.

OT stands for occupational therapist.

T did say that she could ask the other providers that see me not to look at her notes but somehow it's just not enough for me to feel safe to trust and open up to her. If asking someone not to read her notes is all she can do to protect my privacy then it's not good enough. How would she know if they read her notes or not? All I can hope is that they would not invade my privacy like that again if T asks them not to but we can't control others actions.

I don't even know how all this is legal. It frustrates me to no end I tell ya.

This made me laugh and feel thought of. Thank you.

Seriously, I am not a lawyer but I cannot comprehend how this is legal, particularly the part where she did not inform you of the change in confidentiality. It would seem to me the clinic and your therapist have left themselves open to major liability and lawsuits. Seems like a breach of ethics to me.

Can anyone shed light on this from a legal perspective in the US?

I would like to know the answer to this question as well. BTW, it's not like I'm going to sue my T. I could not harm her in such a way. It would be helpful to know though. It would probably help my head stop spinning for awhile. I just don't know what I did wrong or how things got SO messed up.

I was planning on working through the transference with T but since this whole mess blew up in my face, I just can't show much emotion in front of her. It's like I'm scared of her and I constantly do not feel safe. I want to feel that again.

I know this feeling ... to have that safe feeling slip away and all you want is that safety back.

i really hope you are able to get the safety back, yang.

I work in a health care system with electronic medical records and everyone in the system can read everyone else's notes. It is totally legal. In our system, when you go to open a psych note, an automatic warning comes up that you could be audited, but it doesn't stop you. As a family practice provider, I occasionally read psych notes if it seems relevant (if I'm goIng to write a prescription for a psych med, for instance).

I do agree that your t should have mentioned the change in record confidentiality, and I can only imagine how horrible I would feel if my notes were available like that- in fact I see an out of system t for just that reason. I hope you can bring this up with your t and I am so sorry you are going through this.

Yang, you did absolutely NOTHING wrong. What is happening now is not a reflection of you or a consequence of anything you did. This is all on your T and the clinic. I wouldn't let this issue go until you get a satisfactory answer/resolution, but you should do what you think is best.

I think I am confused a bit though. Does your T, your OT, and your neurologist all work at the same clinic?

I hope you can get through this as quickly and painlessly as possible.

Is there any way you can see a T not from that clinic once or twice to get some outside perspective?

Hmm...I knew it worked like that for records regarding physical health, but I guess I assumed it was different with mental health and psychotherapy. I feel like it should be different.

I think I need to look at why I am having such a strong reaction to this.

I still think yang should have been informed of the change.

Holy crap i feel rage at this. This seems like a massive violation of confidentiality. Not from your therapist as such but by the system her office and the powers that be have chosen to use.

OT and T work in the same clinic. My Neurologist works at a hospital that is affiliated with the clinic. I work in healthcare as well and it helps me understand how patient records are acessible to providers but that doesn't mean they should abuse it. It's none of their business unless it is necessary or revelant. I felt like it was none of OT's business what T and I had discussed. If I didn't want to share, she should have respected that. What hurts is it wasn't that way when I started therapy. No one could access T's notes. Thanks to the new software the clinic got, it enabled them to do that. The sad and shocking thing is, I only came to know of that when OT flat out read T's notes to me. Since then, therapy has been lagging a lot until I can't hold the hurt in and than a little bit of the hurt slips out here and there. Friday was different though. I was able to be completely honest because I just couldn't tolerate the hurt anymore and I felt so bad like I'm punishing T by not sharing what troubled me with her when in fact I've been hurting myself instead. That's why I decided to come clean.

IDK any other therapists. I didn't even look for this therapist. My sister made an appointment for me cuz there is NO way in hell I would initiate therapy. Never have and never will. This isn't my first therapist. She is my second. I had a man the first time and I didn't look for him either. My college professor took me to see him and we were not good match at all. I did give it quite some time but realized that it was not going to work so I just didn't do therapy again until 2 years later when sis didn't want me to have bad headaches anymore. T just happend to be apart of the team to help me manage chronic pain.

I am taking a break from therapy and work next week. I will not see T for two weeks which I think is good because I need some space. I miss her but yet seeing her will just stir up the pain. I know that I just can't bear the pain at this very moment. Hopefully by the time I see her again, I can bear the pain a bit better.

I will talk it through with T somehow. I hope we will make it through this rupture. Why do I feel like I need to start from strach again with her?

Yang, i would be devastated. i would have to have confidentiality or stop seeing T.
i would share with T even though it was not her fault, what she puts needs to be approved by you before being submitted or else this rupture is the end. It really should be up to you to share or not share what goes on in therapy. A new software system does not give permission for all of your doctors to know everything. Your foot doctor, eye doctor, dermatologist, and your dentist do not need to know you are in therapy nor what was discussed. Unless you were having surgery and you were on medication...well then you have to disclose a little bit of information...yes you see a therapist. See if you can see what your T writes before it is submitted to the Medical world. You know see if it is possible for you to make changes in T's presence.

I'm amazed that session notes in any US practice would be available to anyone except the therapist and any clinical supervision personnel. There are separate provisions in HIPAA for therapy notes, which are very different from the ones that apply to physician's clinical notations and any other medical records. The only things that HIPAA allows to be available to others (and then only with written permission) are "any summary of diagnosis, functional status, treatment plans, symptoms, prognosis or progress."

My family physician and other medical providers have absolutely no business knowing the content of my therapy sessions. They should know about diagnoses, treatment plans, progress, etc, but the specific things I share with T (like details of my CSA) are not and should not be their concern unless I choose to share with them.

I completely understand your no longer feeling safe with your T, Yang. I hope she can rebuild your trust.

Fixated: I could have written what you wrote. I assumed that it was different for mental health and psychotherapy considering how sensitive the information could potentially be and we are talking about people who are in such a vulnerable state.

What bothers me to no end also is that I work in healthcare so I know a lot about the rules/laws/HIPAA. I have to know these things to make sure that I am not violating a patient's health records/privacy in any way or form.

Thanks Critterlady. You stated my hurt SO clearly in what you wrote. It's why I feel SO violated. I've shared some things with T that I'm SO ashamed of and feel like I would (WARNING TRIGGER!!!!) die knowing if someone else knew of it. I'm SO embarrassed to go back to the clinic but I miss T SOOOO much. Why did I have to have a connection with her? Now I feel like I should have never opened up to her. I would be lying to myself if I said I don't want to see T ever again. She wasn't even the one who violated my privacy. OT did. I'm getting all dizzy again. When will the hurt stop.

Yang, I definitely think you should focus on keeping yourself safe and progressing, but if you ever get to a place where you have the energy, it might be good to bring this to the clinic director. It may/may not be unethical and/or illegal, but patients still deserve to know. You could help the others there.

Yang, I agree with you about the OT person. He/she had no right to tell you what your t wrote down.

My t and PCP are from the same health system so they can see each others notes. Once my PCP asked how I was doing. She would never tell me what the t wrote. Those are private notes and should be treated with respect.

I wouldn't blame my t though. She didn't have anything to do with it. OT should have not read the notes it had nothing to do with the care that they were giving you. I would call their boss and complain.