Do you know if your T lets his billing person have access to your complete file? As in the notes the T takes during the session and afterward, and emails you send the T?

If you found out that your T DID let the billing person see the entire file, would it bother you? Would you find it reassuring that he promises that she doesn't actually read the file; she just pulls out the insurance forms?

[Mactastic]

It wouldn't bother me (pretty boring issues) but if I was dealing with trauma or something very sensitive like that I would have issues with what you're describing. I can't understand why your ins papers need to be a part of your larger file.

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[stopdog]

The first one does her own billing and the second one has someone else, but the second one does not give the biller access to her files themselves.
I pay each week and for a long time just got a receipt each week because of paying in cash.

[Parley]

I would be livid. It is a violation of trust and I would be hurt at the lack of respect shown for my confidentiality. There would be no relationship to fix.

Reassuring me that the person can be trusted would just piss me off more. I've got my own denial issues and I don't need a therapist that can't see the betrayal.

It would be a deal breaker for me. Confidentiality is a very important issue for me, and I would not be able to trust my T if I did not know for certain that everything I stay remains between us two. It's one of the few things I've asked my Ts about at the first session. My current T has no billing person, he handles all that himself (he bills the county, and only tells them the clients' name and personal identification number and the date of the visit), and my previous T also submitted only the name, ID number, and date to the billing department at the clinic she worked for.

I know for a fact that in my country it is against the law for a licenced T or psychologist to allow any other person access to their session notes; if a diagnosis is needed for insurance purposes, they write a statement but do not provide a copy of their notes. (There was an article in today's paper about a psychologist who had left a patient's file in a public place, who now faces a police investigation and possible loss of her licence.) Only other treatment providers are allowed to see the file, and only if the patient gives their express permission unless there is some kind of court order or emergency situation.

I think what happened to you is pretty damn unacceptable.

[Perna]

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.

[Jordy]

M T does her billing herself, but I would be absolutely livid if my file was shared with anyone.

Once during group she mixed up my last individual session with group, and unknowingly hinted to something I hadn't shared in group yet. Even though what she shared was actually harmless, only said we had discussed my horses during that session, I hated the fact that she let it slip. So someone having access to my file would be sooo much worse!

I think I would need to read my session notes before I determined how upset I would be about someone accessing my file.

In a session with YT, I said something really deeply personal and I panicked. The next session I was upset, he let me read his notes... it wasn't noted in his session notes. He says he doesn't write stuff like that down. So I guess if I found this out like you just did, I would want to read my file.

That being said...once I knew I would need reassurances that he had a billing file and a session file and the billing person only had access to the billing file.

[feralkittymom]

I think it's a sloppy practice. My T did his own billing (he didn't process insurance), but he dictated session notes and then had a freelance person transcribe his tapes. But I was never identified by name on the tape. All clients had an assigned number, and the "master list" was only in his possession. All files were similarly encoded.

Now when I saw him at the University center, there was less control; more personnel involved, billing through insurance, etc. My understanding is that all files were handled as they would be in any medical practice.

No, all the billing is handled by computer. His file is separate and he keeps it in his office. The only thing they would see is the diagnostic/billing code which doesn't particular matter to me whatsoever. The same goes with my pdoc, although the nurse that calls in meds obviously has access to the file to check on med directions/prescriptions, etc. Again, doesn't bother me; she's his nurse and it is a medical practice. I don't see that as any different that the nurse at my GP's office who I just had a conversation on the phone with about test results.

I would be pretty angry if I knew this was happening. In fact, I had a very stern discussion with a psychiatrist I was seeing about eight years ago. He was using my GP's office to see clients in her office, but I had been assured that my psychiatric file would be separate from my GP's medical file and no information would be shared without my written permission. He also assured me that his file was confidential from office staff and kept in a different locked file cabinet. When I was leaving one day, I saw him hand my file to one of the two office secretaries, she opened it to see when my next appointment was and then threw the file onto a stack of other patient files. Staff were walking in and out of the office getting things and a young woman came in and scooped all the files off the table and trotted off to file them. I was pretty mad (No, I didn't think that the young woman was going to go into the staff room and read all the files, but it ticked me off that I'd be assured my personal information was being treated as private and confidential and a person could just open the file without my consent and another could just come in and walk off with it). I had a conversation with the psychiatrist about the issue. He didn't seem concerned and didn't give much credence to my voiced concerns so I didn't go back to see him.

In my case, the billing person is his wife and it bothers me deeply for two reasons. First, we have mutual acquaintances. Second, much of what I have been talking about for the last two months or so are my difficulties around my feelings for HIM. His ****ing wife having access to that stuff is hugely upsetting.

Between stuff that happened in the last couple of months with him really withdrawing emotionally and now this have me thinking now that on some subconscious level he wants me to quit.

[stopdog]

One thing I do wonder is how detailed or specific the notes are. The one I see does not seem to write down anything specific I say (or perhaps she has both a terrible memory and she cannot read her own handwriting). I am not certain if she even still makes notes. I think it could be possible that sometimes the notes could be truncated or the therapist's non specific impressions.
Just a thought if worried about the specifics.

Originally Posted by stopdog

One thing I do wonder is how detailed or specific the notes are. The one I see does not seem to write down anything specific I say (or perhaps she has both a terrible memory and she cannot read her own handwriting). I am not certain if she even still makes notes. I think it could be possible that sometimes the notes could be truncated or the therapist's non specific impressions.
Just a thought if worried about the specifics.

That's a good point. My T's notes are in phrases and probably not particularly meaningful to anyone but him. I've seen them myself and they really have no specifics. So it really may be that your T's notes aren't at all detailed or coherent to anyone who isn't sitting in your sessions.

I emailed him asking for copies of everything that she had access to, and for him to give back the originals of the emails I sent without making copies of them for himself.

[nottrustin]

I have seen the form that my T sends to her billing person. All it has on it is my name, the date of the appointment and whether I paid by cash or check (or as had happened a couple of times if I forgot to pay her).

[unaluna]

Especially given the circumstances you have stated, here and in the past, i agree with you - he could have put some tiny freakin effort into ensuring your confidentiality, aside from "oh i trust my wife so you should too." Idk. Im glad youre taking some action.

[pbutton]

I'm kind of voting punch him in the throat.
FWIW my T's office keeps two separate files - a billing file and a client notes file. I know this for a fact because T told me today.

[CantExplain]

Originally Posted by My kids are cool

Do you know if your T lets his billing person have access to your complete file? As in the notes the T takes during the session and afterward, and emails you send the T?

If you found out that your T DID let the billing person see the entire file, would it bother you? Would you find it reassuring that he promises that she doesn't actually read the file; she just pulls out the insurance forms?

I respect your feelings, but I am a little surprised at the strength of your reaction.

I assumed that Madame T would discuss me with her husband and astonished to find it wasn't true.

[anilam]

Originally Posted by CantExplain

I respect your feelings, but I am a little surprised at the strength of your reaction.

I assumed that Madame T would discuss me with her husband and astonished to find it wasn't true.

Wouldn't a T have stg more interesting to talk about with his/her spouse than clients?
Also they are bound ethically not to...

MKAC, I wouldn't like this one bit. There's no reason what so ever for him to do so- my current T does his billing but those previous that didn't never shared my file with others (at one clinic all Ts met once a week for supervision, where they talk about their clients and stuff- I was told beforehand, asked to sign a permission slip and reassured that no identifying details would be shared).
I'd be very angry about this- given the circumstances even more so- you two know each other, so she could be tempted to read your file more than in other cases.
I'm glad you're taking actions. Honestly for me this would be a deal breaker- but I'm paranoid about my privacy

[stopdog]

I think therapists talk to their spouses and close friends about clients all the time. Not by name, and I know what the ethic thing is - I just don't think they follow as strictly as it might be interpreted. Think about it, most people talk about their day at work with their spouses. I don't think therapists are different in that way from other humans. People think their jobs or work lives are interesting. I know people who only talk about work. Therapists are not immune. A good client story would be hard to keep to one's self. I doubt I am interesting enough to be talked about much, but I certainly think it possible, if only as something when I told her how badly she sucks at things, might come up at home over a gin and tonic as in I have this client who keeps telling me I suck and so does my whole profession.

[iheartjacques]

I think they have access to the files, not sure, because they have to pull them out and leave them on the T's desk for his appointments for the day. Like dr's files. But whether they get to sit down and read them, I'm not sure. The staff are bound by confidentiality. Same as I work in a school, and am not allowed to talk to anyone about anything I see in a student's file when we pull them out, add to them, and put them back.

Originally Posted by CantExplain

I respect your feelings, but I am a little surprised at the strength of your reaction.

I assumed that Madame T would discuss me with her husband and astonished to find it wasn't true.

This is baffling to me. If my T ever told his wife (assuming he has one) the slightest detail I had said, it would be a breach of confidentiality. I could not get past a thing like that. Even imagining it makes me absolutely furious. Maybe this is because it is impossible for me to imagine people talking about me in positive terms - I don't know. But I think it is mostly because I have learnt to trust that T's office is an absolutely secure place, and if he were to take what I've said outside that office it would pretty much invalidate the whole therapy thing.

So if anything, I think mkac is remarkably restrained in her reactions.

[CantExplain]

Originally Posted by anilam

Wouldn't a T have stg more interesting to talk about with his/her spouse than clients?

Don't you talk to your husband about your work?

Originally Posted by CantExplain

Don't you talk to your husband about your work?

I'm not anilam, but I know that I rarely do. I have colleagues and friends to talk to about that. I have mentioned work occasionally to my H, when something out of the ordinary has happened, but as I say it doesn't happen that often. And he never says anything about his work to me either, unless I ask. So to me it is not hard to imagine a T keeping quiet about what goes on at work.