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Confidentiality in therapy can be revoked in some situations, including a voluntary waiver of confidentiality submitted by the patient, as well as certain legal, medical, or billing reasons. The law regarding therapist confidentiality can be vague in some regions, and people with specific concerns should ask their therapists directly for more information. Generally, all information about therapy and what happens in sessions must be kept confidential unless there is a compelling reason to do otherwise.
In a health care system where records are maintained in a single location, often electronically, therapy notes are part of a patient's medical record and can be accessed whenever the record is reviewed. These notes can include information about diagnosis, outcomes of testing, and general notes. Medical records are tightly controlled, but can be released to insurance companies and on court order, something for patients to be aware of.
Other limitations on confidentiality in therapy involve billing and payments. Third party reimbursement can only be provided if information about the diagnosis and appointment times is provided. Some insurers audit care to determine if it is covered, in which case they may request information about prescriptions and other aspects of therapy. Therapists can also release the names of their clients to debt collection agencies if the clients do not pay, although the agency is not allowed to receive information about why the patient was in therapy.
In cases where people disclose information suggesting they are a credible threat to themselves or others, the law usually requires people to break the rules regarding confidentiality in therapy to report it. Likewise, reports of abuse to people with disabilities, older adults, and children may also be subject to mandatory reporting, where the therapist must file a report if it is disclosed.
If a therapist is taken to court by a patient for malpractice, the therapist is allowed to breach confidentiality in therapy if it is part of the defense. Likewise, people introducing information about their mental status in a legal case waive the right to confidentiality by making it a factor in the case. Additionally, courts can compel the release of records about patients if they are believed to be relevant to a case, even if therapist and client both file objections.
Some places where confidentiality in therapy remain in force include couples therapy, where counselors cannot disclose the content of private sessions, and private therapy for children, where therapists cannot talk about the sessions with parents or guardians unless there is a safety concern. The law also maintains that confidentiality applies even after the therapeutic relationship is terminated.