10 Unbreakable Rules of Therapist Confidentiality

From billing practices to mandatory reporting, here are some things to consider when establishing therapist confidentiality and building trust with a client.

According to the American Psychology Association, “Psychotherapy is most effective when you can be open and honest.” Maintaining so many secrets may be one of the hardest aspects of being a therapist. It’s in our nature to share stories that trouble or impress us, and that extends to sharing other people’s stories, as well, but therapist confidentiality is a crucial component to successful therapy. Clients want to know that their information remains confidential, or they won’t be comfortable disclosing a lot of it.

Thankfully, there are ways to protect therapist confidentiality that will help establish and maintain trust with clients. Here are a few suggestions:

1. Notify clients about privacy rules

Many clients may not know that there are certain times a therapist has to divulge information, like when a clients says they plan to hurt themselves or someone else. Or, when using insurance, you may have to send diagnostic information to the insurance company to obtain payment. You know these rules by heart, so it may be a good idea to outline the exceptions to therapist confidentiality in the first session so there are no surprises in the future should a worst case scenario occur.

2. Adhere to HIPAA

The Health Information Portability and Accountability Act (HIPAA) states the kind of information that must be kept private and establishes certain guidelines for doing so. Simply following these rules will help keep therapist confidentiality intact even if the client doesn’t realize it’s being done.

01-10-unbreakable-rules-of-therapist-confidentiality-and-how-to-earn-trust3. Sharing isn’t caring

However tempting it may be, disclosing client information to anyone—even to your spouse or a loved one—breaches confidentiality. There aren’t many circumstances where talking about a client is necessary, and when they do arise, the information should be shared only with a trusted colleague. In such cases, remember to omit information that may lead to identifying the client.

4. Mind your surroundings

In the very rare (and discouraged) situation where it will advance a client’s treatment to discuss it with a colleague, take a look around and consider if you’re in an appropriate space to do it. Elevators, hallways, and break rooms are subject to a lot of foot traffic. Information could easily be leaked in such public places.

5. Avoid using the information in research papers

Sometimes, you may want to reference a particular client’s circumstances in a piece of research or white paper. While generally discouraged if unnecessary, this practice doesn’t break therapist confidentiality rules as long as you anonymize the client. As with any instance when you have to share information, keep it to a minimum. If it doesn’t add value to your practice, it’s probably not something you need to do.

02-10-unbreakable-rules-of-therapist-confidentiality-and-how-to-earn-trust6. Take care with recordings

Sometimes, therapists find it helpful to record a session and watch it a few times before a client returns. That’s okay, but when the recording has served its purpose, erase it immediately. When not in use, lock any recordings in a safe place.

7. Always ask permission

When doing something like sharing something with a colleague for a second opinion or recording a session, it’s not a bad idea to ask a client’s permission. Asking permission not only sends the message that their feelings are important, but it also demonstrates transparency, which is huge in establishing trust.

8. Consider your expressions

Sometimes a client will tell you something that may shock you. When this happens, do your best to control your expression. While this isn’t a critical part of maintaining therapist confidentiality, it’s important for building rapport with your client. React to everything as though nothing is out of the ordinary, and your clients will feel more comfortable sharing information with you.

9. Lock computers

It sounds like a no-brainer, but how often do we step away from our desks for only a moment, leaving whatever we’ve been working on exposed to the public? Even if you work solo out of a private office, it’s good to get in the habit of always locking your machine, no matter where you are.

03-10-unbreakable-rules-of-therapist-confidentiality-and-how-to-earn-trust10. Secure your paper trail

While most information is stored on computers these days, you may find that you take some notes during a session. Consider keeping a single notebook for this purpose so you don’t have multiple sources of information lying around, and when you fill up a notebook, destroy it once it’s served its purpose.

Also, when possible, use technology to do some of the protecting for you. Let SimplePractice help ease your administrative burden while also lessening the chance of a therapist confidentiality breach.

Therapists, it’s your turn to share. What else would you add to this list?

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