The law protects the confidentiality of all communications between a client and psychotherapist. No information is disclosed without prior written permission from the client. However, there are some exceptions required by law to this rule.
Exceptions required by law to this rule:
SAFETY: If a person is a danger to themselves or others; If a person believes they are in danger by another.
ABUSE: Suspected Child abuse or Dependent Adult or Elder abuse. The therapist is required to report this to the appropriate authorities immediately.
THREAT OF HARM: The client is threatening serious bodily harm to another person. The therapist is required to notify the police. If a client intends to harm himself or herself. The therapist will make every effort to work with the individual to ensure their safety. However, if an individual does not cooperate, additional measures may need to be taken.
Generally, the Privacy Rule applies uniformly to all protected health information, without regard to the type of information. One exception to this general rule is for psychotherapy notes, which receive special protections. The Privacy Rule defines psychotherapy notes as notes recorded by a health care provider who is a mental health professional documenting or analyzing the contents of a conversation during a private counseling session or a group, joint, or family counseling session and that are separate from the rest of the patient’s medical record. Psychotherapy notes do not include any information about medication prescription and monitoring, counseling session start and stop times, the modalities and frequencies of treatment furnished, or results of clinical tests; nor do they include summaries of diagnosis, functional status, treatment plan, symptoms, prognosis, and progress to date. Psychotherapy notes also do not include any information that is maintained in a patient’s medical record. See 45 CFR 164.501. Psychotherapy notes are treated differently from other mental health information both because they contain particularly sensitive information and because they are the personal notes of the therapist that typically are not required or useful for treatment, payment, or health care operations purposes, other than by the mental health professional who created the notes. Therefore, with few exceptions, the Privacy Rule requires a covered entity to obtain a patient’s authorization prior to a disclosure of psychotherapy notes for any reason, including a disclosure for treatment purposes to a health care provider other than the originator of the notes. See 45 CFR 164.508(a)(2). A notable exists for disclosures required by other law, such as for mandatory reporting of abuse, and mandatory “duty to warn” situations regarding threats of serious and imminent harm made by the patient (State laws vary as to whether such a warning is mandatory or permissible).