What happens to the private information you share with your therapist during therapy sessions? It seems like common sense to assume that everything you tell your therapist stays private with your therapist, and that he or she cannot reveal your private information to anyone else without your permission. And that common assumption is, in fact, one of the broadest and strongest rules of therapy.

But there are more rules than that, and these rules are worth knowing about, because they exist for your benefit as a client of your therapist. Most rules governing psychotherapy are set by the therapist’s home state, and may slightly differ depending on the location.

Generally though, no matter where they are located, therapists must do more than simply not repeat what happens during therapy sessions to other people.

It’s in the Past

To start, even after you’ve left therapy, your therapist must protect the confidentiality records of your information. This includes the mere fact that you’ve been one your therapist’s clients to begin with. It doesn’t matter when the therapy took place: without your express permission, your therapist must keep your private information private.

Some may be surprised to learn that in many states, the requirement of confidentiality continues even after the patient has passed away. Then, control over the confidentiality of the patient’s information passes to the representative of his or her estate.

It’s a Group Deal

What about couples or families who go through therapy sessions together? Generally, the requirement of confidentiality extends to the couple or the entire family. But what if one person tells the therapist something that he or she doesn’t want the other half of the couple, or the other family members, to know about? If the therapist agrees to keep that information confidential from the other people in therapy, the therapist cannot later break that promise without first having very specific permission from the person who shared that secret information.

Take Notes

Therapists must also keep written confidentiality records of every therapy session. For example, in California, the therapist’s records should hold the dates of treatment, payments you’ve made to your therapist, any diagnoses or results of psychological tests, any records from other doctors that you’ve shared with your therapist, and your therapist’s notes explaining the treatment that you’re receiving. What’s more, you have the right to see and copy your therapist’s records.

It’s vital for your therapist to keep good records, not only to be fair to you as a client, but to help you continue therapy without setbacks, if you later start having therapy with a different therapist. And it’s comforting for many people to know that if they ever have questions or doubts about what their therapist has diagnosed or why they are going through the course of therapy they are in, their therapists are required to give them complete access to all of their written therapy records.

Insurance

Lastly, there is an unexpected twist to the rules about confidentiality that may not immediately come to mind. What happens to your confidential records when you tell your therapist to send the bills to your insurance company? It depends on the insurance company, but many insurance companies require access to the entire written therapy file before they are willing to pay the bills.

And once the insurance company has a copy of your therapy records, there is no guarantee that your records won’t be seen by people at the insurance company who have no therapy credentials at all, such as insurance adjustors or billing specialists. It would be difficult to ensure that your insurance company will maintain the confidentiality of your records.

Of course, you have to give that permission first. But you may be granting that permission without entirely realizing it, by signing insurance billing forms at your therapist’s office. It’s prudent to read that billing paperwork carefully before signing it.

If you don’t want your insurance company to have access to your therapy records, it might be worth asking your therapist if there is an alternative way to pay for your therapy sessions out of your own pocket. In that case, of course, there would be no need for your insurance company to be involved, and your therapy records would stay completely confidential until you choose to release them.