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Privacy is a myth

Posted by Margaret Donohue on July 21, 2015 at 11:10 AM

I had a new person coming to seek treatment the other day.  I explained that the concept of privacy is a myth.  Let me explain further.  In this profession confidentiality is important.  People would like to believe that the things they tell to their therapist will not be told to anyone else. Unfortunately that hasn't been true for the past decade or so.  It's not that therapists are running around telling people everything the person they are treating says.  It's that the person they are treating has signed away their rights to privacy.  In addition the government has passed laws that limit how much information can be kept private.


If you use insurance to pay for therapy, the insurance company knows how much time you spent in each session, and your diagnosis.  That information is uploaded to a computerized billing system, a claims processing department, and a computer algorhythm for claims processing.  It may go to an employer paying for insurance premiums.  In small companies that makes you identifiable.  The insurance comapny may ask for session notes in order to process payments.  They don't always do this but they can.


If you are involved in a lawsuit, the attorneys for either side can ask for your therapy notes.  If you are indicating you had stress, anxiety, depression, or anything as a result of a personal injury, malpractice case, wrongful termination case, or any other legal case, the attorneys often want session notes.  They get them from a court order. 


If the government thinks you are connected to someone that may have an evil intent toward the goverment, they will ask your therapist to collude with them in their efforts to collect your personal information.  This is the result of the Patriot Act which was enacted following 911.  You don't have to be a terrorist for the government to attempt to collect information about you.  You can work in a sensitive job with a security clearance.  You can know a lot about computers.  You can have the same name as a terrorist.  All or any of those will allow the government to seize your clinical information down to session note levels and NOT inform you.  Your therapist faces prison time if they disclose to you that Homeland Security has paid them a visit.


The government routinely monitors phone calls, collects massive amounts of computer data, and aggregates data.  We now allow massive data collection on an unprecidented scale.  We have homes that are connected to the internet.  We have smart phones, smart appliances, smart homes, smart cars, and health care data on electronic health records on the internet.  Data breeches are common.  If your data hasn't already been hacked you don't have a cell phone, and live in a remote location.  More than 80 million people have had their data compromised.  It's more likely that almost everyone has had their data compromised.


Companies that have their data hacked may not inform the country that their data has been hacked.  We know about Blue cross, Blue Shield, the government employment data bank for sensitive jobs in the CIA, NSA, FBI, the Veteran's Administration, Target, some banking systems, several retail outlets, local gas stations, several websites data banks including Ashley Madison.  But those are the ones we know about.  I know about the local gas station because purchases were made on my credit card on cities where I don't live or shop.


There are limits on confidentiality to attempt to save lives and ensure public safety.  Suicidal, homicidal, people who abuse children or adults can be reported by therapists to law enforcement.  those limits to confidentiality are almost always discussed at the initial session in therapy.  The other limits to confidentiality aren't discussed as much.  They are often in long documents.  In cases where attorneys seize records kept in diaries, chat room logs, and session notes, clients feel betrayed.  They had no idea that trying to get justice for one set of wrongs would open up all their records to scrutiny.


If you haven't had the discussion with your therapist about what they are keeping in session notes, you might want to.  Therapists are making notes available to clients, so they know the content, and so that the client understands the treatment plan.  Rather than acting like everything is private, having a discussion about what is being disclosed and what isn't being disclosed in notes is important.  If you are using insurance to pay for therapy, you may want to think about how much access you are granting your employer to your personal life.  If you are involved in litigation you may want to understand what your side and the other side will do as strategy.  You may want to talk to your representative aout limiting the Patriot Act from it's massive data collection.  And you may want to think about how much Echo, Siri, map my drive, and all the other applications, devices, and smart connected appliances know about what you are doing, where you are at any given moment, and what you are doing.  


Yes, I have Echo, Siri, Map my Drive, Hue, WeMo, and other connected appliances.  I like being able to control the lights in my house from my office in Glendale.  I check in with location features on Facebook and Twitter.  My computer is password protected.  My computer is encrypted. My office is locked and alarmed.  My files are in a locked cabinet.  If needed I can get office space for an hour and see someone in a different location.  Therapy helps.  It can be wonderful and life changing.  But if you aren't aware of who can get access, it can be hurtful.  Talk to your therapist about what they are doing or not doing to protect your privacy.

Categories: Ethics

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