Psychotherapy may be a new and different experience for you, and in some ways may be confusing. Misunderstandings now can lead to problems with your therapy later. Your therapy will be more successful if you know what to expect and what your rights are from the beginning.
The Right to Ask Questions
Many elements of treatment vary from patient to patient. You should know how they apply to you specifically. Following are some questions you may want to ask about your individual treatment and choices:
1. What are the benefits and risks of my treatment?
2. Are there alternative treatments?
3. How likely is my treatment to be successful?
4. If I am unhappy with my therapy or with you, what do I do about it?
Where do I Turn for Help?
Before therapy begins. you also should discuss the logistics of your treatment. Misunderstandings about costs and arrangements can be a potential source of trouble, so make sure you understand everything from the beginning. Discuss what the time and length of your appointments will be, and agree about what will happen if you miss one or want to schedule an extra appointment.
The Right to Satisfaction
You always have the right to ask your therapist questions, whether these are about how the therapy will operate or about your therapist’s own credentials and training. Remember, if you are not satisfied with the therapy, you can end it at any time.
Be sure, however, that you’re not terminating simply because you’re feeling bad—that’s to be expected as your therapy does its work. On the other hand, if you find you are always uncomfortable with a therapist, try to figure out why so you can decide whether to continue or to terminate. You don’t have to love your therapist for your treatment to work, but you do need to trust him or her.
The Right to Confidentiality
You are protected by confidentiality in your discussions with your therapist. This means that, in general, your therapist is legally prohibited from revealing any information about your visits, including that you are in therapy in the first place.
Like any rule, however, this one has exceptions. If one of these exceptions applies to your therapy, and your therapist needs to break your confidentiality, it may seem to you like a violation of trust. For this reason, it is important that you know about these exceptions before your therapy begins.
These exceptions vary from state to state, but some of the most common reasons that therapists may break confidentiality are listed below:
- If you are dangerous to yourself or to others. Your therapist is not held by confidentiality if he or she feels that you are likely to hurt yourself or someone else. However, the specifics of such “danger” are not well defined, and you may want to ask your therapist for more details.
- When there is reason to believe that children, the elderly and certain other groups have been or may be abused or neglected. All states have laws establishing some form of mandated reporting of child abuse; there may be limits on confidentiality when the abuse affects such others as the elderly or the disabled, and in cases of domestic violence.
- When there is a medical emergency. Sometimes, there may be differences over precisely which information about you can or should be disclosed, and to whom.
- When your therapist is attempting to collect on a delinquent account. If you are not paying the bills, your therapist should be able to hire a collection agency. This means revealing that you are in therapy. However, your therapist in this case can reveal only the information essential to bill collection.
- When your therapist is acting under a court order. If a judge orders your therapist to reveal information about you, this overrules confidentiality.
- When necessary for your therapist to prepare a legal defense. If you sue your therapist, confidentiality cannot prevent him or her from preparing a defense. It is unfair to sue and then say, “but you can’t talk about what you did.”
- When your therapist is consulting with other professionals. Your therapist can talk to other professionals in the same institution about you if he or she believes the advice will help improve your care. Conversations unrelated to your care are not allowed, however.
- When information is being used for teaching or research purposes. Many states allow the disclosure of confidential information for training or research, if it is presented in a way that serves a legitimate purpose and does not reveal critical information. If your therapist wants to make an audio- or videotape of you to use in presentations, you must be informed beforehand and sign a release approved by a lawyer. You always have the right to refuse.
Sample of Your Patient Rights
Here is a sample of your patient rights when engaging in psychotherapy. Ask your therapist for their version of your patient rights when working with them.
- To actively participate in developing an individual plan of treatment.
- To receive an explanation of services in accordance with the treatment plan.
- To participate voluntarily in and to consent to treatment.
- To object to, or terminate, treatment.
- To have access to one’s records.
- To receive clinically appropriate care and treatment that is suited to their needs and skillfully, safely, and humanely administered with full respect for their dignity and personal integrity.
- To be treated in a manner which is ethical and free from abuse, discrimination, mistreatment, and/or exploitation.
- To be treated by staff who are sensitive to one’s cultural background.
- To be afforded privacy.
- To be free to report grievances regarding services or staff to a supervisor.
- To be informed of expected results of all therapies prescribed, including their possible adverse effects (eg.- medications).
- To request a change in therapist.
- To request that another clinician review the individual treatment plan for a second opinion.
- To have records protected by confidentiality and not be revealed to anyone without my written authorization. Exceptions to confidentiality are covered above.