You should share as much as you feel comfortable sharing. You absolutely can tell your therapist everything, with no shame. And you never have to share something or answer a question you aren’t comfortable with. You can go at your own pace. What does matter is that your therapist knows the main points of what you’re dealing with, because that’s what they need to choose an approach that can help.
I handle the calls and emails from people looking for a therapist at Reframed Mental Health, and underneath this question is almost always another one: where does what I say end up? Here’s what happens to what you share with us, the few situations where a therapist has to break confidentiality, and how to decide what to share.
Where Does What I Tell My Therapist Go?
The biggest worry I hear is about where the information will end up, and the short answer is that your therapist writes a summary that is attached to the record they keep for you.
There’s no standard for what a therapy note looks like, so notes can vary widely from therapist to therapist. Some note styles are very protective and show very little. Others record a ton of detail. Since the Lindsay Clancy trial, where attorneys argued over what her psychiatrists’ notes did and didn’t say, there has been a lot of discussion within the field about including much more detail in notes.
You have the right to ask a therapist ahead of time what their notes look like. You also have the right to see the records your therapist keeps, including the notes attached to your record. Some therapists keep informal notes for themselves, called “psychotherapy notes,” that aren’t attached to your record. Those have extra protection under HIPAA. Your insurance company can’t get them, and they generally can’t be released to anyone without your written permission, even when your records are requested.
How we write notes at Reframed Mental Health
All of our therapists use the same note style. It’s designed to meet insurance companies’ requirements and to be as protective as possible. Your note includes:
- What your emotional experience looked like during the session, and whether it was appropriate for what you were discussing (this is called affect)
- Your diagnosis and symptoms
- The themes you discussed, not the details (for example, “concerns with family relationships,” not the details of the fight you had with your mom)
- The approach your therapist used
- What your therapist recommends as next steps
And that’s it! If someone read one of our client notes and nothing else, it would be extremely hard to tell who it was about or what happened in their week.
Can my therapist talk to other therapists about me?
Sometimes. Therapists can only talk to other therapists in their own practice, or the therapist they have for consultation or supervision, which is a therapist who provides feedback and collaboration. They cannot talk to your former therapist or a therapist outside of their practice without your express consent. At Reframed Mental Health, we believe that every therapist benefits from feedback and collaboration at every point in their career, not just at the beginning. So our team meets together, and a therapist gives the team a broad overview of a client, with just enough detail for us to understand the presenting issue, the approaches they’ve used and how the client has responded. The purpose is to give the therapist perspective and new ideas. Specific details only come up when the team needs them to understand what’s going on, or when the therapist is looking for a specific resource. This is one of the reasons we built Reframed Mental Health as a group and not a solo practice. No therapist, no matter how smart or how well trained, has all the answers, and you get better care when your therapist is properly supported.
Does the admin team know what I talk about in therapy?
Usually not. Our admin team is only involved when there’s an administrative need, like preparing a letter or researching a specific resource. Even then, the admin team only knows what is relevant to completing the task. They are also covered by HIPAA, and every staff member signs a confidentiality agreement.
Do I Have to Tell My Therapist Everything?
No. Go at your own pace with what you feel comfortable sharing. You are never required to answer something your therapist asks if you aren’t comfortable sharing it. Trust gets built over time, and it’s normal to share more as you get to know your therapist.
The one caveat is that leaving out major details can affect your care. Think of this like going to the doctor. If you go to a doctor because you get excruciating pain in your foot every time you run, you wouldn’t tell the doctor your foot is a little sore sometimes, and if you did, that doctor probably wouldn’t be much help. You might not go into every detail of your running routine, but you’d cover the main points: it happens when I run, this is where on my foot it hurts, these are the shoes I wear and this is the terrain I run on. Therapy works the same way. Your therapist needs the main points to choose an approach that can help you.
What if it’s hard to say out loud?
Some things are hard to put into words in the room. We’ve had clients who really struggled to talk about painful things, and they chose to write it out in a journal and let their therapist read it. We’ve also had clients who use art, games or movement to share difficult things. Saying the hard thing isn’t required as long as you share the main points, so your therapist has enough to work with. That’s what counts!
Doesn’t a Therapist Have to Report a Crime?
Therapists are mandated reporters, so there are some things we have to report, but people often misunderstand what that means compared with everything HIPAA protects. In general, what you tell a therapist, even about crimes you’ve committed, is treated like medical information and can’t be disclosed. The exceptions are narrow:
- A child is being abused or neglected.
- You’re at immediate risk of seriously harming someone else.
- You’re at immediate risk of seriously harming yourself.
Immediate is the important word
For harm to yourself or someone else, the risk has to be active or near-immediate. Having suicidal thoughts doesn’t meet that bar. Thinking in great detail about how you would end your life doesn’t meet it either, and neither does wishing someone were dead. Having a plan, having the means to carry it out and intending to act on it does. HIPAA lets a provider share information to prevent a serious and imminent threat, and that’s the bar. Breaking confidentiality is a big deal.
That means you can bring suicidal thoughts to therapy, and it’s one of the most important things to talk about there. If you’re in crisis outside a session, you can call or text 988, the Suicide & Crisis Lifeline, any time. In New York City, 988 connects you to NYC 988 (formerly NYC Well), which also offers online chat and support in Spanish.
What about abuse that happened in the past?
Abuse of a child has to be a current, present risk to that child. If you’re an adult telling your therapist about abuse that happened to you as a child, that generally isn’t something your therapist has to report. New York’s reporting law applies when a therapist sees a child in their work and suspects abuse or neglect, or when a child’s parent or guardian tells the therapist about abuse or neglect. If the person who hurt you still has access to children, like younger siblings, your therapist will talk with you about that.
What Does My Insurance Company See?
Insurance only covers therapy for a diagnosable condition, so every claim includes a diagnosis, along with a code that tells the insurance company what kind of session it was.
Therapists only have to give more information if the insurance company asks for it. That doesn’t happen often, but when it does, we have to comply. It’s one of the conditions of using insurance to pay for therapy. Our team has treated more than 600 clients, and insurance companies have requested documentation for only 3 of them. We’ve spent more time preparing documentation for clients applying for jobs that require psychological clearance (like the NYPD or the military) than we ever have for insurance. HIPAA also doesn’t allow your health plan to share your claims with your employer for decisions about your job. If you’d rather keep therapy off your insurance entirely, private pay is an option, and our insurance and fees page lists our rates.
What If I’m Nervous About Privacy?
Ask your therapist what kind of notes they keep. There are a few common note styles, so once you know the name, you can search for it and see the format. And tell your therapist why you’re nervous. Since there is no required style, if they know the reason, they may be able to adapt some things to help you feel more comfortable.
If you’re still looking for a therapist, you can meet our team, or read about how to choose a type of therapy.
The Bottom Line
You can share freely without shame, but you don’t have to tell your therapist everything, and you can go at your own pace. Share the main points, because that’s what your therapist needs to help you. What you say is protected like medical information, the exceptions are narrow, and at Reframed Mental Health, your notes are written to protect you. If you have privacy questions, bring them to your free consultation and we’ll walk you through them.