Badass Therapists Building Practices That Thrive
Welcome to Badass Therapists Building Practices That Thrive, the ultimate resource for mental health professionals ready to step into their power, grow their practices, and create a career they love. I'm Dr. Kate Walker, a Texas LPC/LMFT Supervisor, author, and business strategist who's here to show you the path to success.
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Badass Therapists Building Practices That Thrive
146 Your Secrets Are Safe: How Therapists Really Protect Client Information
Get your step by step guide to private practice. Because you are too important to lose to not knowing the rules, going broke, burning out, and giving up. #counselorsdontquit.
okay. So, jennifer, have you ever seen like comedians and they'll talk about like I bet my therapist gets on the phone with her other therapist buddies and they just crack up over the stuff that I go through in my therapy session or something like that.
Speaker 1:Oh, absolutely, and I've also fallen victim to that belief as well that you know if I'm struggling with some crazy mental health thing that my therapist is like. Oh my God, I got to tell everybody.
Speaker 2:Yeah, and we even talked about in the episode we did about do therapists need their own therapists? Right, when we have stuff we go to another therapist. We don't go to our husbands, we don't go to other therapists. I mean, I'm sorry, like our friend therapist that's what I mean by that. But we absolutely do like go to our own personal therapist.
Speaker 2:But and there's a giant but embedded in all of this we don't share client confidential information, and it goes by a lot of different names sensitive information, phi, protected health information and, you know, sometimes, clients. I think, first of all, well, I think there are two misconceptions. The first one is the first one. Like I just said, you know, oh my gosh, I'm going to get on the phone and talk about all the stuff I heard today. We don't do that. But I think the second misconception is they walk in as a new client and they think that we already have their information, especially if they've been referred by their physician or another therapist. Right, I mean because so many times I just did this. The other day I went to my physician and I was referred to another specialist and you know they already had the information because I sign a form that everybody in this network has access to my health records. But with mental health it's a little bit different and there are different laws and different layers, right?
Speaker 1:Oh, absolutely. And so I I know a lot of therapists out there. You know as they're going through. You know, prior to getting fully licensed they're encouraged to work for, like community mental health, and you know an intensive outpatient program, often referred to as an IOP, and I I've worked for an IOP and a lot of times, by the time I get to the client for therapy, they've seen a psychiatrist, they've seen a case manager, they've seen a psychiatrist, they've seen a case manager and they've seen a nurse. And I'm like so you know what brings you here for therapy.
Speaker 1:You know in a very generic sense, and a lot of times they're like oh, I got to tell you again because there's this conception that everybody knows and we really don't, and a lot of that you know. We have our different layers of you know HIPAA compliance and our state compliance, and we also have a code of ethics. Whether we're a social worker or a licensed professional counselor or a licensed marriage and family therapist, we all have to abide by these certain rules and regulations that stipulate what I can and cannot share. By these certain rules and regulations that stipulate what I can and cannot share, even if you're another therapist, I can't even ask you was this person a client of yours, and you can't tell me that person was a client of yours unless there are certain documents in place.
Speaker 2:Yeah, and that's the ROI, the release of information. And when you go to your brand new physician, you're filling out so many things you may not even realize that you're filling this out, Especially if you're going into, let's say, a system like Jennifer you're describing right, when there's so many specialists. They're basically saying, hey, we're going to share this with all of these people. But you do notice it when it asks you to, for instance, fill out the name of your partner, you know and, hey, can we share, you know records with this person in case you know of an emergency right, and sometimes that's what it looks like is sort of an emergency contact form, and so then you're aware, oh, yes, I'm giving permission for you to share information with my husband, my partner, my wife, whatever, and so in that sense, yeah, we can share information, but there are some really important differences, and Jennifer you were talking about, like in law enforcement, you know, because that can be confusing, especially when we can Google mugshots and court records, right, I mean, it's different.
Speaker 1:Very different. You know, in a previous life I worked in law enforcement and when you commit a crime, even if you're just a suspect you are. Now your information has been entered in this database that all of these other agencies are privy to. Now they can't go and tell their next door neighbor or their sister's, friend's cousin hey, you know, you know, bobby Sue, she was down at the pool hall and she was drunk. I mean, they're not, they're not doing that, but your information is out there. If you get arrested, that's not an admission of guilt and that's not a conviction, but your mugshot is still on Lubbock County mugshots for now, until ever, and you have to go through a lot of stuff to get it expunged. And I think a lot of people don't realize that all of that doesn't translate over into the various professions. They just think that, oh, everybody's going to know about this If I talk about this trauma I had at six. Who else is going to know about the trauma I had at six? And is it safe with this person?
Speaker 2:Yeah, I wonder if even folks listening to this right now, if they've been on the fence about going to see a therapist, and they're looking at the title of this and they're like, oh, I got to know this because you've been holding back from therapy, thinking that the therapist is going to share when they shouldn't, or you're that person who thinks that they know everything when you sit down across from them at the, so you know. Going back to the legal system, you know, and when we get a subpoena, it's like, okay, the legal systems involved, kind of all bets are off. We have to comply with the subpoena. Are we going to share information? Well, we're still going to advocate for you.
Speaker 2:We're still going to be, like I really don't want to share. Is there any other way we can get around this? Okay, is there any way that I don't have to share this? Maybe I can just give you a summary. Right, we're going to continue to fight to protect your information, because that's our job. We. You know you own that information. Anything that comes out of your mouth belongs to you, and all we are are the custodians. Right? It's like if I loaned you my car, right? I'm loaning you my car and not giving it to you, right? So don't drive it all over the place and share it with your friends.
Speaker 2:When your information is given to us, we are mandated by all the things Jennifer was talking about to protect that, and so you know, most states and HIPAA have conditions under which we must reveal, and that's you know, just a few. You know if you're a danger to yourself, you're a danger to someone else. You release and give us information about current ongoing child abuse, elder abuse and, of course, the subpoena. So one of the things that's really important is that you understand that at the first meeting, because you know, back in the day, we'd hand you a stack of paper and say, okay, read all this and sign it and then we can get going with your session. And you're like, oh my gosh, I want to get through this because I want to start talking. Nowadays. We're most likely going to send you a link, but it's important that your therapist actually explain to you what you're signing. But, most importantly, about those exceptions to confidentiality, right? I mean, jennifer, you talked about that before.
Speaker 1:Oh, absolutely, and it goes to say that it is a lot of paperwork, and if you are going in for your first session, whether it's a virtual session or you're face to face with your new therapist they should be taking the time to go through each of those documents, especially the portion that covers what information is shared, not shared, and in the event it could be shared, and really making sure you understand that. And so if you've ever been to therapy and your therapist didn't do that, I empower you the next time to ask those questions, because it is so important that you know and understand what that process is. It's your therapy, it's about you, you are the focus, and if you don't know what's going on or you don't have any idea of you know the process and the methods I mean, we do, obviously, it's our profession Then you have the right to ask those questions and get that information.
Speaker 2:Absolutely. You made me think of you know. So, okay, let's say, I've got the release, I'm the therapist, right, I've got the release of information, you signed it, you're my, you're my client. And so I'm looking at this thing and I think, okay, I've got a golden ticket, now I'm just going to share, share, share, share. No wrong, that's not how this works either. On a piece of information, the client gets to specify what is shared and it must be specified with whom it can be shared. So if you come to that first session and you're saying, you know, I really would like you to talk to my physician, they have my records. It's important you understand what medical conditions I'm going through I'll say, hey, that's great, fill this out, put your physician's name, put their contact information. We'll both sign it. We'll put it down when, how long this lasts, how long I have this permission.
Speaker 2:But wait, there's more. I don't just get on the phone with your physician and start spilling my guts about our sessions. I still am the custodian and so, even if you didn't put down, hey, I don't want you to talk about my childhood with my physician. If the physician is sharing information, I'm not going to talk about things that are irrelevant to our conversation. Right, it's, it's so. It's not a blank check, it's not just. You know, I don't even know what to say. Blank check is the best word, right? I'm not just going to spill my guts and talk about everything. In fact, if I'm a really, really prudent, good therapist, I'm going to wait to hear okay, physician, do you have any questions for me? And the physician, if they're a good physician, will say hey, do you have any questions for me? And the physician, if they're a good physician, will say hey, do you have any questions for me? Because that's what we're doing. We're trying to piece together a picture of you and something that's useful and kind of. I want to loop back around.
Speaker 2:So let's say, let's say we get the subpoena, or we get a release of information, or something comes to us and we're like okay, I feel like I really need to contact Jennifer, You're my client. I really need to contact your previous therapist to talk about some information, are you okay with that? And then you say, yeah, I'm okay, we fill out the paperwork. I'm going to talk with you first, like, here's what I want to talk about. Is that okay with you? And I'm not again, just not going to take this hall, pass this blank check and be like all right, here we go, we're going to break it down, grab your coffee, get a glass. We're going to just let's hash this out.
Speaker 2:No, it's not that right. It is a quick conversation in most cases and it's very much to the point and you get to tell me what you want discussed. And I know you may think, okay, but I'm not the expert. Yes, you are. You are the expert. It's your information and if I think I need clarity, if I come back from that conversation, I'm like, ah, I still need to talk to them again. It would be so helpful if I could talk about this thing that happened to you when you were 12. If you say no, then I'm like all right, good to go. If you say yes, then I will. We'll meet again. We'll continue to process that. You have so much power here, clients. It's really important that you know that, especially if you, if you're not a client and you're hesitant to go to therapy. It's really important that you know this right.
Speaker 1:Very much so. I like that you talked about it's not free reign. Going back to my previous occupation in law enforcement, I learned very early on that we are not consumers, we are products. Is my responsibility to not treat my client like a product, to treat my client as a human with thoughts and feelings and experiences and and part of that is not, you know, even not into intentionally sharing stuff that could be misused to the detriment of my client to the detriment of my client.
Speaker 2:Which brings me to social media. Right, I mean holy moly social media, and Jennifer and I are on the socials a lot because we're always looking for threads with mental health providers. We want to answer questions, we want to do exactly what we do here, but we love the interaction, we love helping out. But here's what we see, especially in mental health referral groups, which tend to be closed. You know you've got to answer questions. There are really good admins, but if you have a post counselor, I'm talking to you. That starts with. I have a client who dot, dot, dot, Stop, Just stop.
Speaker 2:Even if you are being a really good therapist and you want to get additional help for your client, or perhaps you're retiring or moving away and you're trying to get your client some additional help so that they transition to a new therapist, stop before you start revealing information in that thread. You don't know if this is a small town and the information that you're revealing especially. I mean I read one last week and it was like this person is this age, they are this gender and oh, by the way, they're a veteran and oh, by the way, they suffer with this illness and utilize these services. I mean with every single word this therapist was putting in the thread. Someone who was in that small town could probably know who that was. And this is the thing. Now I'm talking to you, general public.
Speaker 2:Your protected health information isn't just your name, your phone number, your address, blah, blah, blah. Your protected health information is any identifying information, right. So you know, if I thought about, like, when Dr Phil saw Britney Spears, well, first of all, he actually said he saw Britney Spears, but he wasn't licensed at the time, but anyway, it was still problematic. Yeah, so even if he had not said Britney Spears name, instead he had said I saw a blonde pop star in her mid 30s who used to be on Mickey's Clubhouse, Disney Channel, and she wore a yellow boa constrictor at one of her concerts.
Speaker 2:I mean, all of a sudden, we'd be all going okay, we totally know who this is. That's what I'm talking about you therapists talking to you revealing protected health information in these threads. I mean it's like's like Jennifer said, we are the product. There are bots, there are people scouring this information in order to put more stuff in your feed, get more things targeted to whatever. I mean it's just not a secure place and it's definitely not HIPAA compliant or ROI compliant yes, that's the word I'm looking for.
Speaker 1:So yeah, I got. I heard an example in grad school that was said that basically if your client could read it and thought, think it was about them, then that was too much information. Even if, even if it wasn't like, even if they put like I'm looking for a therapist for a female with anxiety and depression, um, suffering the loss of a parent, takes blue class, blue shield insurance Well, that could be a lot of people. But if I read that and I'm the client and I thought that that was about me, that that is enough for a counselor to have blurred those ethical boundaries Right.
Speaker 2:And, don't forget, most of you have your name on. I mean, right, it's. It's just very, very, very dicey and I love these groups, don't get me wrong. I love therapists, helping therapists, and we even host a thread in the Texas counselors creating badass businesses group called ISO in search of but it's easy to put in search of a therapist in the Frisco area who takes Blue Cross, blue Shield and specializes in something, something.
Speaker 1:Yeah, you don't even have to say I need a therapist. It specializes in anxiety and depression and works with teens.
Speaker 2:Yep, and that's how we want you to do it. And if you do need an ROI which you all do I shouldn't have said, if everybody listening to this who's a therapist seeing clients you need an ROI In addition to the paperwork explaining the exceptions to confidentiality. And how do you build an ROI? Well, we're going to bring in our friend ChatGPT, and I'm going to put on my glasses so I can see my other monitor and I'm going to put on my glasses so I can see my other monitor so you can ask chat GPT to help you construct a release of information. Please don't go to an attorney, please don't spend a lot of money on this. I mean, you can go to groups like ours. We give these things away and if you really are anxious about it, of course you can have an attorney check it. And if you really are anxious about it, of course you can have an attorney check it. But if you give chat GPT a prompt, something like help me write a HIPAA-compliant release of information form for a counseling private practice, in, insert the name of your state, include fields for client name, provider name, recipient purpose, type of info released, time limits and signature, and then, of course, you can customize it. Add your practice name, your contact info, include what types of information can be released. Remember what we said earlier client has the power, so make sure you give them those options, even if it's just a blank, like a line helping you understand what you can and cannot release. And then include expiration dates, which generally, if there's no expiration, it's 12 months from the date that it's signed that it will expire and the language that the client for revocation purposes and the language that the client for revocation purposes and the spoiler alert the client can revoke this at any time. You just want to make sure you have that in your ROI so that the client knows that they have that power right.
Speaker 2:So go to your favorite GPT I guess not GPT, your favorite AI? I'm a chat GPT. I guess not GPT your favorite AI. I'm a chat GPT fan and you can build your own ROI with your brand and your information and you're good to go. I mean, if you follow the stuff we're talking about in this episode, I mean you're going to be good. But I get it. You want to contact an attorney? Have them double check with you, please. Please do so as long as you feel good, as long as you're feeling comfortable and mainly for the potential clients listening to this. If this is what's been holding you back from going to therapy, I want you to feel empowered. Now you've got some questions you can ask this brand new therapist, this potential therapist that you're also going to interview. Right, they're not just interviewing you, you're interviewing them, and now you've got some information about how we handle protected health information. So go to therapy, all right, and we will end.