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Oct 22

Confidentiality, Protections and Issues

In this day and age, confidentiality is more important than ever in the therapeutic setting. It is crucial that a client can trust that the sensitive issues that the client relates in session stays in the session.

The legally protected confidentiality found in a therapeutic relationship is the bedrock of trust.

As detailed below, PeoplePsych therapists, like all licensed psychotherapists, are required to comply with the legal and ethical guidelines regarding client privacy and confidentiality.

General Guidelines

Both state and federal laws cover client privacy. The Illinois Mental Health and Development Disabilities Confidentiality Act (ILCS 110 et seq) covers many of the confidentiality issues faced by both client and mental health care provider. Basically, it states that all records and communications are to be kept confidential and cannot be disclosed absent legal exception or a client’s permission. The statute defines confidential communications, creates exceptions and privileges, speaks to issues of access to, and disclosure of, mental health information, and enforces confidentiality breaches.

The Act encompasses all medical records including all notes, test results, medications, medical history, diagnosis, treatment provided, evaluations and any other document found in a client’s medical file. It also protects all communications made between a client and therapist in session.

There are some limitations to confidentiality enumerated under statute and case law. Here are some of them.

  • Reasonable suspicions of child/elder abuse or neglect must be reported.
  • Immediate clear and present danger to self or others. Your therapist must take steps to try to prevent the harm which can include calling police or appropriate emergency personnel.
  • Therapist consultation with a professional colleague who is also bound by the same level of confidentiality.
  • Court subpoenaed medical records.
  • Signed specific Release of Information (ROI) will allow a therapist to release specific information.

HIPAA Also Provides Protection

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) provides a national set of standards for the protection of client medical and health insurance information that include the HIPAA Privacy Rule. It protects all forms of a client’s protected health information including handwritten chart notes, electronic chart notes, and all information that you share with your therapist, and information that you or your therapist provides to your insurance company. HIPAA ensures that a client is informed of their rights concerning their health records and sets rules and limits on who is able to access and receive medical records.

HIPAA creates national standards and the HIPAA Privacy Rule provides a minimum level of protection. Only that information which is necessary may be shared and then, only with informed consent on the part of the client. The Privacy Rule also adheres to your insurance company and its employees, preventing them from unauthorized disclosure of client records.

Health insurance companies and agencies such as Medicare and Medicaid are also bound by HIPAA and its bounds on confidentiality. If a client’s therapy is being paid for or reimbursed by an insurance company, a therapist must share some information with the health insurance company to ensure that payment is covered. To that end, a therapist can share very limited information such as a diagnosis, and dates of treatment. A therapist will have a client sign a Release of Information so that the therapist can share this information with an insurance company if appropriate.

What is Release of Information (ROI) and When is it Needed?

Absent the limited exceptions to confidentiality, a client’s medical and therapeutic records cannot be shared without their express permission. A Release of Information is a legal document signed by a client that specifies what may be shared, with whom, when it may be shared and any time limitations on the records being shared.

Information to be released may be limited to billing records, diagnosis, dates, a summary of treatment, and the like. This can speed up insurance reimbursement. A Release of Information can also allow a client to transfer their medical records from one health care provider to another. It can also allow a therapist to coordinate a client’s care with your other health care providers if that is appropriate. All parties here would be bound by confidentiality as well.

A Release of Information can be revoked by a client at any point in time.

Privacy and Children: How is a Release Handled When There Are Children Involved

A child generally cannot give legal consent. Therefore, when a child is in therapy, a parent consents to their treatment. Children have a right to privacy and confidentiality in therapy, and the same limitations and exceptions apply to them. Therefore a child in therapy needs to understand that confidentiality may be breached in the face a threat to harm oneself or another. It may be helpful for a therapist, the parent and the child client to sit down and discuss the issues and limits on a child client’s right to confidentiality at the beginning of therapy.

Under Illinois law, a parent or legal guardian of a child aged 12-18 who is receiving therapy is entitled to certain records pertaining to their child’s therapy. The parent or guardian is entitled to records pertaining to the child’s current condition, diagnosis, any treatment and medications provided the child and information pertaining to treatment and services needed by the child. Other records require the child’s and therapist’s permission. If permission is denied, the parent is required to get a court order to obtain those records. If the child is over the age of 18, a Release of Information (ROI) is required for a therapist to share any information with a parent concerning that child’s therapy. Parents of children over the age of 18 years of age can have a difficult time accepting the limitation, but it is important confidentiality of clients be maintained both legally and ethically.

A parent or legal guardian must give consent for the sharing of a child’s mental health records by signing a Release of Information on behalf of the child for the transfer of records between therapists, for example. A general Release of Information is insufficient to release mental health records under Illinois law. The written consent must include all of the following in order to be effective:

  • The name of the person or agency to whom records are being released.
  • The reason for the release of the record.
  • The types of records being released.
  • An ending date past which the consent is no longer effective.
  • The signature of the person giving consent and of a witness.
  • Information that consent may be revoked at any time and of the consequence of refusing to grant consent.


PeoplePsych is a team of psychotherapists serving Chicago – offering compassionate guidance for clients wanting to make positive changes in their lives. Our highly skilled therapists can assist you in overcoming the fear of vulnerability to experience authentic connections with others. Contact PeoplePsych today at (312) 448-7218 or

Life can be complicated, messy, and rarely progresses in a straight line.  PeoplePsych is a Chicago-based psychotherapy group that treats adults seeking profound change in their lives.  We provide services that affirm the dignity, worth, and value of all individuals. We strive to create a safe non-judgemental space for clients to explore the issues that bring them. To connect with one of our therapists, please contact our Clinical Coordinator at (312) 252-5252 or