Psychotherapy is a treatment relationship which works in part because of clearly defined rights and responsibilities held by both patient and therapist.  This framework helps to create the safety to address difficult issues and the support to make difficult changes.  As a patient, it is important that you are conscious of your rights because this is your treatment, the goal of which is you well-being.  There are also certain legal limitations to those rights of which you should be aware.

Diagnosis

Diagnoses are technical terms which describe the nature and severity of your symptoms.  In North America, the American Psychiatric Association's Diagnostic and Statistical Manual, Fourth Edition (DSM-IV) is generally used as a guide in determining diagnosis.  If you are interested, your therapist will discuss your diagnosis with you and a copy of the DSM-IV will be made available for your review.

Decisions Regarding Your Treatment

Your active involvement in identifying goals, selecting approaches, and assessing effectiveness is essential to the success of your therapy.

You have the right to ask questions about anything that happens in therapy.  Your therapist will be willing to discuss how and why he or she has decided to take a particular approach, and to look at alternatives which might be more effective.

You have the right to refuse the use of any therapy technique.  If your therapist plans to use any unusual technique, its benefits and risks will be explained and discussed with you.

You have a right to ask about your therapist's training for work with your particular concerns, and to request a referral to another therapist if you decide that your therapist is not right for you.  You are free to leave therapy at any time.

You have a right to discuss your therapy with anyone you choose, including seeking the second opinion of another therapist.  You have a right to repeat anything your therapist says to you.

The Role of Managed Care Organizations

If your health insurance benefits are administered via a managed care organization, it is important for you to be aware that benefits cannot be used until the managed care organization approves their use.  Managed care organizations set limits on choices available to both you and your therapist.

If you use your health insurance to pay for your treatment, you must allow your therapist to inform a managed care reviewer of your problem, the treatment he or she suggests, and how you are functioning in many areas of your life, as well as to provide regular updates.  This information will likely be provided to the managed care organization by phone and in writing.

While all insurance companies claim to keep such information private, the laws and other rules that apply to therapist confidentiality are stricter than those which apply to managed care organizations.  If you are concerned, you may wish to discuss these issues with your therapist fully before treatment is started and information must be sent to your managed care company.

Managed care reviewers decide how much treatment your therapist can provide to you, based upon the information provided.  The managed care organization can refuse to allow the therapist to treat you.  It can refuse to pay for any of your treatment, or may pay only a very small part of its cost.  It can limit the kinds of treatment options your therapist may make available to you.

Your managed care organization may approve you treatment but limit the number of sessions you may have.  While many insurance policies list a maximum number of appointments allowed for psychotherapy, the managed care organization does not have to allow you to use all of these appointments, even if you and your therapist believe that more treatment is needed.  If you are dependent upon a managed care program for your health care, it is important that you be aware that you may need to consider treatment choices other than those which you and your therapist would prefer.

Many managed care organizations contract with local general hospitals to provide inpatient mental health services on a per diem--or flat fee per day--basis with the understanding that the hospital is financially responsible for then paying for all required inpatient services, including individual psychotherapy.  As a result, local hospitals generally require that their own salaried staff provide all psychotherapy to you while you are hospitalized. Should you need hospitalization, your therapist may be able to offer recommendations to inpatient clinical staff but will not be able to provide direct are to you.

Your therapist will assist you to appeal a managed care organization's denial of necessary sevices but it is important for you to know that appeals are generally available only within the managed care organization itself.  Nebraska does not yet have legislation which regulates managed care organizations, as it does with traditional health insurance.

Records of Your Treatment

Both the law and professional standards require your therapist to keep complete and accurate records of your treatment, including notes taken during and after therapy sessions.

Although the Health Insurance Portability and Accountability Act of 1996 specifies that you have the right to inspect and obtain copies of most health information, psychotherapy notes are specifically excluded. Also excluded are information gathered in anticipation of civil, criminal or administrative actions.

Psychotherapy Associates philosophy, however, is that you may obtain a copy of your chart at any time, at a reasonable fee for copying and handling, and with reasonable advance notice. You have the right to request that your therapist correct any errors in your chart. Because professional records can be misinterpreted or upsetting to lay readers, if you request a copy of your chart it is recommended that you review them in the presence or your therapist so that you may discuss the contents.

Treatment records are maintained in a secure location, for a minimum of ten years following completion of therapy.

Treatment of Minors

If you are under eighteen years of age, please be aware that the law may provide your parents with the right to examine yyour treatment records.  Your therapist will request an agreement from parents that they consent to give up access to your records.  If they agree, only general information regarding your treatment will be provided to them unless there is reason to believe that you will seriously harm yourself or another, in which case they will be notified.