To what extent is your privacy protected? What situations legally justify your therapist to release information about you?[1] [1] Since the first edition of this book, the Health Insurance Portability and Accountability Act (HIPAA) was passed in 1996, bringing with it a mass of complexities relating to patient privacy. There remain many still unsettled legal questions and issues relating to the so-called Privacy Rule, which there is not space here to discuss. If you wish to know more about the legal status and interpretation of patient privacy, see Wikipedia's article about HIPAA at: http://en.wikipedia.org/wiki/HIPAA. These questions do not always have clear-cut answers. There may or may not be special laws in your state to protect the confidentiality of psychotherapy. The legal status of therapy is still ambiguous in many states. Even in those where laws have been passed, legal protection is sometimes not reliable unless your therapist is willing to face a jail sentence if need be to maintain the confidence you have entrusted in him. If you feel a situation is likely to arise that would put legal pressure on your therapist to release information about you (for example, in a child-custody hearing), you should ask your therapist what his or her commitments to confidentiality are. "_Leaks_" More frequently, confidentiality is broken due to informality {261} rather than due to an intentional release of information. For example, if you are referred to another therapist or to a physician, the chances are that information about you will be shared by your original therapist with the new therapist or doctor. You can ask your therapist _not_ to release information in this way, but if you do, the care you receive as a result of the referral cannot benefit from your first therapist's understanding of you. On the other hand, if you do permit your file to be shared with a new therapist or doctor, you will probably not know in advance know what his or her own policies about confidentiality are. There is a second way that information about you may be released. Often, therapists discuss information about their clients with colleagues in an effort to provide better help for them. It is often to your definite advantage to have other therapists share their assessments and ideas with your therapist. But if you ask your therapist to refrain from discussing your case with professional colleagues, he or she will very likely agree to cooperate with you. If you believe you have special reasons to be concerned about protecting the confidentiality of your relationship with your therapist, it will help him or her to know this, and it may be possible to request that special precautions be taken to protect your file from access by others.