Why privacy matters so much for this topic
For many people, the hardest part of seeking help for a sexual concern is not the problem itself but the thought of anyone else knowing about it: a partner, a family member, an employer, an insurer, or someone they might bump into in town. Knowing how privacy works in therapy, and where its limits are, can make the decision to start much easier.
Privacy questions are also a perfectly reasonable thing to raise on a first phone call, before you have said anything about the concern itself. You might ask who will see your information, whether anything goes to your doctor or insurer, and how the practice prefers you to get in touch. A clear answer to those questions is part of deciding whether a therapist is the right fit, and asking them says nothing about what you plan to share.
Confidentiality is the starting point
The American Psychological Association (APA) notes that psychologists consider maintaining your privacy extremely important, that it is part of their professional code of ethics, and that it is a condition of their professional license. Psychologists who violate confidentiality risk losing the ability to practice. The APA also notes that being open about your most private thoughts and behaviors is part of what makes therapy effective, which is exactly why this protection exists.
Dr. Lehmann's practice describes therapy as confidential, with limited exceptions required by law. She will not share information with anyone else, including your physician, without your written permission, and she reviews the exceptions with you at the start.
The limits of confidentiality
Confidentiality is strong, but not absolute. The APA gives these examples of situations where a psychologist may have to share information:
- If you reveal that you plan to hurt yourself or someone else.
- Abuse, exploitation or neglect of children, older adults or people with disabilities, which psychologists must report.
- Some court cases, in which a psychologist may have to provide some information.
The APA also notes that psychologists will answer your questions about those rare circumstances. The exceptions it describes concern safety and the law, not embarrassment. If you are unsure whether something you want to say would fall under one of them, you can ask about the rules first, in general terms, before deciding what to share.
What HIPAA adds
The federal HIPAA Privacy Rule also applies to health information. According to the U.S. Department of Health and Human Services (HHS), it gives you rights over your health information and sets limits on who can look at and receive it, whether that information is electronic, written or spoken. HHS lists psychologists among the providers who must follow these rules when they conduct certain business electronically, such as billing health insurance.
Under the Privacy Rule, HHS says you have the right to:
- See and get a copy of your health records, and have corrections added
- Receive a notice explaining how your health information may be used and shared
- Ask a provider to restrict how it uses or shares your information
- Get a report on when and why your information was shared for certain purposes
- File a complaint if you believe your rights are being denied
HHS also notes that, without your authorization, a provider generally cannot give your information to your employer. For mental health in particular, HHS keeps a one-stop guidance page explaining when information may be shared with family members and when it may be disclosed for health and safety reasons.
Insurance and what it sees
HHS notes that health information can be used and shared to pay for your care. If you use insurance, your plan receives the information it needs to process the claims. Some people weigh this when deciding whether to use insurance or pay privately. If it matters to you, ask the practice what billing involves before your first session. Does Insurance Cover Therapy for Sexual Concerns? covers the cost side.
Couples sessions: who hears what
Privacy works differently when two people are in therapy together. Therapists vary in how they handle information one partner shares privately, for example on a phone call, in an individual session, or in a message. There is no single rule, so ask before you share something you would not want your partner to hear:
- If I tell you something on my own, could it come up in a joint session?
- How do you handle it if one of us has an individual session?
- Who can see or request records from our couples sessions?
Sexual concerns can be part of individual therapy or couples therapy, and Dr. Lehmann can talk with you about which format fits your situation when you call. Individual or Couples Therapy for a Sexual Concern looks at that choice.
Protecting your own side of the conversation
Some privacy risks have nothing to do with the therapist. The APA notes that email is less secure than the telephone for a first contact, and Dr. Lehmann's practice asks that you do not send health details, diagnoses, insurance numbers or card numbers by email or through the website form. A short message with your name, how to reach you and your general availability is enough. Save the substance for a phone call or a session.
It also helps to think about shared devices and calendars. An appointment labeled plainly on a family calendar, or a reminder that pops up on a shared tablet, can reveal more than you intend. If you plan to use video sessions, Telehealth Therapy for Intimacy Concerns in Michigan covers privacy at home. More on how Dr. Lehmann approaches these concerns is on the intimacy and sexual concerns page.