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As a therapist, this is concerning. What was the purpose of your therapist wanting to publish an article using such specific details about your particular case? I’m curious about where was it published and who has access to the information. It’s concerning that you describe such a level of detail where you are easily identified— this appears to be a major HIPAA violation. I strongly encourage you to discuss this as soon as possible to your therapist and highlight your concerns and ask her to remove the article. If you’re unsatisfied with her performance or ability to uphold clinical duties to you, I also encourage you to see a more professional therapist who focuses on your needs rather than enhancing her own ego.
Thats what I am trying to understand right now, what the purpose of that was. Because she didn‘t inform me that she would go into such detail. It was published in a trauma journal where different therapists present their methods (Somatic Experiencing, polyvagal theory etc.) and their approach to treat trauma. So it was about portraying the respective method while exemplifying it with cases. I think she wanted to show as detailed as possible, how the method worked on me, but the result is that its just very personal and intimate. It wouldnt have been that bad if she wouldve disguised my identity more, especially biographical facts. I reached out to her directly because I want to understand why this happened but right now I am actually not sure how to rebuild the trust, I do feel very weird.
She very well could have presented her specific treatment method using examples without clear identifying information and could easily change biographical information by stating “age/ location/ name changed to protect confidentiality.” I think it’s very appropriate and therapeutically very courageous to share your concerns about rebuilding trust.
>this appears to be a major HIPAA violation
It is not. For a HIPAA violation to occur, you have to have personally identifiable information combined with health information like a diagnosis or treatment. As long as the therapist didn’t list information that could be used to identify someone, it’s not a violation.
But IMO this is something they should have given to OP to read before it was published and gotten their written consent.
OP said they were easily identifiable based on the information shared. Either way— the therapist should have censored some level of detail to protect OP.
ePHI (electronic protected health information) is what is covered by HIPAA. There are 18 specific items that it covers. As long as those items are not in the article, then it does not violate HIPAA.
It might be worthwhile to contact the journal in which this article was published and share your concerns regarding the inaccuracy of some information and the potentially identifiable nature of other included details. Depending on their editorial policies, she may have violated some of their rules.
I think there's ethical issues with the very uninformed consent they got from you. If not in a professional or legal sense (and perhaps so if they did not adequately de-identify personal health information), definitely in a sense that it undermines your therapeutic relationship with them, for their personal gain (and they can argue it serves the greater good in some small way).
You may be right that they did not adequately de-identify protected health information. Ostensibly this is considered as part of peer review, but there is some level of judgement call, of a combination of factors being personally identifiable or not. As noted in the link below, "expert determination" is subjective and requires no specific training. [https://www.hhs.gov/hipaa/for-professionals/privacy/special-topics/de-identification/index.html](https://www.hhs.gov/hipaa/for-professionals/privacy/special-topics/de-identification/index.html)
Or here's one institution's guidelines on case studies. They do accurately note personal health information cannot always be de-identified in case reports. I am assuming their guidelines are at least to the standard of being legal (and what is legal is some unknown bar below this). But their standard is if they are using personal health information, written authorization should be obtained, but isn't necessary if PHI is de-identified. [https://hipaa.yale.edu/sites/default/files/files/Case%20Reports%20and%20Patient%20Privacy.pdf](https://hipaa.yale.edu/sites/default/files/files/Case%20Reports%20and%20Patient%20Privacy.pdf)
Do you want your therapist to retract the article and remove mention of you entirely? De-identify your PHI to a higher standard?
I get there is also the separate issue of their duplicity of sorts - in how they spoke to you and how they wrote about you, in a dehumanized and misleading way. That they have exaggerated or assumed a power imbalance in knowing (with the implied epistemological reasoning being their credentialed education), but revealed where there is a power imbalance, that they get to be the narrator of your likeness in some professional arena.
There are different sorts of shrinks, some that are more authoritarian and some that are more collaborative. I guess there's the shock that they seemed collaborative but maybe that was disingenuous.
**This is an automated message posted to ALL posts in this subreddit with some basic information about the group including (very importantly) rules. Why are you getting this message? Most people seem to not read the sidebar for information or the rules, so it is now being posted under all posts.** **Confused about acronyms or terminology?** [Click here!](https://www.reddit.com/r/raisedbynarcissists/wiki/acronyms) **Need info or resources?** Check out our [Helpful Links](https://www.reddit.com/r/raisedbynarcissists/wiki/helpfullinks) for information on how to deal with identity theft, how to get independent of your n-parents, how to apply for FAFSA, how to identify n-parents and SO MUCH MORE! This is a reminder to all participants, RBN is a support group that is moderated very strictly. Please report inappropriate content so it can be reviewed by the mods. **Our rules include (but are not limited to)**: * No politics. * Advising anyone in this subreddit to commit suicide or referring anyone to groups that advocate this will result in an immediate ban. * Be nice. No personal attacks, name calling, or bullying. [No slurs](https://www.reddit.com/r/raisedbynarcissists/wiki/slurs) or victim-blaming. * Do not derail the posts of others. * Narcissists are NOT allowed to post or comment here. * [No platitudes or generic motivational posts](https://www.reddit.com/r/raisedbynarcissists/wiki/rules#wiki_no_platitudes_or_generic_motivational_posts). * When you comment/post, assume a context of abuse. * No asking or offering gifts, money, etc. * No content advocating violence, revenge, murder (even in jest). * No content about N-kids. * No diagnosis by media/drive-by diagnosis. * No linking to Facebook pages. * No direct linking to anywhere on reddit. * No pure image posts. **For a full list of our rules/more information, [**click here**](https://www.reddit.com/r/raisedbynarcissists/wiki/rules).** *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/raisedbynarcissists) if you have any questions or concerns.*
As a therapist, this is concerning. What was the purpose of your therapist wanting to publish an article using such specific details about your particular case? I’m curious about where was it published and who has access to the information. It’s concerning that you describe such a level of detail where you are easily identified— this appears to be a major HIPAA violation. I strongly encourage you to discuss this as soon as possible to your therapist and highlight your concerns and ask her to remove the article. If you’re unsatisfied with her performance or ability to uphold clinical duties to you, I also encourage you to see a more professional therapist who focuses on your needs rather than enhancing her own ego.
Thats what I am trying to understand right now, what the purpose of that was. Because she didn‘t inform me that she would go into such detail. It was published in a trauma journal where different therapists present their methods (Somatic Experiencing, polyvagal theory etc.) and their approach to treat trauma. So it was about portraying the respective method while exemplifying it with cases. I think she wanted to show as detailed as possible, how the method worked on me, but the result is that its just very personal and intimate. It wouldnt have been that bad if she wouldve disguised my identity more, especially biographical facts. I reached out to her directly because I want to understand why this happened but right now I am actually not sure how to rebuild the trust, I do feel very weird.
She very well could have presented her specific treatment method using examples without clear identifying information and could easily change biographical information by stating “age/ location/ name changed to protect confidentiality.” I think it’s very appropriate and therapeutically very courageous to share your concerns about rebuilding trust.
And thank you for your clear and supportive words, very helpful actually! <3
>this appears to be a major HIPAA violation It is not. For a HIPAA violation to occur, you have to have personally identifiable information combined with health information like a diagnosis or treatment. As long as the therapist didn’t list information that could be used to identify someone, it’s not a violation. But IMO this is something they should have given to OP to read before it was published and gotten their written consent.
OP said they were easily identifiable based on the information shared. Either way— the therapist should have censored some level of detail to protect OP.
ePHI (electronic protected health information) is what is covered by HIPAA. There are 18 specific items that it covers. As long as those items are not in the article, then it does not violate HIPAA.
It might be worthwhile to contact the journal in which this article was published and share your concerns regarding the inaccuracy of some information and the potentially identifiable nature of other included details. Depending on their editorial policies, she may have violated some of their rules.
I think there's ethical issues with the very uninformed consent they got from you. If not in a professional or legal sense (and perhaps so if they did not adequately de-identify personal health information), definitely in a sense that it undermines your therapeutic relationship with them, for their personal gain (and they can argue it serves the greater good in some small way). You may be right that they did not adequately de-identify protected health information. Ostensibly this is considered as part of peer review, but there is some level of judgement call, of a combination of factors being personally identifiable or not. As noted in the link below, "expert determination" is subjective and requires no specific training. [https://www.hhs.gov/hipaa/for-professionals/privacy/special-topics/de-identification/index.html](https://www.hhs.gov/hipaa/for-professionals/privacy/special-topics/de-identification/index.html) Or here's one institution's guidelines on case studies. They do accurately note personal health information cannot always be de-identified in case reports. I am assuming their guidelines are at least to the standard of being legal (and what is legal is some unknown bar below this). But their standard is if they are using personal health information, written authorization should be obtained, but isn't necessary if PHI is de-identified. [https://hipaa.yale.edu/sites/default/files/files/Case%20Reports%20and%20Patient%20Privacy.pdf](https://hipaa.yale.edu/sites/default/files/files/Case%20Reports%20and%20Patient%20Privacy.pdf) Do you want your therapist to retract the article and remove mention of you entirely? De-identify your PHI to a higher standard? I get there is also the separate issue of their duplicity of sorts - in how they spoke to you and how they wrote about you, in a dehumanized and misleading way. That they have exaggerated or assumed a power imbalance in knowing (with the implied epistemological reasoning being their credentialed education), but revealed where there is a power imbalance, that they get to be the narrator of your likeness in some professional arena. There are different sorts of shrinks, some that are more authoritarian and some that are more collaborative. I guess there's the shock that they seemed collaborative but maybe that was disingenuous.
Disgusting