If you are really concerned about this possibility, ask your insurance officer how health claims are handled and whether health information is requested by your employer from the insurance company.
If you are then still concerned and feel that you need to avoid potential complications at work, you may prefer to see a therapist on your own and refrain from using your employer's insurance coverage. If you see a therapist in private practice, your decision to pay your own bill may be expensive for you. If finances are a problem, bear in mind that you can frequently locate competent help through county, state, or private counseling agencies. If you go to an agency, remember that you will almost certainly be asked whether you have insurance coverage. If you admit that you do, you will have defeated your purpose in going to an agency on your own to protect your privacy. It is, after all, your right to obtain treatment that you elect to pay for.
MAGNIFYING YOUR NEED FOR SECRECY
After reviewing these ways in which confidentiality may be broken—by accident or sometimes excessive informality, by legal requirements, or by what to many of us constitutes an invasion of personal privacy by insurance companies—you may wonder to what extent information that you disclose in therapy really is protected.
In fact, very seldom are the details of therapy divulged to others without a client's advance consent. Most of us do not need to be worried by legal exceptions to confidentiality: most of us are not actually homicidal (though we may feel very angry at times!); most of us are not determined to take our lives (though we may at times feel very disheartened); most of us are not concerned that a court will order us to be examined by a psychiatrist.
I have tried to give a realistic picture of confidentiality in therapy. The fact that you receive mental health counseling or therapy may inadvertently be disclosed by such things as a billing that goes astray or by a fellow group member's inclination to talk too much outside of the group. If you decide to make use of insurance coverage, there are possible consequences you ought to be aware of.
I have tried to underline the fact that most people who enter therapy blow out of proportion the real significance of these possible, but comparatively infrequent, "leaks."
Karl A. Menninger, a renowned and original contributor to psychiatry, quotes one of his patients who shared her intelligent reflections with him:
"When I look back upon the many months I pondered as to how I might get here without anyone knowing, and the devious routes I considered and actually took to accomplish this, only to realize that some of the symptoms from which I suffer are respectable enough to be acknowledged anywhere and valid enough to explain my coming here, it all seems so utterly ridiculous. I looked furtively out of the corner of my eye at the people I met here, expecting them to betray their shame or their queerness, only to discover that I often could not distinguish the patients from the physicians, or from other visitors. I suppose it is such a commonplace experience to you that you cannot realize how startling that is to a naive layman, like myself, even one who thinks he has read a little and laid aside some of the provincialism and prejudice which to some extent blind us all. I see how there is something emotional in it; if the patient feels only depressed or guilty or confused, then one looks upon his consulting the psychiatrist as a disgraceful recourse; but if some of the symptoms take form in one of the bodily organs, all the shame vanishes. There is no sense to it, but that's how it is. I have written a dozen letters to tell people where I am, the very people from whom in the past six months I have tried to conceal my need of this."[[2]]
[[2]] Karl A. Menninger, Man Against Himself (New York: Harcourt, Brace and Company, 1938), pp. 455-456.