Help me find out what my shrink really thinks.

January 31, 2011 6:27 PM

I'm going to be requesting my psychiatric records; what should I know beforehand?

I understand that under HIPAA (I'm in the US) I don't have the right to see therapy notes and that my doctor may refuse me access to other records on the grounds that seeing them would be harmful to me. The details of how this works in practice are fuzzy to me.

I suspect my pdoc is not going to be super eager to turn my records over. I'd appreciate accounts of how this works in practice. Have you made a similar request? How did it go? Were you able to see your case write-up or just bare bones diagnosis information, etc.? Did you have to appeal?

posted by reren to health & fitness (6 answers total)

I asked my therapist if I could see my notes from first session -- he read them to me and we talked about it. I'm not sure what would have happened if I had asked to see them again - I was satisfied with him just reading them aloud.
posted by sweetkid at 6:39 PM on January 31, 2011

I can't really tell you how this works in practice because I've never actually had to do it, but the ethics of the counseling profession state that you just don't hand someone a copy of their records without discussing them. The preferred, ethical approach is to read and discuss together so that the patient understands them. This is especially true for any assessment results that requires trained interpretation. For medicine management notes, they will probably be short and not a complete narrative...mainly just a quick review of symptoms and side effects. Therapy notes will tend to be more narrative...topics that you discussed, behaviors observed by the therapist ("Client appeared anxious when talking about the abuse, evidenced by twisting his hands and fidgiting in the chair"). Each therapist will have their own style for record keeping. Inpatient hospitalization notes will have at least one entry by direct care staff/nurse per shift that references what they observed you doing that shift (pt watched TV alone, appeared tearful several times, etc) plus an additional note for significant behaviors (pt became very angry at another pt and was asked to return to his room. Appeared to calm down and rejoined the group 10 min later). The main thing to keep in mind is that they are a therapists observation of you, along with what you talked about. They may interpret your behaviors differently than you do and record what they see. It doesn't mean they are wrong, which is why it's important to discuss records with the client so they understand the different viewpoint and how the therapist uses the records.
posted by MultiFaceted at 8:29 PM on January 31, 2011

Not directly about how you get to see the notes, but: plan a different activity to take place directly afterward, and in company with someone else. Whatever else happens, you are going to be reading something written about yourself at what is likely to be a painful stage in your life. Plus, depending on why you want to read them in the first place, you might be confronted with observations and conclusions about you and your behaviour that you disagree with, and might find hurtful or even offensive. This is not going to be comfortable reading, and will probably stir up unpleasant feelings and thoughts. Anticipate that, and arrange to have something else fun and distracting to do afterwards to help you decompress and recover.
posted by talitha_kumi at 8:55 AM on February 1, 2011 [1 favorite]

Check the website for your state's Department of Mental Health (it might have a different name) to see if they post laws/ regulations about this.

For instance, here are New York's. It outlines what records can be requested and how to appeal when a records request is denied... maybe your state has a similar guide.

If this is very important to you and you expect it to be an ordeal, you might try talking to someone at your state NAMI office about your legal options.
posted by Sifleandollie at 11:26 AM on February 1, 2011

Thanks for the answers! They've all helped me get perspective on how this might go. I appreciate it immensely. I'll come back with an update when I get my info, though that might be a while.
posted by reren at 6:18 AM on February 3, 2011

I have gotten and read my complete psychiatric records. I've written a description of the experience, since there doesn't seem to be a wealth of information on this topic.

1) Requesting my records
I did meet with some resistance from my treators, though not as much as I had expected. My request was seen as unusual and greeted with some uneasiness. In some cases, I was met with immediate agreement. In others, I had to insist that I knew getting my records was my right and that I was confident that I could handle the information my file contained. Knowing the law was helpful. The people who had my charts were concerned that I could comprehend the technical information my chart contained and that I could handle seeing my experience recounted in bald, unflattering language. They mentioned hearing of cases in which patients committed suicide after reading their files.

2) Getting my records
In one instance, I was given the records with few preliminaries (once they were convinced I could handle having them). With my current treator, there was a lot of discussion about my expectations and aspects he wished to clarify.

3) Reading my records
I didn't do anything special to prepare to read the notes, or need extra emotional support afterward. I did not find much that was disturbing or surprising. In some ways it was rather like reading a diary of my worst days, written by someone else. Though the forms were repetitive, being able to view myself through another's eyes was fascinating. More practically, I came away with a better understanding of my treators' approaches, the course of my sickness and my diagnoses. There were instances when I disagreed with the description, and reading about my worst times was saddening, but overall it was a valuable experience.

Requesting your psychiatric records isn't for everybody, I'm sure. But I would encourage anyone anyone with a history of mental illness who is interested to seek out their records, if they feel they could withstand the experience. In my experience, it can be highly enlightening.
posted by reren at 8:18 PM on August 19, 2011