Psychotherapist-Patient Privilege, Recordkeeping, and Maintaining Psychotherapy Case Notes in Professional Practice: The Need for Ethical and Policy Reform Confidentialité Des Communications Psychothérapeute-Patient, Tenue Des Dossiers et Des Notes De Cas De Psychothérapie Dans le Cadre De L'exercice Professionnel : Nécessité D'une Réforme Déontologique et Politique

[EDITOR'S NOTE: The views expressed in this article are solely those of the author, who is providing a critique of current note taking practices. Many if not most bodies that regulate professional counselling and psychology would not recommend the keeping of two sets of notes for clients.]In a recent article advocating for best standards of recordkeeping practices for psychologists in Canada, Taryn Bemister and Keith Dobson (2011) provided a broad overview of the ethical and legal parameters of recordkeeping facing contemporary psychologists and offered many viable recommendations. They promoted and advanced a professional space for important dialogue and debate, and their contributions may have tangible impacts on policy issues governing best standards of practice. They advised all practicing psychologists to thoroughly record every major transaction that occurs between the patient and clinician and include this in the patient's file. This recommendation includes everything from phone calls to e-mail correspondence, text messages, and, when appropriate, the intimate (and potentially graphic) details of disclosures and confessions made in the sanctity of the consulting room at the discretion of the clinician, especially if they find such material relevant. All of this, they professed, should be put in the official file.They also advocated that clients should be allowed (and even encouraged) to examine the psychologist's case notes, including current process notes in the session (see Bemister & Dobson, 2011, 2012), which they argue are a patient's legal and ethical right. I have challenged these recommendations because they place the client's privacy and confidentiality at risk, do not protect the patient from thirdparty exploitation, and unnecessarily compromise the therapeutic relationship (Miills, 2012). Instead, I urge the profession to adopt a different perspective with regards to recordkeeping that places the patient's best interests and the therapeutic framework above legal paranoia. Given that Bemister and Dobson's (2011, 2012) recommendations have real consequences for mental health professionals in private or independent practice, the fate of professional policy is at stake.Throughout this article, I will point out various ethical and legal conundrums I have experienced in private practice with regards to recordkeeping and offer a set of suggested guidelines for mental health practitioners united in a common goal of optimally helping their clients. Although therapists of all kinds and from different backgrounds may find this project of value, many of the orienting principles I address may apply to psychotherapists, counsellors, social workers, and psychologists who have a diverse breadth and scope of practice and thus offer multiple clinical services to the public. Therefore, many of the issues discussed here are aimed at the general mental health practitioner.CONFIDENTIALITY AND THE DISCLOSURE OF RECORDSThe concern over patient confidentiality, protecting the integrity of the therapeutic encounter, and professional autonomy in recordkeeping within ethical and legal contexts has been intensely discussed within psychoanalysis for more than a decade. We largely owe this debt of gratitude to two Canadians, psychologist and psychoanalyst Allannah Furlong and psychoanalyst Charles Levin, who have advocated for preserving the inviolability of confidential therapeutic relationships (Koggel, Furlong, & Levin, 2003; Levin, Furlong, & O'Neil, 2003), thereby stimulating noteworthy discussions on ethical and legal reform for therapeutic practitioners and patient rights (Des Rosiers, 2003). Various clinicians have been concerned with the invasion of patient and therapist privacy for some time, especially with regards to the betrayal of confidentiality (Bollas & Sundelson, 1995; Cordess, 2000; Garvey & Layton, 2004; Levin, 2003), and thus see an urgent need to institute an ethical practice model (Fisher, 2008). …

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