Tag Archives: Hipaa

DBT Summary Letter

This is a follow up to my post “A roadbump while looking for records”. You should read that first.

I googled the office address of the DBT therapist that I got off of his website. I found the therapist who moved into his office after him. I figured it was a long shot, but called her anyway.

She got back to me promptly and was very kind and apologetic, she said that she didn’t know how to contact him.
But then the next day I got a voicemail message from the DBT therapist. Apparently she had found a way to get in contact with him. He didn’t leave a number in the message, but said he would call again to try to reach me later.

I waited a bit over 2 weeks without a call back from him. I had no phone number to call him at. I called back the therapist who had moved into his old office and left her a message. Shortly after, I got a call from the DBT therapist. I wasn’t able to get him to agree to send full records (not a surprise) but he agreed to send a summary letter.

Finally I got a letter from him in the mail. No return address listed. I think he must not be practicing right now, because I never got a contact phone number for him and the letter doesn’t even have an office address as a heading or footer. Also, after speaking with him he took down the entire website with his outdated contact information.

I scanned the letter and put it up here. Edited out some identifying bits.

The envelope was post marked April 9th. So it took over a month from when I started at the end of February trying to contact him to when I got the letter in the mail.

This was probably the most work I have gone through to get any records and the least fulfilling.

It reads mostly like a textbook explanation of DBT. So little of the content of the letter feels specific to me.
I got a kick out of the bit where he wrote “We discovered several vital functions and reinforcing properties of her self harm..” as if I hadn’t already had an understanding of these before meeting him.

I realize 12 sessions is not a huge number of sessions, but I don’t think it is an insignificant number either. I get the feeling reading the letter and based on our no-pleasantries-exchanged-phone-conversation that he didn’t remember me and struggled to write the letter based on a few scribbles in a notepad.

I was most interested in how he would describe terminating the treatment.
He kept telling me that I needed to call him if I was going to cut. If I couldn’t agree to call him then he told me we couldn’t meet any more.

Phone anxiety aside (This has gotten better over the years, but never completely gone), I didn’t want to do this because it is hard for me to judge if I am going to cut in a situation or not. I don’t really know if I’m going to cut until I’ve done it. I think about cutting a lot. Only a very small percentage of the time do I act on it. If I called him and then did not cut after the phone call (even though the purpose of speaking to him was to help me avoid cutting) I would have felt guilty for making the phone call. If I didn’t cut then, I would have bothered him for no reason. I’d have worried I had called him during a time when I wasn’t going to cut anyways. I probably would have half-heartedly made a small injury to ease my guilt.
His request for me to phone him would actually increase my self injury rather than decrease it. And I’m fine with my self-injury in general (I was pressured into going to the DBT and was very ambivalent about it) but that doesn’t mean I want to intentionally enter into a situation that will needlessly increase it.
I’m not sure how well I articulated that to him. I’m better at expressing some of these things now, because my meta-cognition has further developed.

Whatever the reason, he doesn’t appear to have understood my objection to the phone calls. Still I had often wondered if he realized he messed up when he told me ‘phone calls or no therapy’. I imagine he thought the ultimatum would get me to fall in line with his rules, but it backfired and I left.
His letter reads as if it were more of a mutual agreement, instead of a “do this or leave” command.
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Would people be interested in more posts like this where I post some of my records with comments? I have a few other topics I want to talk about here first, but if people are interested, I can also do more like this one later.

A roadbump while looking for records

Last week I was speaking in therapy about the therapy I had been in during high school, this included my experience with DBT.
It inspired me to google my DBT therapist. I found his website. He’s moved to a new location very far from where I met with him.
I looked at the list of articles he’s written. There was one on psychodynamic therapy. That threw me off. Nothing about the time I met with him would have led me to guess that. It somehow made me vilify him less, because now the possibility exists that we might have some similar theoretical views.
It’s strange though because everything else on his page is about DBT and CBT, all but this one out of place psychodynamic article.

I decided to read the psychodynamic article.
Looking at the abstract I realize, “I think I’ve read something else that cited something similar”.
I continued reading, “No. I’ve definitely read something else that cited this exact study.”
It only took looking up two recently-ish read articles to find the one I was thinking of.

I’d had this other article folded open on my desk for weeks to the page he’s cited on and not had a clue.
I had that particular page open, because I’d highlighted some interesting quotes. I’d been thinking of writing about it here. I feel the quotes address the key problems I had in DBT.
The highlighted quotes had nothing to do with his contribution to the article, but what a strange coincidence that he would be on the same page.

I decided I want to contact him for my records. The idea is in my head. I’m stubborn and don’t want to let go of the idea once it is there.

As I’ve mentioned before, I am collecting my psych records bit by bit. It started as a effort to get closure with the therapist who kicked me out of school and then spread to all my other treatments as well.

Private practice records are harder to obtain, so I have fewer of those, but gathering as many as I can is a project I pick up from time to time.

I called the number on his website. It was disconnected. Maybe I dialed wrong, I tried again and again and again. Definitely disconnected.

Double checked the website, looks like it may not have been updated since 2008.

I checked the whois info, but it was set to private via a third party.

After some debate, I decided to send an email. Less than ideal for this situation, but I included my phone number and address so he could contact me.
I don’t have anyway of knowing if he still actively checks this email address. It is associated with his domain name and if he’s not updated the website enough to fix his phone number, I have doubts that he would also check the email.

The next day I received two phone calls from a “withheld” number. They didn’t leave a message and I was unable to answer at the time. I wondered if it was him. I’ve been waiting since then to see if this “withheld” number will call again, but they haven’t. I’ve been kicking myself mentally for not excusing myself to answer the phone.

I decided to pursue other options, while waiting.

I looked up his lisence. It’s active and was renewed in Jan 2010, so I know he didn’t just decide to stop practicing.

I called a former employer to ask if they knew a way to contact him. They didn’t.

I called his state license organization to see if they could help. They had information, but couldn’t disclose it due to privacy reasons. Understandable.

I called ABCT(his website said he’s a member). They said that for $54 I could join and gain access to their member database which maybe had the information I was looking for, but couldn’t guarantee.

I realized I could look in the APA member database for him. I ran a search. He showed up, but I received a notice saying “This Member has opted not to publish information in the directory”.

I’ve google searched his name and location in every imaginable combination, including yellow page searches. I only find his old office and the new number that is disconnected.

I googled for obituaries to make sure he’s not dead. Nothing came up, so I assume he is alive.

I’m tempted to send him another email asking if the “withheld” number was him and if so apologizing for not answering and then listing times I am more available to answer the phone. But I don’t feel confident enough that it was him. I have a guess of someone else it might be. If it was him why wouldn’t he send me an email saying he’d tried to reach me by phone unsuccessfully?

It’s funny. A reason I left was because he wanted me to call him whenever I was going to cut. I objected. He said he couldn’t meet with me if I couldn’t agree to that. Now here I am trying to find a way to phone him.

Besides sending him another email, I am out of ideas.
It’s a strange situation. I have a right to my records, but what is one to do when the person holding the records is unreachable?

24 hours

It’s scary how fast things change.

A month ago I was having a perfectly fine uneventful day. It was the last day of my week off before school started. I was feeling wonderfully relaxed.

Then I checked my mail. I’d previously requested my records from a partial hospital program I had been to several years ago. They’d arrived. I wanted them more for my obsession with recording keeping and possessing anything anyone has ever  written about me and storing it in my filing cabinet than anything else. There was some curiosity about how they would write about the part where I was forced to take off my pants despite clearly refusing, but mostly I planed to skim through it and file it away.

First couple of pages, nothing too exciting.

Third page. “Hey! They got my age wrong. Typical.”

I read more. “Wait a second. I don’t have schizophrenia. ” I looked at the top of the page. It had someone else’s name on it. It wasn’t about me. There were 3 pages of someone else’s records in the middle of my stapled packet.

To say I was not pleased would be a major understatement.

Confidentiality is a major hot button issue for me. If they were careless with this person’s info maybe they were or will be careless with mine?

I work very hard to keep my privacy. I don’t have any close friends and especially not at school. I can’t trust anyone. If someone gets too close they might find out how crazy I am and somehow that will lead to my school finding out, because no one can keep a secret and that will lead to me getting kicked out of school again. I know it’s paranoid, but I have to protect myself. No one else will.

This reactivated and exacerbated all of my fears about my privacy being violated, anger towards health professionals who have been sloppy with confidentiality in the past, anger towards people who have used my personal information against me. I had just an overall sense of powerlessness, anger and feeling overwhelmed. I can’t put it into words that do it justice so I’m just going to stop trying. Point is I was extremely upset. I’m getting teary now a month later writing about it.

It took less than 24 hours for me to fall apart. The day after getting the letter I called the hospital. It took talking to 3 people at the hospital to get someone who understood what it meant when I said “HIPAA Violation”. One person said “Hippo Violation?” and tried to transfer me to security. No joke. Class act they’re running. They fed me a “We’re taking this seriously” line.

I was having cycling panic attacks. I’d taken my maximum daily dose of klonopin and it felt like I hadn’t taken a thing.

So what next? Clearly the logical step is to take a bunch of painkillers, right? Of course. So I did that.

And well I had a box of nicotine patches I’d been hanging onto for over a year just this sort of occasion. I’d thought about throwing them out before, lucky for me I still had them. I put all of them on from the previously unopened-box.

I lay down in my bed for awhile. I’m not sure how long, maybe an hour. I decided I’d made some bad decisions. I took off the patches and made myself vomit up as much as I could. I was extremely dizzy. I realized I had no mouthwash. I zig-zagged my way over to the store to buy some. Came back, vomited some more (this time without the help of fingers).

I felt significantly calmer once the dominant problem shifted from emotional to physical. I went to sleep for the night. I was still a mess for the following 2 weeks,but that first 24 hours was the worst part of it.

It is terrifying to look back and see how quickly things escalated. At the time it felt like much longer than a day. It’s scary to know that no matter no stable I am for how long these things can still happen out of nowhere. I’m always at risk that one day I could be fine the next I might kill myself.

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This is the end of the post, but here’s some more writing anyway. I didn’t want to get bogged down with extraneous information that isn’t about the point of the post, but here some is.  I didn’t want this swept under the rug. I wanted to throw everything at them and not let them get away with it. I called more lawyers than I could keep count of and each kept referring me to another lawyer. I kept calling them until I reached one who never returned my call. A lot of this lawyer-calling was more related to my past school issues than my present issue. I was extremely lenient with my school. I could have been significantly more aggressive, but opted for gentler methods because I wanted to preserve my relationship with the school.

Ultimately it turned out that part of the other person’s file had been put in my folder my the social worker who had done both of our intakes. None of my pages were missing from the file (or so they tell me). They said they’d “talk” to the social worker. So wrist slapping, basically. I get it mistakes happen, but these mistakes can have big consequences.

Oh yes I should have gone to the hospital. Blah, blah, blah. Don’t anyone dare lecture me. I’d have gladly gone to get checked out physically  at the point where I’d vomited things up. But I didn’t want to be trapped there and risk messing up another semester of school. I know okay, priorities, maybe ours are not the same. School trumps physical health. And also wasn’t exactly feeling very trusting about hospital’s abilities to keep my confidentiality so no way was I going to risk telling them more information.