Staff Perspective: Patients Recording Sessions – Anxiety All Around

Staff Perspective: Patients Recording Sessions – Anxiety All Around

For many decades, people have been able to record each other in secret.  Every so often, this fact flairs up anxiety for one group of people or another.  But recent events in the DoD around this issue made me wonder if the anxiety has somehow changed as I noticed my personal anxiety over the issue was different.

A few months ago, I was in a department administrative meeting when a provider brought up the recent secret recordings patients made during behavioral health sessions within the DoD. The first related to the NPR report from October 2015, where a military patient secretly recorded sessions with his mental health providers, resulting in an investigation and charges of professional misconduct (for the full report, go to  A second was an audio recording a patient’s wife posted on YouTube, involving a substance abuse counselor at the post I work at ( The cases were very different from each other, but they both involved the same scenarios where patients or family members covertly recorded the therapists during sessions, then gave this information to others. 

When the provider in the meeting mentioned these cases and the possibility of developing a policy where patients are not allowed to secretly record session, an interesting debate broke out around the table, with people talking both in support of and against then equally changing their minds.  While watching this, I sat back and thought, “How are my own arguments on both sides of this issue so strong?  And where is my anxiety coming from?” 

In the first recording case above, the patient may rightfully have recorded problematic care that needed to be addressed, and the only true way to discover this might have been through covert recording.  Is this something I may have done as a patient?  Possibly, if I felt there was no other way to uncover what was truly happening.  Would I have felt I was disrespecting the professionals I was recording?  Yes, but in that particular case I may have already been feeling disrespected as their patient. 

In the second recording case above, I found it interesting that the professional, in my opinion, was actually vindicated in what she was saying and proven to be following not only the law and military regulations, but assertively protecting her patient’s right to confidentiality.

So again, I’m left feeling puzzled as a professional who wants to be respected and feel comfortable with patients, but also as a citizen and patient who wants to be able to protect myself.

As I’ve spoken with other providers and continued to self-reflect on the issue, the following topics keep coming up:

  • If we as providers are doing what is right and ethical, why would we be concerned about being recorded?
  • Patients have the right to record, don’t they?  Actually, this depends on the state.  Texas law, for example, allows covert recording as long as one person, such as the patient, knows it is happening.
  • Providers have the right to feel respected.  Those I’ve talked to, myself included, indicated that covert recording would feel very disrespectful.  But these same providers also admitted that if a situation was genuinely created where the patient felt secret recording was necessary, something had gone wrong in the therapeutic relationship and/or the patient may have reason to record.

The big topic of anxiety that kept coming up has to do with advancements in technology.  These days, people are able to cut and splice recordings together with relative ease and in a way that can misrepresent what truly happened.  The words “out of context” kept coming up, and I believe that is what makes current anxiety over this issue different.  Not only can a recording not reflect what happens in a full session, or series of sessions, but recordings can literally be pieced together to what the developer wants to be shown.  This is also a big issue for the legal people involved in this conversation.  What ends up being made public could be edited to the point of total misrepresentation and questionably bring up legal challenges.  Careers could be seriously damaged through such misrepresentation.

So I’m left feeling very conflicted.  I’m nervous about the idea that I can be secretly recorded.   Partly because technology has made it much easier for things to be taken out of context , and partly because I would feel disrespected and somewhat violated – the therapy room is supposed to be sacred space after all, and if I discovered I was being secretly recorded the trust relationship would feel broken.   But I’m also very uncomfortable with the fact that I feel the above nervousness.  I do believe that patients have a right to protect themselves against questionable medical/behavioral health practices, and this protection may mean they need to record what is happening.  In this way, problematic providers can be held more accountable for their actions. 

My personal hope is that patients will feel comfortable enough to address their dissatisfaction or concerns directly with their providers.  I hope providers create an environment where patients feel safe enough to tell us what they are concerned about, feel heard, and if there are still differences, feel there are other ways these can be resolved.  If a patient let me know ahead of time they were recording me, I would feel some anxiety, I think most people would when they know they are being recorded, but I don’t think I would feel disrespected or violated.  It WOULD prompt me to explore what about the therapy relationship was potentially in question, and hopefully work through these difficulties. 

However, I do acknowledge that hope does not always equal actuality.  There may be circumstances out there where patients should covertly record what is happening in order to ensure quality of care within our profession.  It is a sticky subject.  My challenge to providers and patients alike is to consider both sides of this issue and have a better idea where the line is on the issue of it being right for covert recordings and when it is wrong, and to notice the large grey area in between.

Dr. Debra Nofziger is a Deployment Behavioral Health Psychologist with the Center for Deployment Psychology.  She currently holds the CDP position at Brooke Army Medical Center in San Antonio Texas.