When you do therapy with me, my trainers, interns, other causal therapists or any other therapist, for that matter, you are entitled to confidentiality. Our licensing requires it. Causal therapists, especially, wish to provide it.
Limits to Confidentiality
Nevertheless, there are limits to the confidentiality I offer. If you have shared with me that you or someone you know has abused, neglected or exploited a dependent adult, an elderly person or a child in your care or if you have failed to protect a helpless person in your care I am mandated by my licensing board to report. If I report “against” you, you are welcome to sit with me in the process. Further, if you lose custody of your child as a result of my report, I pledge to you that I will work extra hard to help you become the best parent you can be and to heal the hurt in your own childhood which led you to abuse or neglect your child. Additionally, I will document your growth for you, so that earning your child back is effective.
Additionally, you cannot express to me intentions to hurt someone, including yourself, for I am mandated to take the steps necessary to protect whoever is at risk.
Limits to Secrecy
On the other hand, if you are in couples counseling, I ask you to understand that there is a “No Secrets Agreement” which protects both parties. Even though there may be appropriate times for an exception to this rule, this is an agreement we all make together.
On some occasions I have agreed to keep a secret from a spouse who was in couples counseling. The criteria I would use then to keep a confidence confidential, is (1) it appears that there is too little gained by revealing it and (2) it may be more harmful to reveal it than helpful.
If you saddle me with a secret, insisting on confidentiality despite our No Secrets Agreement, I may choose to honor your request. If I believe the lack of information puts your partner at a major disadvantage in the relationship (i.e. you are having an affair and intend to continue, knowing this would be devastating to him or her), then I will have to release myself from treating you as a couple, because by continuing, you are not investing in the relationship or in honoring the No Secrets Agreement, and by continuing with you I am betraying your partner along with you when I keep your secret. If, in my professional opinion, your secret puts your partner at risk (i.e. a communicable disease), then I will give you a choice between you telling your partner or me.
If you participate in the Relationship Skills Workshop, you are not guaranteed confidentiality. However, all members of the group in which you belong will have been asked to honor confidentiality. They will be allowed to discuss their experiences in the workshop with others, but they are simply not allowed to reveal names, and if they do so, they agree to hear out the group’s disappointment, member by member. You will not be allowed to saddle another member of the group with a secret that they cannot share with the group, if it pertains to the group process. If you reveal information about a member of the group such that it becomes public information you may be exiled from the group and from PaRC, as well.
A Time for Secrecy
There is a time for secrecy. For example, if the truth will cause harm to an innocent person, it is moral and ethical to keep a secret and unethical to tell anyone who would expose the party needing such protection. If you are hiding Jews in your attic to protect them from Nazis taking them away, you must vigilantly maintain your secret.
If I am treating someone for kleptomania, it is important that she have the safety of confidentiality. She will need to freely discuss all her drives to steal in order to heal. In this case secrecy will lead to an open and healthy lifestyle some day. Confidentiality is necessary to get her there.
Not only that, but I would also need to keep a bank heist or even a murder a secret if I am treating someone who has no further plans to kill and wants treatment to insure he will not kill again. Confidentiality is necessary to do this work.
On the Table from Therapist to Patient
While it is incumbent upon your therapist to keep your sessions confidential, this therapist does not want you to consider confidentiality an approval of secrecy as an ethic or a lifestyle.
As a therapist and a person who places a strong value on ethics, I believe that we should not be allowed to get away with dishonorable behavior. That does not mean I have a thirst to punish or to see punishment take place. I have not. As a matter of fact, I consider the drive to judge and punish a possible symptom of an illness. I believe reality provides plenty of natural consequences, which are wonderfully configured to force us naturally to self-correct. When a dependent person is at risk, it is incumbent upon us to tell.
In other cases secrecy allows us to be someone who we are not. Living in secrecy protects us from the natural consequences of our behavior and enables us to continue behaving in ways that are damaging to ourselves, our relationships, and to others.
Unburdening without Consequences
Secrecy is often designed to allow someone to unburden their heavy conscience while avoiding the natural consequences of their misdeed. Often the notion of loyalty is coupled with secrecy to further protect someone from the consequences of their actions. The secret may be shared to lighten the load. In this way intimacy is launched and loyalty is consecrated with a “promise-not-to-tell” and then this pact is finalized by a threat of emotional blackmail. Nevertheless, the ‘holder’ of this secret now has to find someone else upon whom he can unburden his load. And “Oh! What a tangled web we weave when we conspire to deceive” [Shakespeare].
Covering a Crime against Dependent Persons
Dependent persons would be children, the mentally retarded, physically disabled and elderly in the care of another adult, and patients or clients in the care of therapists, doctors and counselors. In all of these circumstances one person is the designated protector and guide, while the other is the designated dependent and student. Just as parental rights can be a cover for abuse and neglect, confidentiality can be a cover for the therapist more than the client, and sometimes the cover-up is for criminal behavior.
As much as natural consequences tend to ultimately teach us lessons for bad choices, when that behavior is actually a crime or puts weaker people in jeopardy, then secrecy is unethical and constitutes conspiracy. I say this harshly, because there is a time to tell. For example, if an adult is molesting a child and swears another adult to secrecy, keeping that secret implicates the secret keeper as a co-conspirator. That child and future children would be protected were the secret out. Any conspiracy to protect a criminal act against helpless or dependent persons is wrong, if not evil. Further, where there is the capacity for one criminal act there is a probability of past and future ones, unless the perpetrator is exposed and identified.
A sin worse than abuse is repression. Repression deprives a victim of the opportunity to recover. This is classically when the victim herself is asked or told not to tell by her offender or her offender’s supporters. She has been asked to put her offender’s wishes above her own needs. Most of these clients have complied for some period of time. In these cases, the client was not only the victim, but now she has been forbidden to work through her traumatic experience in deference to someone who doesn’t deserve such a sacrifice. The injury is now compounded since the victim has been further violated by the request that she keep the improper secret, herself, to protect her offender.
Ironically, the victim often thinks that protecting their offender has some nobility to it. I am proposing that protecting abusive people is unethical. No matter how innocent one is of injuring others, it is unethical not to report abuse of an innocent person, even if that person is yourself.
Healers are in a parental and care giving role with weaker or dependent persons. I have known situations in which the doctor was seduced by a patient, and succumbed, which is as outrageous as a parent blaming his child for seducing her. However, the person who has the power to determine events, such as the therapist/doctor/counselor/clergy is always the responsible party, just as the parent or adult is always the responsible party. Some therapists who have exploited their client(s) actually blame the weaker party for seducing them, even though she took the training for her profession to include ethics, agreed to the licensing requirements and now holds the position of authority. She becomes honor-bound to provide a healthy and moral compass. When one becomes an authority, the copout that the child or the patient “made me do it,” is inexcusable. The child is still in training, and the patient is a patient because she does not yet know how to represent herself and is often still predisposed to sacrifice her own needs for those of parents or authority figures. She may have wrongly learned that to ingratiate herself to someone in authority makes her safer or more valuable. This is especially the case when she is the weaker party and so may be prone to act out childhood experiences in the context of treatment.
Mental health is always threatened by secrecy of this magnitude and cannot survive bad ethics. Saddling a child or a patient with a secret inflicts further injury by truncating the opportunity to heal and rebound. The capacity to work through childhood issues such as sexual abuse, addiction, parental weakness, unethical role modeling, exploitation, parentification (taking care of the parent) and family secrets, has now been compromised. The client or patient now has been forced into carrying a secret to protect her therapist, parent, priest/rabbi/pastor, mate or boss against her own interests.
All of this is to say that our mental health and that of those around us depends upon whistleblowers. Whistleblowers are the guardians of society, and secret keepers (even the victims) are our weakest link. I am a mandated reporter against dependent abuse and victims of sexual exploitation. Those of us in the helping professions are the definitive reporters. However, when it comes to sexual relations between a therapist and a client, unfortunately we cannot report for you. All of us need you to step up when the time comes. Doing so will promote your mental health.
Protecting a False Image
Sometimes secrecy protects a false image. A healthy life is one lived where truth can be put on the table, and life can be lived in the open. In other words, if you don’t want anyone to know you’re an alcoholic, you need to give up drinking. If you don’t want anyone to know you’re a kleptomaniac, you need to give up stealing. If you don’t want someone to know you’re unfaithful to your mate you best not be unfaithful or get a divorce. Therapy will help you get to the drives or choices that led to your infidelity, but it should also look at the values that allowed you to practice ignoble behavior for so long. Most likely you will identify poor role modeling.
If you have a husband who will lie to the boss for you when you have a hangover, you need to free him from lying for you. When nature becomes our natural adviser, we do our best growing. If you were in couples counseling, I might personally advise your mate to stop protecting you. I’d suggest that you call for yourself and perhaps say, “George, I’m going to either come into work with a hangover or I’m going right now to find an AA meeting, which do you prefer? Odds are, you will not be fired. Living life “out of the truth” only gets you in deeper. Living life in the truth gets you stronger faster and earns you real respect to replace the false respect you have been seeking.
Lives lived in fear that someone will learn a truth and then reject you are often liberated in the process of therapy. Sometimes it starts with telling the therapist your secret and ends with you telling the truth and dealing with the fallout. Sometimes the fallout turns out to be nothing after all. Sometimes the fallout forces you to self-correct and to grow. Sometimes the fallout is compassion that you have carried so much for so long for so little reason. Sometimes the fallout is to discover that most of us have pasts, and when you shared yours they were inspired to share theirs in return. Sometimes we discover our own character and the true character of others when we share a secret. Sometimes it is revealed to us with who we should be in relationship and who we should let go. Sometimes we learn what we need to do to make amends. Sometimes we simply discover the intimacy of sharing without burdening the other with a secret. Most of us develop a taste for relationships that include forgiveness for the sake of growth.
Commiserating with Denial
Many of us hustle others to hear the “truth” we want to hear. Once I was a matchmaker for a dating business. The sales department, either having no scruples or no vision, sold a package to a woman who was about 5'5" tall and who weighed about 300 pounds. I could not provide a date for her without deceiving other paying clients. I finally decided to confront her with the truth.
“Delilah” (the name is changed), I said, “You have so many wonderful traits. There must be many people who would love to know you. I could match you up with some people you might enjoy, except for one problem…”
I paused at this point. I always paused at this point, because if I’m about to tell someone something they’d rather not hear, I prefer it be their choice. Hopefully they will take this opportunity to own the problem aloud.
“What’s that?” Delilah asked.
“Your weight,” I responded, a bit disappointed that she didn’t seize the moment of truth. “Most people would have difficulty with your weight.”
“What’s wrong with my weight?!” she demanded. I was caught by surprise. I didn’t expect this, because I was sure she knew what I meant. I decided to follow with an estimate of how many pounds she might be over weight, and I proposed that she was at about double what a healthy weight would be. Before I could say, “You’re about double a healthy weight,” she spoke again.
“There is nothing wrong with my weight. I don’t know anybody who thinks there is anything wrong with my weight.”
“Well, I’ll tell you what,” I suggested. “You ask ten people among your family and friends what they think, and then we’ll talk again.”
Delilah called me the next day. She had spoken to ten people who were amongst her family and friends and, additionally, ten strangers out in front of Ralph’s Grocery Store. All of them had agreed with her that there is nothing wrong with her weight! I can picture it now. I can see an obese woman asking strangers in front of Ralph’s, “Is there anything wrong with my weight?”
“No,” they’d say, passing by her, not wanting to get into it and getting on with their business. The lesson is this: If asked the right way, we can get just about anyone to agree with us about nearly anything. That’s how denial can work for so long. How you ask the question telegraphs how honest an answer you seek.
Some people brought up in dishonesty believe you’re supposed to lie to protect people’s feelings. One woman told me she confronted her mother about how she’d never been told the truth about things growing up and how every conversation they’d had was superficial. Nobody was allowed to tell the truth about their feelings, and they couldn’t even tell the truth to each other about the littlest things. Her mother replied, “That’s a social skill, honey. You’re not supposed to tell people the truth. It hurts people’s feelings.” The woman asked her mother back, “Do you have any idea how much it’s hurt me all these years to never have a real conversation with you and to never know how you really felt about me or what you really thought? Do you really believe I can’t handle a little pain now and then in order to know what the truth is?”
Some of us learn in early childhood, “If you don’t have anything nice to say, don’t say it.” We learn to be good little positive thinkers for our parent’s sake. Some of us even learn in infancy not to cry because it upsets our parents too much. As a matter of fact, hiding negative feelings becomes an ingrained and primitive talent that is predicated upon survival, and if anyone moves to challenge our airs we may reflexively snap back like a cornered dog. Hiding negative feelings leads to an inauthentic personality, which conceals a lifetime’s worth of buried fear, hurt and anger. Having become so fake, we secretly believe way down inside that we are not good, that we are, in fact, frauds. We may actually believe if we ever explore the truth of who we are, it will be discovered that we are inherently bad or unlovable. So, at our core, underneath all our upbeat attempts to be positive, we may be hiding a deep depression for our parents’ sake. To heal this drive to be deceptive about ourselves lest people judge us, we have to decide whether or not we are willing to secretly betray our parents in the confidentiality of therapy so that we can finally live an authentic life in the world.
Sometimes we worry that if we say something that brings up painful feelings we will be blamed or responsible for retractions or making it better. All these assumptions are born of childhood messages to us that we shouldn’t express feelings or that truthful information will make our parents uncomfortable about themselves or cause them to feel betrayed by us.
So much concern for the feelings of others turns out to be a fear that the other person will get mad at us. We’re really worried for ourselves. We don’t like to feel someone’s negative feelings, especially if they’re directed at us. Perhaps we don’t know what to do. Are we supposed to fend it off, defend, or avoid it? We really are simply supposed to allow the other person to express themselves, if only briefly. It won’t hurt us. We would do well to say, “I’m so glad you could tell me how you feel.” Perhaps we can say, “Thank you for your honesty. I will consider what you have said.” Most of us don’t realize that it simply won’t hurt and we can handle it. Handling it earns us respect and teaches others as well as ourselves to grow.
Hiding to Avoiding Authenticity
So much deception and secrecy is done in order to appear good. If people only knew how much those from whom they are hiding are also hiding, more of us would stop pretending life and start living for real. If they only understood how they were wasting so much of their one life pretending rather than being.
If you bring your spouse into therapy, you must understand and agree to the “no secrets policy” previously mentioned. That means that if I am forced to keep matters relevant to the marriage a secret, I may have to terminate work with you to avoid betrayal of your spouse when I have information that he deserves to know. This is perhaps the only way a therapist can remain ethical. Some people have been raised in a mire of deception and think nothing of asking professional secret keepers to join them. Nevertheless, when one understands that by keeping a secret for Millie, I am betraying the mental health of John, one can see that my only alternatives are to betray confidentiality (not an option), to terminate therapy, or to insist Millie either reveal her secret or quit her betrayal. Of course, the next therapist and the next will all have the same dilemma.
Thus, good therapists do not keep confidentiality comfortably at all times. If we had no problem with secrecy, no matter what the secret, and if we believed in a secrecy ethic, then we might be enablers of your pathology. It is not therapeutic to contribute to protecting your dysfunctional fears. A good therapist may push you to tell the truth or to even expose your unhealthy choices or habits. A good therapist may encourage you to share a burden with someone. A good therapist may ask you to take a look at your worst fears and to plan for various possibilities that might come with disclosures. A relationship group or group therapy is a safe place to begin, as long as the therapist can assure your safety and protection from misguided or mean-spirited feedback. Look for a group that has rules against judging others within the group and where understanding others in the room is the ultimate goal. In this case a therapist can evaluate and help you correct your coping mechanisms, too.
This does not mean that matters that may not be relevant to the health of the marriage must be brought out. Sometimes, it is important to determine what is relevant and necessary to communicate as well as what is irrelevant and unnecessary to say. For example, both parties may need to put on the table whether or not they had consenting sex with other adults before their marriage, but may not need to discuss with whom or how much, unless it’s truly relevant. If a mate was sexually abused in childhood and has not been treated for that abuse, it might be important material to share with a prospective mate or a spouse with whom sexual intimacy issues have developed. If the sexual abuse has been treated, it may not be relevant material to bring up. On the other hand, part of treating sexual abuse is removing the secrecy and repression ethic from the trauma. Part of treating sexual abuse is realizing you are not to blame and sharing your pain with others who will give you support and understanding, as well. Another part of healing sexual abuse is giving up the role of victim and finding the courage to make healthy choices and put unhealthy choices under scrutiny. Actually, I have never met a treated victim of sexual abuse who needed to continue their secrecy.
Secrecy is sometimes appropriate, but for the most part, a person who lives in secrets and keeps secrets from those with whom he frequently interacts is handicapping the relationship.
On the Table Between Therapist and Therapist
Please understand that I agree that confidentiality is an essential context for healing. My issue is that there is something pathological about the way some therapists wear it and represent it. I see therapist telegraphing the importance of keeping secrets so that the patient picks up on it. It can be an unhealthy message when we should be encouraging clients to live life so that they don’t need to keep secrets.
Perhaps it’s my imagination, but I keep running across evidence that confidentiality can become a life-style for therapists, even out of the frame, as well as a cover for our own inadequacies in the frame. Sometimes it appears to me that confidentiality has turned into a mandated blind spot. Other times it appears that those parts of us still in denial are attracted to confidentiality and we wear it as a comfortable cover. At this point in time, I dare say that confidentiality is more important to therapists than it is to clients, although I believe it should be defended and protected for those clients who really need it.
Narcissism seems to lie at the core of the excessive protection of confidentiality. Some of us become therapists to help others in order to get our identity needs met. When a young child learns he has to disguise his true feelings and observations to protect his parent’s feelings, then lack of authenticity is born as a personality disorder. The child learns to bury his pain and anger for his parent’s sake and to “put on a happy face”. He learns that “if you can’t say anything nice, don’t say it at all.” The child learns that he must be a positive mirror for their parents, and ultimately for the world, and that one should “forgive and forget” and “let the past be the past.” They learn that sometimes it’s not polite to tell the truth or that some truths should not be told or even that most people can’t handle the truth, especially parents and especially patients. Some grow up with this ethic. Others are revolted by the weakness of people and become chronically contemptuous of others, as well as honesty. Any of these can be maintained in the psychotherapeutic arena under the guise of confidentiality. Incompetence can be preserved the same way.
The untreated narcissistic therapist may still object to any material which “blames the parents” and could be inclined to help the patient reframe his or her anger away from the parent, a la behavioral theory or even toward the self, a la internal drive theory. A cognitive theorist may focus on positively thinking one’s way out of a depression rather than explore the acting out so as to uncover the scary original wounds. A behavioral theorist might look at a child who’s bouncing off the walls from repressing untold anger, hurt and fear for their parents, and diagnose them with ADHD. They might then refer the child for medication without even assessing the family system. The child will meet with a psychiatrist who will prescribe Ritalin or the like and return to a behaviorist while the parents will learn more modern state-of-the-art techniques for controlling and repressing the child.
All the contemporary variations on treating “bad seeds” rather than original wounds and their concomitant repressed feelings lead to a need for confidentiality, a la the confessional. Rather than learning to identify acting out as clear clues and communicators of original trauma, therapists often rush to modify the behavior while colluding to keep the ugly secrets. In this way we don’t have to unearth the ugly emotions underlying the behavior. In this way we don’t have to presuppose that behind the ugly behavior is an innocent child, perhaps now grown, and a damaged, untreated parent.
Sometimes, but not often, a high regard for secrecy is imperative. Sometimes what is more important is that the client who requires secrecy has confidence that their therapist is capable of protecting his or her privacy. Sometimes the secret needs to be aired so it can die in the therapist’s office. Sometimes, the client needs to feel safe enough to open up, and the only place they can do that is in therapy. Ultimately, however, a client is not healed if they leave therapy still believing in privacy and secrecy as a life-style.
When therapists look at confidentiality as more than privacy, they possibly telegraph shame to the patient. We need to be careful never to allow confidentiality to turn into a cloak for client shame or therapist inadequacies. We need to be certain that we not let the somewhat unnaturalness of the frame turn into a feeling which stigmatizes the client or casts him or her as an inferior person in our ambiance of mystified boundaries and superiority and our aura of aloofness and perfect appropriateness.
When the therapist looks at their patient as an innocent victim who only learned to cope in ways that would protect their parents, they don’t see the need for confidentiality or secrecy quite so clearly. The therapist is just trying to remove arrows from their patient’s soul by listening to that which can finally be told. Confidentiality should usually be looked at simply as a private sanctuary for working through forbidden thoughts and urges. As you can tell by this document, my clients are encouraged to be open about their lives, and they continue to surprise and delight me with their openness.
The trouble with confidentiality and narcissism is that they can conspire together in an iatrogenic sort of way to perpetuate pathology. There are certain myths they tend to authenticate:
- One should leave the therapy office feeling good.
- I am to blame (perhaps bad) for my mental illness (not my parents).
- Confidentiality implies I should keep my innermost self a secret.
- Secrecy is healthy and appropriate.
- Therapists should help me keep my secrets.
- One should not express anger and pain but rather should act nice in the real world, even if they don’t feel it.
- Pain should be avoided, because it’s hard for other people to take, even therapists.
- Therapy is about learning to mask the badness inside of me and learning to feel better or learning to be happy like everybody else (is acting).
- My life is nobody else’s business but mine.
- What I’m discussing should be a secret.
- Therapists are not only supposed to lack judgment, but they should be permissive and not invested in ethical behavior.
Case Studies and Personal Experiences in the Field
Mary decided to try therapy again because she was still lonely and rather afraid of people and of relationships. When her new therapist discussed participation in a relationship skills group as part of her treatment, she declined because too may people would know her business. When this therapist suggested that she needed to work on her fear of intimacy, she expressed surprised, because her last therapist had told her, “Well, you certainly have a right to your privacy.”
This therapist asked Mary what kinds of things she would be afraid people would find out about that she didn’t want anyone to know. She thought for a while and finally said, “It’s not about anything in particular, I’m just afraid that people will judge me if they know me.”
“Have you avoided relationships because you fear judgment? Have you thought that to be known is to be judged?” Mary thought a minute and answered “yes.”
“Perhaps you need to learn how to respond to someone’s judgments, and perhaps you need to learn how to avoid relationships with judgmental people, and finally, perhaps you could learn to give up being so judgmental, yourself. You need to know by what criteria one should decide who is safe for the long-term relationship and who is worthy of your openness.”
Judy’s mother died when she was a young child. She still appears wounded and vulnerable. She never got over it and entered therapy as a young woman. Her therapist was a woman and they worked together for years. Judy fell in love and became engaged. She asked her therapist if she would come to the wedding. Judy’s therapist told her something like this (and you've heard it before yourself): “Your confidentiality should be guarded at all costs. It wouldn’t be safe. This is what boundaries are for. You need to be protected at your wedding from awkward moments that come with socializing.” Judy still didn’t understand why it wouldn’t be safe to invite her therapist to her wedding. Her therapist further explained that maybe Judy might notice her talking to one of her friends. Maybe the friend might ask how she knew Judy. Maybe she might accidentally reveal their therapeutic relationship by being avoidant or maybe Judy would be wondering what her therapist was saying about her to other people.
I cannot be certain that this is what her therapist said to her, but I do know that this is what Judy at least inferred from what she said. If the therapist gave her the impression that she could not control what she might say, I believe that was a mistake. This is a person who has been trying to learn to trust. She needs the skills to know how to tell if a person is trustworthy and what to say or do when they fail to act trustworthy. If her own therapist can’t control what she might say about Judy, who can she trust? Her own therapist does not appreciate her own reasons for not going to the wedding. She is simply mimicking something she was taught was ethical. She failed to see that therapy is a corrective emotional experience and she could fill in the role of Judy’s mother at Judy’s wedding. Judy had suffered the profound loss of her mother as a child. It would have been meaningful for her therapist to be there. It might even have made Judy proud. She could have come to the wedding but not to the reception. Judy was not worried about confidentiality. She was not worried about what her therapist might say until her therapist told her that she should worry about it.
Josephine, a social worker
Josephine, a social worker, and Dr. Mario, a psychiatrist, taught analytic theory to graduate students in the field of psychology. They taught the material together and had a practice together, as well. They had different last names, so most of us didn’t think at first that they were married. At one point, a discussion on television talk shows developed, and they each expressed their disgust that people would open their lives up in public like that.
The last day of class, a student asked if they were married. One of them responded, while the other remained silent, “Why would you want to know?”
Confidentiality had become a lifestyle, or perhaps they were predisposed and attracted to the profession’s life-style of confidentiality. They had become people who lacked spontaneity and openness, so much so they verged on dishonesty and deception.
When the Caller I.D. gadgets came out
When the Caller I.D. gadgets came out, I received a mailer from one of the officers of a professional organization of therapists to which I belong. She was sounding the alarm against caller ID and suggested that therapists get their numbers blocked and advise all their clients to get their numbers blocked, as well. She went on to say that it part of our profession to recognize areas in which confidentiality might be violated, and technology has brought a new threat to privacy. As I thought about it, I wondered, excepting annoying solicitations, whom might I call that I wouldn’t want them to know who I am? I wondered what kind of person would make calls to me not wanting me to know their identity? Further, I wondered why I should not know who is calling me? Finally, I wondered if our mandate to confidentiality might make some of us paranoid or if any of us might even have taken up this profession to insulate ourselves from personal responsibility? I threw it in the trash, and I have regretted it since, as I’d love to quote it exactly.
Once, I had a famous client
Once, I had a famous client sitting in my reception room waiting with a few others for the rest of her group to arrive. An unknown face was waiting there as well. My very famous student inquired enthusiastically if he was going to be a new member of group. A few days later I got an irate call from my landlord regarding my patients violating the confidentiality of other patients by talking to them in the waiting room. I am guessing that it was the therapist, not the patient, who was upset, so upset as to not be clear that there is no confidentiality promised in the waiting room between patients. It’s up to them to set their own boundaries. I did, however, ask the members of my group not to talk to other people’s clients in the waiting room. What a shame.
On one occasion
On one occasion, we were taping the parenting class. I had a very large office, the largest in the suite to accommodate such classes. However, I had to share the waiting room and a common area, which led to five doors and offices. Since a number of my students were arriving, I had left the door open for a few minutes. One of the therapists shielded his client with his coat as he was leaving. He complained that having the door open for my group to come in was a violation of confidentiality for his clients. I wondered if I were just allowing one client to come into my office at the same time his client was coming or leaving, would he have still felt it necessary to shield his client with his coat.
When I was in graduate school
When I was in graduate school I was taking a class in “Supervision II.” Our professor told us that each of us was to bring in a dialogue from one of our sessions. We could tape record it or bring in a transcript. In this class of fourteen students, every student reported on their case study with a transcript. Each of them said they didn’t have any clients who agreed to being recorded. Remarkably, all of my clients had agreed to taping. All of them were even open to being video taped as well. I brought in a videotape.
The next semester in Supervision III, we were given the same assignment again. I asked permission to bring one of my clients, and my professor was delighted to be invited. The response from other students was similar, except for one woman who brought in a tape recording. She was an excellent student who had evidenced all along that she really grasped the work of therapy. I was not surprised she brought in a tape recording. It supported my unfolding hypothesis that confidentiality may be more for the therapist than the patient.
I had an intern once
I had an intern once who intervened every time I gave a member of my relationship skills group honest feedback. It was as if she leapt between me and my student to protect him or her. She would follow up with something reassuring or, at times even attempted to counter the information I had given. She feared honesty. She left my internship, because she “disagreed”.
Once I had occasion
Once I had occasion to return to therapy. It was shortly after Susan Forward had her license suspended for telling the police and the public how frightened Nicole Simpson had been of her ex-husband.
I told my therapist that I didn’t want confidentiality. As a matter of fact, I told her, “if anyone calls asking about how my therapy is going, you tell them.” I presented her with a written release. “I can’t do that,” she told me. “Is that for you or for me?” I asked. “For you,” she answered. “In that case,” I said, “I won’t be back.” She held her position, and I did too.
Several years later, I became a member of the Santa Monica Zen Center, which entitled me to Daisan (private interview) with Yoshin, Sensei. I began by requesting that he not maintain confidentiality for me, if he ever had any information based on our talks that would clear things up for anyone. “I can’t do that,” he told me. “Is that for you or for me?” I asked. “That’s for me,” he answered. I was glad to stay.
I have a new therapist I see now regarding time and financial issues and strategies, especially with Prop.10 funds becoming available to those who know how to pursue them. She was referred to me by a colleague. I informed her that I would be happy for her to share any information regarding my work with my colleague, and that I had no reciprocal hopes whatsoever, regarding her breaking confidentiality for my colleague. I told her I didn’t want confidentiality unless I shared anything regarding a client or regarding my husband, who I considered entitled to confidentiality. I gave her my statement in writing. She did not say anything. Rather, she accepted the document. I stayed.
I had a client who was a retired therapist
I had a client who was a retired therapist. Janet came to see me because her daughter told her that if she didn’t learn to be more open, they could never have a real relationship. Her daughter complained that her mother had been closed to her throughout her entire childhood. I asked my client to go home and share her insights with her daughter, as they came up. This forced my client into an internal dialogue that amounted to an assumption that she thought she could do the therapy in private, keeping the material she unearthed secret, and then be more open with her daughter. On her first day in group, I expressed openly to her and in front of my other students, that I felt a little insecure having a therapist in the group and I hoped that if she had any issues with me about how I work that she would agree to bring them up to me. She was surprised that I would disclose such a vulnerable feeling in front of her and the others. She noticed that I had modeled openness safely. As a matter of fact, she said, it touched her. She realized that her training had reinforced a secrecy-ethic that she had learned in childhood.
I had a student
I had a student in my relationship skills workshop whose sister was a psychologist. Her sister wanted my license number, because she thought there was something wrong with a therapist who allowed friends to join the same group. (As a matter of fact, I encourage my students to bring relatives and friends and anyone with whom they would like to develop the skills of open communication.) My student’s therapist-sister was mortified that each student’s right to privacy and confidentiality was being violated, by admitting them to the same group as their dear and close friends. This was a sister with whom my able student had a lifetime of difficulty communicating. Her biggest issue with her psychologist-sister was her ongoing need to preserve her identity as the superior sister.
At a recent dinner party I attended
At a recent dinner party I attended, one of the guests asked, “If given the choice between truth and goodness (Talk Show Host Dennis Praeger’s reported philosophical dilemma for Thanksgiving ‘96), should one go with goodness?” The other therapist at the table blurted out that “You wouldn’t want to tell a dying person that they were dying, would you?” I responded, “If I were dying, I would want to know.” I did not add what I was thinking, “And if I lived long enough, I might want to sue you for not telling me the truth.”
I cannot help but think (perhaps because I am a therapist) that a such a sharp and sudden rejection of “truth” as opposed to “good”, followed by an abrupt leaving of the table, is a sign that a person could be uncomfortable with the negative feelings which can come with truth, because they have not yet shed the role of positive mirror for their own parents and because they have not faced their own buried pain out of loyalty to their parents. I believe that if you cannot do it for yourself, you cannot lead another to do it. I believe our field is abundant with “internal drive theorists” and behaviorists who refuse to contemplate the contents of the “black box,” because they have not done their own work yet. Perhaps this makes them too compatible with confidentiality. If you are afraid to face buried hurt, fear and anger left over from childhood, you have to be repressed or closed, inauthentic, somewhat incompetent, or perhaps even dishonest. If you do not have a deep and abiding reverence for the truth, you may not be a good role model. It would seem to me you’d have to hold sacred a treasured place in your heart for secrecy and deception. Hiding out in the frame might suit you just fine, especially that part about confidentiality, but if this is what you are doing, you are defrauding your patients.
Playing “good” could be like playing God. It reminds me of the adage, “If you give a person a fish they can eat for a day. If you teach them how to fish, they can eat for a lifetime.” I’m inclined to think that if you do good for a person you make them weak. If you tell them the truth with good intentions, they may become strong by choice. When the good person is gone, the client may return to secrecy. When you expose truth its effects are longer lasting and more pervasive.
I happen to believe that there is very little truth that cannot be told. I believe that if you use skills and kindness, you can reduce pain in the long run by telling the truth sooner than later. I do not believe that truth leads to blame. When it does, you have identified a person with whom it is not safe to be in a relationship. I believe truth simply reveals cause and effect. I believe truth is an opportunity to heal.
I’d rather have the truth as much as I can get it. So much evil is done via deception. Truth exposes evil, which is often cloaked in good. While good depends upon personalities and is often the cloak of deception, truth as a system would become a place where evil and deception could not hide. That is the goal of healing.
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