Wednesday, October 27, 2021

Here’s why I would never deny patients any details about my work

As a condition of my therapist’s license, I’m required to disclose my identity to potential patients. My therapist writes after every session, saying that she has consulted a number of therapists over the years, but that I’m the only one I use for emotional needs, the subject that I’m most interested in.

I recognize that disclosure of information like this should be a routine part of any therapy relationship and that many people consider it risky. When I was still an undergraduate, several people (of varying genders) complained about my openness with my therapist.

It was not uncommon for my therapist to remind me at times of the possible blowback and to remind me that I’m a public figure and that some people will try to take advantage of me. I say that this happens “of varying genders” because many therapists are men who act a certain way with their female patients (and vice versa). I often listen to female clients protest that they should get less treatment because they are women.

I believe that open communication is healthy and important. Not all cases are the same and not every situation is the same. My approach is that there should be as little burden on my client to protect me. Not every client requires the same level of disclosure, and I know this. If clients indicate their need for confidentiality, my job is to respect that and to give them all the information I possibly can.

My job is to be fair to clients and me. But I can’t point a finger at my clients or their therapists if I suspect something. I don’t have all the information I need, and when I see something I don’t believe, I call my professional colleagues to corroborate it. It is those professionals who are the first to tell me, “Yes, you know this.” Often their perspective, backed up by data, convinces me that a client will be happier, feel less pressure, and get the best quality work.

There are always two sides to every story.

There is often pressure to be “sensitive” and to communicate something to a client to avoid hurt feelings. This is often a basic human instinct that is superimposed on a therapist-client relationship by professional peers, many of whom may be upset if they feel their patient is displeased. Once a relationship develops, a therapist must assert her authority without being disrespectful. This is why there are times when a client is upset with me for saying something, for example, about sex – not that I am suggesting sex is wrong, but that I want to protect my client, who is not my lover, by letting her know what I’m feeling about what she’s sharing.

On the other hand, a therapist should not “flatter” a client by being particularly nice or saying he or she has known her for 20 or 30 years. Therapy is about self-love, forgiveness, and growth. It is definitely not a waste of time to talk about things that sound difficult, that are sensitive, or that might bring out emotions that a therapist does not want in the conversation. I never feel good about asking a client to keep information private, but I always try to be sensitive to that.

I don’t believe in secrecy, as it can only produce secrecy. But I try to keep counsel with a client whenever possible to help build healthy boundaries. I always provide clients with an agenda of what I would like them to say and what they would like me to say about their issues. A complete confidentiality agenda wouldn’t help.

I can’t avoid the reality that therapeutic relationships are not always healthy, that we have lots of work to do, and that people in therapy are often the same as people who don’t need therapy. But therapy can be a process of growth. This is my hope for every client and for every therapist.

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