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The Ethics of Confidentiality
There's an ironclad rule, going back to therapy's earliest days, that clinicians should never talk about clients, unless it's for consultation or teaching purposes—and then only with a client's informed consent. But today, when therapists and clients are often on a first-name basis, and fewer people feel there's a stigma to being in therapy, the rule may have become anachronistic. What's the harm in talking about a client with your family, friends, or colleagues at social occasions, especially if you omit names and identifying details? After all, therapists are gregarious, too.
Unsure of the ethical merits of openly challenging traditional rules about confidentiality, few therapists want to be quoted on the issue, but many have strong feelings about it. "Therapy can be so isolating," says one senior therapist, who declined to be identified, "and talking about a client with my wife or a friend cuts through the loneliness." Another therapist, who works primarily with traumatized clients, says that talking about an occasional client with her friends helps ward off burnout. "It's like a buoy for me when I feel like I'm drowning," she says. Sometimes the actions go beyond mere words. One distressed therapist rushed to a lunch date. "I just got a call from the world's most depressing client," she said. "He sounds just like Eeyore," and she launched into a sorrowful braying imitation of her client's recitation of his latest personal crisis.
Such behavior is definitely risky business. "When you talk about a client, you never know when 'six degrees of separation' will come back to haunt you," says therapist and attorney Steven Frankel. Someone may overhear you or be involved with someone you casually refer to.
To avoid the temptation of what appears to be innocent fun, it helps to remember the purpose of the confidentiality rule, says Chicago family therapist Mary Jo Barrett, whose ideas about ethical guidelines were shaped by a survey she conducted with hundreds of clients about what they most valued in therapy. The most frequent answers were safety and security. "They didn't use words like ethics or boundaries," she says, but notes that it was clear that they were putting the ethical rules about confidentiality into their own language.
According to Barrett, the potential harm in these days of more informal, less stigmatized therapy, isn't to clients' reputations, but to their sense of safety and security. If there's any chance that your actions will undermine that fundamental trust—the basic foundation of the therapeutic relationship—she adds, it isn't worth the risk.
Autism: For a comprehensive listing of research of autism: www.talkaboutcuringautism.org/medical/autism-studies-jan-2009.pdf; Deer's Wakefield articles: British Medical Journal 342 (January 5, 11, and 18, 2011); http://www.cdc.gov/mmwr/ preview/mmwrhtml/mm5733a1. htm; http://askdrsears.com/thevaccinebook. Wikipedia: APS Observer 24, no. 2 (February 2011).