Thursday, January 10, 2008

New Confidentiality Question

I have a hard time dealing with the fact that at my mental health clinic, AIDS Health Project, the conversations with my therapist and psychiatrist called "confidential" are actually reviewed by a "care team" or "crisis team" of people I don't know - which has absolutely been helpful in emergencies, or off-hours. But the access to my therapy notes, even if useful, feels over-exposing. I don't have a question about that. I accept it.

But - in my blogrolls section (low in sidebar), under the category "Mental Health Blogs", there is a category titled "Questionable Mental Health Blog" which lists a blog called "The Therapist Mumbles". This blog consists of a psychotherapist posting his or her therapy notes about his or her clients - anonymously. Which content certainly could be learned from and possibly helpful to a reader in similar, or different circumstance to or from a client. The - anonymous - publicity could also elicit or break trust in some reader getting help through therapy, though.

What do you think about it?


Merelyme said...

that doesn't seem kosher to me. i would never want to go to such a therapist myself.

whimsicalnbrainpan said...

Ok that is just way past wrong.


I want to extend a hand of friendship ...I myself have a blog on blogger..I came across yours and wanted to send some love. check out my site it is an online community for people with HIV/AIDS. feel welcome to join
In hopes of inspiring,

Greta Perry said...

Oh geesh girl. I take a week off from reading and feel like an awful friend.
Every blogger and every person and every professional knows they sometimes cross the line of betraying confidence. There area plenty of "medical bloggers" who blog about their patients.

I follow the Milblog rule of blogging: "Blog it if you are comfortable that your mother, commander & your enemy will read it."

You are really finding your voice as a blogger and "whatshisname" is just a wonderful and honest glimpse into your life and into your situation. If it helped you and only could help him - and you felt the need to get it out - you are great in my book. That has to count for something???

Sarah said...

The fact that the therapist discusses cases on his (?) blog reminds me of columns I used to read in Ladies' Home Journal called "Can This Marriage Be Saved?" I think they were written for entertainment more than for problem solving. But what I didn't like most was his cynical attitude--"47,425 hours of listening and nodding." He doesn't deserve another client.

Sarah said...

The Shameless Lions Writing Circle! Roar for Powerful Words! I like it.

laughingwolf said...

seems to me only you and your 'therapist'... the rapist, if you will... know it's about you, but that does not make it 'right', even if it is 'anonymous' information :(

+PHc said...

Merelyme and Whimsy and Sarah,
Thanks for the opinions. I'm going to ask if his or her patients know heor she does that, because, I think even supervised therapists are required to tell their patients that they share information with their surpervisors, clinically, as "the patient."

THANK YOU for extending your hand in friendship. Love back. I will visit your blog and say the same there. Thanks for the invitation! AND FOR THE CREATION OF AN INCLUSIVE HIV/AIDS COMMUNTIY which used to sort of exist in San Francisco and does no longer. I don't like being segregated out into a demographic without choice, and I need community.

Both my mother and my enemy read, and a lot of the time knowing that does not make writing what I have to say comfortable - but I have no commander and probably need one badly.

Mamabeek said...

Hi there! I came across your blog via a comment in someone else's. I found this post particularly interesting because I am a Marriage and Family Therapy Intern and a doctoral student in Clinical Psychology.

I am a part of a clinical team, and it also pains me that my private notes must be shared across the whole mental health department. I see the importance and utility, but like you, it makes me squirm. Therefore I keep them as vague and clinical as possible while still conveying the main issues.

I sometimes blog about general situations, or make references to specific ones that frustrate or interest me in my therapy, but I would NEVER go into the sort of detail this person does; detail that would allow someone, even if it was the client his or herself, to recognize the person I was talking about. The LAW, not the rule, and this is nation wide as far as I know, is that what happens between a therapist and his or her client stays there and the only exceptions involve law enforcement, Adult or child protective services, or medical professionals if there is a danger to self or others, or some sort of abuse going on. It's not uncommon to create vignettes that combine various elements of different cases one has seen, for the purposes of teaching, professional development or even sometimes storytelling. Even in graduate psychology classes where we are all bound by the same laws and the point of the class is to discuss our fieldwork, we change identifying information that might lead to someone knowing who we are talking about, or we get a release of information from the client to discuss the case.

Most of the posts I read on this blog you mention were quite specific and didn't have the feel of fiction. Some of the scenarios are so unique it seems to me that anyone connected with the case would know the players in a heartbeat if they stumbled across the blog. If that is the case then this person is not just unethical, but breaking the law! If S/he feels the need to discuss these cases then there is always the possibility of joining a professional consultation group in which everyone is bound to confidentiality.

It's a really, REALLY important point to understand that psychotherapists are not like medical doctors. MDs are not constrained by the same confidentiality as therapists. HIPPA yes, but HIPPA is not nearly as comprehensive a set of rules as what we therapists must abide by. People tell us things they have never told ANYONE, sometimes they haven't even admitted to themselves until that moment what they say to us. That gives us enormous power over our clients, and therefore enormous responsibility not to misuse that power.

There is one situation in which this might not be the case... and that is if this person is not a therapist at all, but a coach. Beware coaches, for useful as their work may be, they are not bound by the same laws that psychotherapists and counselors are. They should still observe these laws if they are ethical professionals, but they aren't legally compelled to do so.

Therapist Mumbles said...

Thanks for alerting me to your mention of my blog, and the discussion.

I hope that I can clarify a few things. First, the details of the lives of people mentioned in any of my posts are so altered that if an actual client read the post they would probably recognize the issue, but not that it was them. Also, you don't know where I am or who I am, so that adds a bit to the difficulty of someone taking it personally.

I dealt with this issue months ago on the blog.

My intention with the blog is just to express my amazement with how humans struggle to find comfort and to make sense of their lives. It is often a very confusing picture.

I write it as if I believe people I know will read it. I know my kids look at it once in a while. My wife doesn't usually take the time.

Any books written for the public or for other professionals will have case studies; and with books the author's picture is usually right there on the cover.

I am flattered you all took the time to consider the issue. Rest assured, I am very aware of how important confidentiality is in therapy.

I hope you are all working for a better health care system in America.