We were all seated at large round tables enjoying a celebration of a dear friend’s son. We guests went around the table introducing ourselves. A woman across the table stared at me after she announced her name.

“You look familiar she said.” I smiled at her. I knew very well how she knew me but I did not want to say.

“When I look at you,” she continued, “I get this good feeling.” Her voice trailed off. I discreetly got up and went to the ladies room. Sure enough, she followed me. “You know, don’t you?” she said, looking at me, mystified.

“Yes,” I told her, “You came to see me for therapy last year. And I’m glad you didn’t blurt that out at the table!”

“Ohhhhh.” She replied, remembering.

“I’m glad you had a good feeling,” I kidded.

That wasn’t the first or only time there were awkward moments encountering clients in public situations. Generally, I pretend I don’t know the person at all if I am in front of others. Why do I do that?

Every kind of therapist has to abide by a code of ethics. And we do. Or should.

So, for example, The American Association for Marriage and Family Therapy has a Code of Ethics which reads, in part:

Principle II 
Marriage and family therapists have unique confidentiality concerns because the client in a therapeutic relationship may be more than one person. Therapists respect and guard the confidences of each individual client.

2.2 Written Authorization to Release Client Information. Marriage and family therapists do not disclose client confidences except by written authorization or waiver, or where mandated or permitted by law. Verbal authorization will not be sufficient except in emergency situations, unless prohibited by law. When providing couple, family or group treatment, the therapist does not disclose information outside the treatment context without a written authorization from each individual competent to execute a waiver. In the context of couple, family or group treatment, the therapist may not reveal any individual’s confidences to others in the client unit without the prior written permission of that individual.

2.6 Confidentiality in Consultations. Marriage and family therapists, when consulting with colleagues or referral sources, do not share confidential information that could reasonably lead to the identification of a client, research participant, supervisee, or other person with whom they have a confidential relationship unless they have obtained the prior written consent of the client, research participant, supervisee, or other person with whom they have a confidential relationship. Information may be shared only to the extent necessary to achieve the purposes of the consultation.”

Did you notice, in paragraph 2.6, the words, “do not share confidential information that could reasonably lead to the identification of a client”? In other words, I cannot even say, “Hello” to you if that means that someone will come to believe that you are my client! So I don’t.

Here is what the American Psychological Association has to say:

4.01 Maintaining Confidentiality
Psychologists have a primary obligation and take reasonable precautions to protect confidential information obtained through or stored in any medium, recognizing that the extent and limits of confidentiality may be regulated by law or established by institutional rules or professional or scientific relationship.

4.04 Minimizing Intrusions on Privacy
(a) Psychologists include in written and oral reports and consultations, only information germane to the purpose for which the communication is made.

(b) Psychologists discuss confidential information obtained in their work only for appropriate scientific or professional purposes and only with persons clearly concerned with such matters.

4.05 Disclosures
(a) Psychologists may disclose confidential information with the appropriate consent of the organizational client, the individual client/patient or another legally authorized person on behalf of the client/patient unless prohibited by law.

(b) Psychologists disclose confidential information without the consent of the individual only as mandated by law, or where permitted by law for a valid purpose such as to (1) provide needed professional services; (2) obtain appropriate professional consultations; (3) protect the client/patient, psychologist, or others from harm; or (4) obtain payment for services from a client/patient, in which instance disclosure is limited to the minimum that is necessary to achieve the purpose.

4.07 Use of Confidential Information for Didactic or Other Purposes
Psychologists do not disclose in their writings, lectures or other public media, confidential, personally identifiable information concerning their clients/patients, students, research participants, organizational clients or other recipients of their services that they obtained during the course of their work, unless (1) they take reasonable steps to disguise the person or organization, (2) the person or organization has consented in writing, or (3) there is legal authorization for doing so.”

Finally, here are corresponding excerpts from the National Association of Social Workers.

“1.07 Privacy and Confidentiality

(a) Social workers should respect clients’ right to privacy.

(b) Social workers may disclose confidential information when appropriate with valid consent from a client or a person legally authorized to consent on behalf of a client.

(c) Social workers should protect the confidentiality of all information obtained in the course of professional service, except for compelling professional reasons. The general expectation that social workers will keep information confidential does not apply when disclosure is necessary to prevent serious, foreseeable, and imminent harm to a client or other identifiable person. In all instances, social workers should disclose the least amount of confidential information necessary to achieve the desired purpose; only information that is directly relevant to the purpose for which the disclosure is made should be revealed.”

So important is confidentiality to therapists that the Social Work credo even states:

“(r) Social workers should protect the confidentiality of deceased clients consistent with the preceding standards.”

You can read all this and more on each of the above organizations’ websites.

So how do I write such detailed stories for this newspaper and for my talks?

The answer is simple: I make them up. Or at least, I make up the stories about other people. The stories about me are true disclosure. For clients, I don’t merely “change identifying information.” All the information originates in my own head.


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