I had 2 times that it was really hard not to tell and one time I told and still think it was the right thing to do even though I know by all standards it was wrong. The time I told I can't explain b/c it is too specific to the very rare circumstances.

The other two were heart-breaking. One was a regular nursing home patient who always said I reminded her of her daughter. She had the same dark curly hair and green eyes that I do, was the same height and build, etc. Nobody else even knew she HAD a daughter so it was a little confusing. Finally I asked and she told me her daughter has spent her adult life in and out of the state hospital until she killed herself. She was, of course, bipolar, and her mother saw it in my eyes. When I dug around in her chart enough I found that she never mentioned the daughter in her history but when her son had visited he'd told the social worker that there had been a daughter who died so there was a brief note but otherwise nothing b/c the patient couldn't stand to talk about it. It must have hurt her terribly to see me but she also got something from it. I always wondered exactly how much she could tell because without ever telling me she made it pretty clear she KNEW.

The other time was one of my long-term care psych patients. We had gotten very close because she had a severe injury and we spent probably more hours together than I spent with any other patient in my whole career. She had schizophrenia but was paranoid about talking about it so one day when she admitted she was hearing voices in the moment I was surprised. I reassured her that she was safe and tried to help her not feel so isolated by it by saying that lots of people hear voices. I really meant 99% of the people where she lived did but she asked me if I did. At the time I had not had auditory hallucinations but I'd had visual ones and definite paranoia and it was really hard to not be more honest than was healthy for her.

I had some big words of advice that were actually good and then I forgot completely while I was typing this for the 2nd time after accidentally deleting. So maybe I'll remember and be back.