I don't think about it at all. I use names when they're people I have relationship issues with and possibly I don't use a name when I make an occasional reference to 'a friend'. I absolutely don't worry about it. Whatever naturally comes forth is the way I communicate. I don't believe in secrecy with my T. I see no purpose or point in speaking in a convoluted way. The therapist is bound by confidentiality so what is the issue with using real names? I don't understand.