[okiedokie]

Hi,
Well most of you know I recently signed up for a DBT class/group, whatever you want to call it. My T and her colleague co-facilitate. Well last week my T was home sick so it was only this other guy that I don't know at all. Well, at one point when we were talking about one of our weakest areas I expressed that describing feelings was probably one of mine. He said, "so is that what (insert my t's name here) is trying to get you to do?" I could have died right there! He just told everyone in the group who my T was! That is no one's business but my own!

So, do you you think he violated my confidentiality? I have no idea who anyone else's t is in the group. Why do they all get to know who mine is??? Furthermore, I think it is a HIPAA violation.

What do you think?
Thanks,
Okie

[SweetSunshine]

Okie.. most definitely is a violation of HIPPA. There is no way that man should have given out your T's name. I am so sorry you were violated this way. Please find out who you need to tell and let them know about this!!!

[Perna]

I don't think it violated any confidentiality; theoretically people could legally follow you and see you go into your T's office, etc. (not that they would :-) it was insensitive to you and whether you wished it known who your T was. But I think that is just a personal sort of thing. It could be that ALL the people in your group are clients of his or your T's and you just don't know/hadn't realized that?

Maybe you're lucky and perhaps the others didn't quite understand and think, since your T is also a group member, that it was something the three of you were working on (so part of group) or something your T was trying to get your to do in group a previous week, etc. But I can't imagine anyone else "caring" who your T is? And you could ask other people who their T's are, that's not "confidential"/rude? but you may not know them at all so I can't imagine why you would care anymore than why they would care whose yours is?

Since it really bothers you I would stay after (or come early) and talk to him and tell him you didn't like the comment and feel "exposed" (or whatever you feel) by his having made the comment and used your T's name. Or, if you don't want to do that, I'd make a "joke" of it at the start of group and discover if everyone has one of your leaders as T and who has who, etc. I'd say something like, "Since InsensitveTName blabbed who my T was to you all last week, I want to know who you all see; does everyone see InsensitiveTName or YourTName?"

[Flowerb]

I feel for you. And I have to respectfully disagree with Perna - it is a violation of confidentiality for your group therapist to identify your individual therapist. If someone follows you to your therapist's office, they are invading your privacy and they can leap to assumptions but they don't really know why you went into that office. This therapist has a professional duty to certain levels of conduct and he knows for sure who your therapist is.

In my group, I found out one of our group members had started seeing the group therapist individually. (she told me directly after a meeting.) It bothered me sometimes because it felt like they were continuing a conversation that the rest of us knew nothing about. But the group therapist never once said anything about doing individual therapy with this person or referenced anything directly from a private session. These relationships are very complicated.

I do agree with Perna that it is likely that the group members will think he was referring to a previous group session or things that have happened around group - unless he was very specific. But I'd definitely talk to him about it.

I firmly believe that it very much violated the HIPPA confidentalty... It makes me furious personally... that is my opinion... this man.. had no right.. and personally, I would follow up... if he does this.. what else would he do? Sorry but that is what I think when I hear things like this..

[Perna]

HIPPA is about medical records, only. There's no "record" involved here, no medical information. It was a question, not a giving of information; "Is that what Susie is trying to get you to do?" is about therapist Susie and Okie can answer, "None of your beeswax" if Okie doesn't want this idiot therapist to know Okie's opinion of whether it is what Susie is trying to do. No one except therapist Susie has a "right" to her first name. No mention (that I know of) was made of it being Okie's therapist or connecting it to Okie in that fashion. Who in group knows that Okie even sees an individual therapist?

No one but Okie (and the insensitive therapist dude) knows if "Susie" is the same Susie as the other group leader. Lots of people are/can be named "Susie". It's not like he said, "Susie LastName, Okie's therapist and the other cotherapist of this group who is out sick today and last Tuesday in Okie's individual session was trying to do. . ."

It's potentially insensitive but not a confidentiality violation. I say potentially because I think if a poll were taken of who would mind such a reference in a group setting, "Is that what Susie is trying to do?," wouldn't think anything of it and would say "yes, exactly" or "no, I don't think so" or "I have no idea, you'd have to ask Susie." Since group leader didn't know Okie or Okie him, there's more room for both to make mistakes in getting to know one another and this looks like one of them. But you can't learn about other people without questions and/or mistakes to see where people "are".

[sunrise]

Hi okie, I think it would be really helpful for you to talk to both your T and the other co-T of the DBT group about this in a brief 3 way meeting. To clear the air and address any problems this revelation may have caused. Take care.

[okiedokie]

Well, that sounds like the mature thing to do, but we'll see...

Perna, one of the requirements of participating in this group is that you are required to have your own T. It just so happens that my T co-facilitates the group. The other individuals have their own therapists too, but insensitive facilitator mentioned my T because she was home sick that day. And he was trying to get me to say more than I was willing to say. He did ask if "My T" was trying to get me to do such and such in private therapy. I was very embarrassed. HIPAA protects medical information, you are correct. Psychiatric/mental health is protected health information (PHI).

Of note, I did try to talk with him about it on the phone today and he was a complete ***. He said, "so, what's the injury?"

Under the circumstances, I don't think I will continue with the group. What pisses me off is that I'm out $600 big ones. And, what cracks me up, is that this module is on interpersonal relationships!!

Frankly, it's not worth the anxiety to make this go away. I feel as if to pursue this is digging a deeper pathological hole for myself. The whole situation feels very unfair.

DocJohn, it would be great if you would weigh in on this, but I doubt you read every post, so probably won't even see it.

Thanks again for all your replies. There is a lot of wisdom on this site.
Take care,
Okie

[MissCharlotte]

((Okiedokie))

Yes, it was a violation. It was also insensitive. This guy needs more training.

hey. sometimes... people know not what they say. he probably thought that everyone in the group had told everyone else who their individual therapist was. of course, he was wrong. and he needs to learn to be more careful with that - but i really do think that it was an honest mistake.

i guess i think... that whether he was in breech of regulations or not... can you understand how it was an honest mistake and how it isn't a mistake that is likely to lead to loss of your job or your suffering stigma from your peers. i mean... it wasn't a mistake that has resulted in people who didn't know you had borderline personality learning that you did in fact have borderline personality. it wasn't a mistake that has resulted in people learning that you see a therapist when they didn't know that you did see a therapist. so... no major harm done.

on the other hand... i do understand why you felt upset that he said that. and i think that it is worth saying something to him about that. because he should learn that he needs to be careful with that kind of thing.

Bottom line : YES, he broke confidentiality. But, looking at if the break in confidentiality brought harm upon the client, he probably will not get in trouble for it...

Okie, are you sure you want to quit the group?

I understand that you feel uncomfortable with what happened, but maybe you'd like to wait until your therapist gets back? Maybe you could discuss with your T?

Maybe your T has never made a mistake in which you felt like your confidentiality was broken, but has your T ever made a mistake? I know mine has. I know that my new pdoc sure as hell as. But I'm not quitting yet. What do you do when your T makes a mistake? It just sounds as though the group could do a lot of good and what happened was unfortunate-- and it would suck for you to lose all that money, too. Any way you think you could keep going?

[okiedokie]

I hate drama, and yet it continues....

My T is very understanding and pissed too on my behalf. She intends to speak to "insensitive co-facilitator."

I do understand that people make mistakes. When I make a mistake, I fully own it and apologize and I always hope and expect that others will too. I guess "expect" is problematic.

This 2 week group experience has been very provocative for me in many ways and VERY stressful.

I don't have BPD so am second-guessing if this is even the right group at all? I think the skills are good and could be helpful to anyone including me, but I'm not a big fan of drama and so far, from what I've seen, groups are all about drama. Please tell me I'm wrong!

I don't feel the need to get him in "trouble" for any of this. I just wish his response had been a little more empathetic. But, then, I don't know him at all, so maybe he doesn't "do" empathetic? I dunno. I guess I'm trying to balance my anger with my compassion, and then when I'm tired of thinking about it, I'm pissed that I'm in this situation at all.
Okie

My diagnosis of BPD was contingent on my qualifying for DBT. For a couple years... Clinicians said that while I had some borderline traits, my presentation was different and so they didn't think that I had BPD. But then when DBT was being trialled in the region they said that they thought that would really help me so I should go along and take the personality inventories and see whether I would qualify. They thought the qualifying tests were over-inclusive so they were fairly sure I would get a look in. I studied up on the BPD criteria (and read about how the MMPI was scored) in order to 'magnify' my symptoms in the appropriate direction... (I consoled myself with the thought that that was a 'very borderline thing to do) ;-)

When group started I certainly did go through a phase of wondering what the hell I was doing there. The phase lasted... About 10 months of my 12 month program. I found myself... Repulsed by some of the things that other people in the group did and by some of the things that other people in the group said. It was hard. I kept asking myself 'am I like them? is the way I see them the way other people see me?' It was hard for me identity-wise. Over time I became fonder of them, however. Gained some understanding of why they were led to say / do those things. Got a lot out of DBT too with respect to coping skills (though would never have admitted that at the time!) But they are skills that I have turned to ever since and they really help me out when times get tough.

Sounds like part of what is hard is that he hasn't conveyed understanding / appreciation of your point of view. Basically... He hasn't got the hang of the 'validating' aspect of DBT yet. I think the 'validation' is a fairly hard skill to acquire... Especially for people who have some kind of narcissistic injury... He might be feeling defensive more than anything else, which of course doesn't help you a great deal.

Can you think about why you might be feeling so upset about what happened? Do you feel... Betrayed? Do you feel... Like so much of DBT is kind of imposed on you (the structure and stuff is out of your control) and this privacy was a way of retaining some of it? I guess I'm wondering if it might help to talk to your therapist about some of those feelings. Maybe...

For me Okie, I value my privacy when it comes to my therapy.. and who my therapist is.. and who my MD and Pdoc is..

And again, I would be very angry if someone did this... especially in capaicty of co-facilitator.. I have had some people dig into my records... so I feel very strongly about this issue..if you have ever had your privacy invaded - I guess I am saying.. then you know how it feels..

For me, it always brings up the issue of - if he can do that.. what else does he feel he can do... it puts a "fear" in me that the person could then so violate other criteria... and in the past I have found that to be true.. if the person had said.."oh, I am so very sorry"... then you know that the person "gets it"... but this person did not "get it"... so it for me brings up questions.. on his future behavior.. not just in this class.. but any other..

just my thought...

[DocJohn]

I think what others have said here more than capture my own feelings on the topic. The co-facilitator was insensitive and likely broke your confidentiality, but probably not intentionally and certainly didn't appear to mean to cause you any harm. Therapists are human, make mistakes, and should own up to them when confronted with them.

Honestly, if you run a group, therapists have a much harder time with this issue than one-on-one therapists, because they may be privy to additional information about each person that the group as a whole doesn't know. That's why groups can be harder for therapists to conduct, but it's no excuse for not being vigilant for respecting one's clients' privacy.

I'm glad you talked to your therapist about this issue... I think that was the right course of action to take.

[RACEKA]

Where I have therapy the therapist comes into a mutual waiting room when they are ready to get your for your session. Clients see you walking with your therapist to their offices for sessions.

If anyone from the outside called to find out who your therapist was they would be turned down.