I have been struggling lately with deciding whether or not to stay in my DBT group after continuously feeling very vulnerable, stressed, and a week ago I was really triggered.

I was so triggered that I called my therapist and left a phone message in which I vented. I didn't even realize I'd been angry with the facilitator. I called the facilitator the C word. It felt safe to do so, and I thought it was confidential between me and my therapist.

While on the phone with the facilitator this morning (I was asking her if i could take time off group, she said yes), I found out this morning that last eek when I left the venting message for her, my therapist had been concerned, and I guess something didn't add up for her or the facilitator, who she had a conversation with (I had not indicated when they saw me that I was so upset with the facilitator - I honestly didn't realize in the moment though). The facilitator ended up asking to hear the message and said / thought it might be helpful to her. So my therapist let her listen to the message.

I think that the main thing here is that I feel violated, and in a sense, betrayed. That wasn't meant for the facilitator to hear. I didn't even mean what I'd said. I never gave permission. Now she knows I called her the C word.

I ended up apologizing to the facilitator. I meant it. But it also felt weird. I did not get an apology from her. She did not ask for an apology from me. But it just felt right to apologize.

Now I'm struggling with shame over feeling anger and expressing it like I did. I'm beating myself up.

This is the first time I've felt any kind of unprofessional and like "omg wth" vibe from this place. I have loved it there up to this point. I've been there for like 2 years, maybe a little over that.

I do think I'm going to have to speak to both my therapist and the facilitator and tell them how I feel about this.

[piggy momma]

Where I am that is a huge violation of confidentiality. I don’t blame you for being upset - I’d be furious. The one thing I’m wondering tho - is it all within a clinic where the therapists have shared consent? You would have had to explicitly consent to their sharing of info tho, but that’s the only situation I can think of where what happened would be ok.

Originally Posted by piggy momma

Where I am that is a huge violation of confidentiality. I don’t blame you for being upset - I’d be furious. The one thing I’m wondering tho - is it all within a clinic where the therapists have shared consent? You would have had to explicitly consent to their sharing of info tho, but that’s the only situation I can think of where what happened would be ok.

Yeah its within a clinic. I was wondering that too. Like if I'd signed something a while back that I just don't remember.

[Ididitmyway]

Wow. That sucks. It is a breach of confidentiality, you are correct. I can imagine how heartbreaking this was for you since you've loved the place. So sorry this happened to you.

[weaverbeaver]

I am so sorry you are feeling so ashamed. I can understand you frustration and anger over how this has been handled. I feel it has been handled appallingly and your confidentiality has been broken. The sad thing is that’s it’s been broken by the two people who are meant to keep it and not to share anything about you to the other. Do you feel safe enough to go back there?

[unaluna]

I dont think you have any expectation of privacy over a voicemail, technically speaking. I mean, i sympathize, but its kinda like confessing to a crime online - anybody can hear.

I didn't commit any crime though. I was venting and upset. There was no...threats of violence etc. But these are therapists committed to confidentiality and ethics.

[unaluna]

Originally Posted by KnitChick

I didn't commit any crime though. I was venting and upset. There was no...threats of violence etc. But these are therapists committed to confidentiality and ethics.

My point is, you can expect confidentiality IN PERSON with your t. They cant and dont guarantee confidentiality otherwise. Writing an email, they usually include a notice that says "this is not confidential." I am saying, a voicemail is probably more like an email than it is like an in-person session.

I just thought of something. The facilitator is a colleague and also has ranking on my therapist. Maybe that's different then. I still feel weird about it though! Will try not to worry.

Originally Posted by unaluna

My point is, you can expect confidentiality IN PERSON with your t. They cant and dont guarantee confidentiality otherwise. Writing an email, they usually include a notice that says "this is not confidential." I am saying, a voicemail is probably more like an email than it is like an in-person session.

Gotcha and TY! I'm not exactly sure if that's the case but its worth looking into whether a therapists vm is confidential or not.

[unaluna]

Originally Posted by KnitChick

I just thought of something. The facilitator is a colleague and also has ranking on my therapist. Maybe that's different then. I still feel weird about it though! Will try not to worry.

Ive written some uh EXPRESSIVE emails to my DBT group t, and copied my individual pdoc on them because she was at the same facility, and she would get very nervous on my behalf. I was like, hey, my permanent record is already shredded and burned, i cant worry about it anymore! That was ten years ago, so...

[Echos Myron redux]

In the UK at least, the voicemail falls under the therapist's responsibility to confidentiality. I strongly suspect it is the same in the US.

[lesliethemad]

voicemails and emails are confidential in the US

[SlumberKitty]

I think it's less that voicemail and emails aren't confidential and more that they are vulnerable to interference either via hacking or like in the case of OP sharing. Whereas what you say face to face is confidential because you're in a closed room and unless it's being recorded or something, no one can hack it. I would feel uncomfortable if I were the OP knowing that my voicemail got shared but being that they were both my providers (unless I misunderstood) there is probably some sort of sharing arrangement even if I'm not aware of it. For example. My pdoc and my T work at the same office. I assume they could speak about me if there were something radical happening with me. As for day to day stuff probably not because they are both balancing their caseloads, but if I go to the ER or Heaven Forbid IP, it would probably come up in conversation between the two of them. Do I like it? Well IDK, but it seems like a possibility at least. HUGS Kit

Thanks to all who responded. I haven't read the most recent responses yet, but I just want to say that I am comfortable going back (someone asked if I'm comfortable going back) and I will be going back at least for therapy and medication management. I also called the facilitator's and my therapist's supervisor as well as the facilitator directly, to give my input and feedback on the situation.

[Shotokan Karate]

Originally Posted by KnitChick

I have been struggling lately with deciding whether or not to stay in my DBT group after continuously feeling very vulnerable, stressed, and a week ago I was really triggered.

I was so triggered that I called my therapist and left a phone message in which I vented. I didn't even realize I'd been angry with the facilitator. I called the facilitator the C word. It felt safe to do so, and I thought it was confidential between me and my therapist.

While on the phone with the facilitator this morning (I was asking her if i could take time off group, she said yes), I found out this morning that last eek when I left the venting message for her, my therapist had been concerned, and I guess something didn't add up for her or the facilitator, who she had a conversation with (I had not indicated when they saw me that I was so upset with the facilitator - I honestly didn't realize in the moment though). The facilitator ended up asking to hear the message and said / thought it might be helpful to her. So my therapist let her listen to the message.

I think that the main thing here is that I feel violated, and in a sense, betrayed. That wasn't meant for the facilitator to hear. I didn't even mean what I'd said. I never gave permission. Now she knows I called her the C word.

I ended up apologizing to the facilitator. I meant it. But it also felt weird. I did not get an apology from her. She did not ask for an apology from me. But it just felt right to apologize.

Now I'm struggling with shame over feeling anger and expressing it like I did. I'm beating myself up.

This is the first time I've felt any kind of unprofessional and like "omg wth" vibe from this place. I have loved it there up to this point. I've been there for like 2 years, maybe a little over that.

I do think I'm going to have to speak to both my therapist and the facilitator and tell them how I feel about this.

That could be considered a HIPAA violation. Your therapist was supposed to ask you if it was alright to play the message for her. If you were to agree to it, then she would have you sign a release form.

[Ididitmyway]

Emails and voicemails are absolutely confidential in the US. Revealing their content to anyone without client's consent is a violation of confidentiality.

That said, this particular situation is a little different if the therapist and the facilitator are colleagues. Confidentiality here may not apply if they both say that their interaction was a "peer consultation".

Oftentimes, therapists within the same agency exchange information about mutual clients (if the same client attends a group and individual sessions with different therapists) without the client's explicit formal authorization because this goes under "peer consultation" category. I don't agree with this and I believe that it is still a breach of confidentiality because the client should be in charge of what is and isn't shared between two therapists in this situation, but, technically, you can't challenge this legally.

In the US, oftentimes, therapists are under pressure to reveal confidential information about court mandated clients to their parole officers in the form of "progress reports". Legally, they still have to obtain the written consent from the client, but they often don't. It often comes down to the therapist's choice to lose their job vs to comply with their ethical standards.

[SalingerEsme]

That is terrible to break confidentiality like that without a signed waiver. SO SORRY.

[unaluna]

I searched the HIPAA website for this a couple of years ago. I stand by what i said, and by what slumberkitty said.

[Pennster]

I am curious about this. I found this on a lawyer’s site:

E-mails and Texts from Patients. The foregoing rules apply to e-mails or texts by the covered entity or business associate to patients; the same rules do not apply to e-mails or texts from the patient. “The Security Rule … does not apply to the patient. A patient may send health information to you using email or texting that is not secure. That health information becomes protected by the HIPAA Rules when you receive it.” (OCR Guide at p.31).
HIPAA, E-mails, and Texts to Patients or Others | Holland & Hart LLP

So this seems to say that when a provider gets communication from a patient/client, the provider has a responsibility to treat it as a confidential communication. The fact that the method of communication is in itself not secure doesn’t absolve the provider of the responsibility to keep it confidential once he or she is in possession of it.

This sounds reasonable to me. It seems like a violation to me that a provider would feel free to share a patient/client’s information with anyone just because they recieved it via a voicemail. Like the problem with voicemail is that it may be inherently insecure, not that it gives absolution to the provider to break confidentiality once he or she has recieved it.

[Anne2.0]

There's technical violations of confidentiality and then there are ones where your expectations of confidentiality are violated.

I would imagine it highly likely that you signed a release of information from your T to your group facilitator and vice versa (I did when I was in group therapy and had a different individual T). Did you exclude any content, such as "if I leave a voice mail message cussing out the group t . . . ?"

If you did sign a release of information, then there can't be any violation of confidentiality because of course you agreed they could share information without any restrictions.

I could understand why it felt like a violation, because you didn't think that T would have her listen to the message. I think my first instinct would be to feel betrayed-- and that's a powerful feeling for me-- I would have at least wanted to know that or been asked ahead of time, even with a signed release. If I step back from it (easy for me to do, because I'm not you), I could see why your T wanted to let you group T know how you felt, and she could talk talk talk to her about it or -- to be more accurate and less filtered, have her listen to the message. I think your T was trying to do the best she could to communicate with your group T, which after all was why they collaborate together. It wasn't for gossip or prurient matters, but to try to resolve this as soon as possible, so what happened wouldn't interfere with your therapy.

[ArtleyWilkins]

Originally Posted by lesliethemad

voicemails and emails are confidential in the US

Voice and emails are really not considered secure in the U.S. As a teacher, we are instructed to be very careful about email correspondence, particularly when discussing special education students, for instance, due to federal protections, etc. We keep it down to students initials and just the bare facts, etc.

[Bill3]

To me, the legality of the sharing (and I do think it was legal under these circumstances) is not the main point. The main point, to me, is what I consider to be the very poor judgment involved in allowing the facilitator to know about and actually hear the OP refer to her using the C word.

You mentioned that the facilitator outranks your T. I wonder if that played a role in T’s decision to share the vm. It shouldn’t have.

It would have been more than ample to simply tell the facilitator that OP was very upset with her. The facilitator should not have asked for the vm, and should have declined to listen to it if offered.

[downandlonely]

I'm sorry to say this, but I think the irresponsible part was calling the group facilitator the C word on a voicemail. If it was in a private therapy session, it would be ok. But in public, we need to be careful about what words we use to describe other people, because it can back to haunt us.

Originally Posted by downandlonely

I'm sorry to say this, but I think the irresponsible part was calling the group facilitator the C word on a voicemail. If it was in a private therapy session, it would be ok. But in public, we need to be careful about what words we use to describe other people, because it can back to haunt us.

This may be your opinion, DL, but I completely disagree. I did not see it as public. I thought this was confidential. And yes while calling someone the C word is never helpful, constructive even irresponsible, it can happen. It happened for me in the heat of the moment (not saying it's ok, it's an explanation) I find your post unsupportive, blaming, and invalidating. I don't need that this morning.

Edit: I had been feeling awful about all this yesterday. ("What's wrong with me?" "No really what's wrong with me?" "I cannot believe I did that" I was diagnosing myself in my head and that also felt awful). To have you rub my face in this feels just the same.

You seem also to be operating under the guise that I don't care and am looking for sympathy for being hurtful. I do care. I was not looking for sympathy for that particular subject however I did need support yesterday and to just bounce my thoughts and feelings off someone.