Pressured by counselor / confidentiality of client's name

Hello: I am new to Psych Central and seeking insight into a counselor's behavior. It was my 2nd session with her. In the first session, she had suggested I had Attention Deficit, co-existing with previously diagonosed depression (since childhood). I did some research and was enormously relieved to see my behavior described down to a T. Some puzzling things were now clear. I had high hopes when I met her for a 2nd session.

I have had successful long-term relationships with therapists. I have also, prior to this, had one short-lived bad one, when a psychiatrist misdiagnosed my condition and insisted I continue on medication that made me unable to function in daily life in many ways for months. I had told the new counselor about this in our first meeting. Her reaction was ambiguous to me -- I did not think she entirely believed my version of events. I brought this up at the 2nd session. She told me she had not thought that, which I accepted.

A few minutes later, she began to ask me to tell her the name of the person who had referred me to her. This was another client, with whom I had an extramarital affair (my first and only). While I had decided I would discuss the relationship, because it was important to me, I did not want to name him. I felt that this could violate confidentiality between him and the counselor. I thought it would be unfair to talk about someone else she might be counseling. I began to tell her that I had a relationship with him, and said he was not married but had been married before. She jumped in and gave me his name. I was floored. She said she had "intuition." I questioned why she felt she had to know his name. She kept saying withholding his name was standing in the way of her treating me. When I continued to press this question, she said I was "arguing and defending my position" as though this was a problem. She said her knowing what I had said about him did not affect the confidentiality of her relationship with him. I was extremely upset that she had engaged in a "guessing game" when I had told her I objected to telling her his name. She said that because I had "taken a chance" by telling her I was concerned about her reaction to me in my first section, that she had also "taken a chance."

I see a number of red flags here:

She named one of her clients to me without the client's permission.

She pressured me to reveal something painful and that I told her I did not want to talk about. She made a guess. She could have said "I cannot treat you under these circumstances. There may be a potential conflict. Whether you go forward is up to you."

She did not think I could have a valid point of view in opposition to her's -- she told me I was "arguing and defending my position."

When I retreated and appeased her, she was thrilled and complimented how "intelligent" I was.

In conclusion:
I'm sure this is not the counselor for me.
I am very upset that my friend's name was used when he had indicated to me he would be uncomfortable about it. Perhaps we both naive? This may hurt a friendly, caring relationship, which is very upsetting to me.

I would very much like to hear from anyone else on the confidentiality issue.
Did she violate my friend's confidentiality? It seems like an odd Catch-22 situation. I already knew his name so, from that point of view, confidentialty was not breached. But is there any context in which a therapist may confirm to another client the identity of another client?

I would like to hear from others about therapy in which they felt bullied and how it affected them. Did you feel it was a valid tactic? Did you feel it did you more good than harm?

For the sake of keeping this thread to its stated area of psychotherapy issues, please do not respond about A.D. unless you feel that this is necessary for understanding the immediate topics of confidentiality and feeling pressured. Thanks for listening.

Hi, I think that your feelings about her and the red flags are on target.....

Discussing other clients and by name is unethical.

Go find another therapist!

Thanks for your input. I'm grateful.

When I read your post I thought... Why does she need to know WHO the person is? When I put myself in her shoes, I can seem myself being very curious about what client had referred you. I'm sure most people when someone mentions something like, "I heard from a friend that you are a good...." I have a friend who recommended you... " The first thing that would pop into my head is .... I wonder who that was. HOWEVER, if you told me.. that you were uncomfortable disclosing this information, I would not pressure you for it. I'm might still be curious, but I won't pressure you to disclose this information.

Now I think it is pretty common for T to get clients by way of other clients. I think they should know how to handle this professionally. I would think that treating two people who you know are connected in some way would certainly create biases. I can certainly see you concern here.

Have you talked at all to the person who referred you to this counselor? Based solely on what you said here, I think your friend should be at least made aware that this counselor has made the connection between you too.

Ingomar, if it were me, I would ditch this counselor immediately. You have very little invested with her, only two sessions, so you should be able to drop her and find someone new with little angst about termination.

I think she was unethical and just plain not a good counselor in what she did. If you don't want to reveal any particular piece of information to her, she should not force you, or play a guessing game, or sneakily try to get the information anyway. She treated you in a way that did not have the good of your mental health at stake. She also violated confidentiality for your friend. She is all around bad news!

I would find it hard to go to therapy with a counselor who knew all about me from another client. Your friend may very well have talked about you numerous times to his therapist, as a woman he was having a relationship with. Your T should not have this information unless you want her to, such as in couples or family therapy.

If it were me, I would explain what happened to my friend and let him know because of this you will not be seeing his T anymore, that you value your friendship with him too much to put him in this compromising position.

If this T works in a clinic, where there is a supervisor, I would report this to her supervisor. She deserves at least a slap on the wrist from someone.

Ingomar,

You do have red flags flying here. Is there EVER a theraputic situation that is helped by "bullying"!

No matter what else you said, I think it is very important to realize you feel bullied by this person. How can you trust her and work with her if you feel bullied and/or manipulated by her.? I think that would be a deal-breaker for me.

Maybe you should keep looking for a new T you can trust more. I'm sorry this happened to you.

Leslie

One thing that clients often misunderstand about confidentiality is that it is essentially one way. It is unethical for therapists to reveal confidential information about a client without the proper consent or appropriate reason. But there is nothing that goes the other way. Your friend may or may not approve of you talking about him with a therapist he is seeing, but it would stand to reason that he might expect that you would do so since he referred you to his therapist. It is likely that he has talked to her about you.

Secrets in therapy, just as in any relationship, stand in the way of healing. I can see a legitimate purpose in establishing who your friend is. You knew, and your friend knew, that you were both going to the same therapist. How much chance is there that she wouldn't have put together who is who? I'm betting that she knew and had no doubt who referred you, and her purpose was to get that bit of information out on the table in order to prevent it from being an awkward secret that could interfere with your therapy. She did not reveal any confidential information, because she did not tell you anything that you didn't already know, or that she didn't already know that you knew. The only thing revealed was the fact that she knew (or had intuited) something that you didn't know that she knew.

You now have options. You could talk to your friend about what happened, thus establishing that your identities are out in the open. Then you could find out how okay he is with knowing that the therapist knows who you both are. Maybe he will be okay with that.

You could talk to the therapist about your concerns and ask to clarify how confidentiality applies to your situation. This will give you the chance to see if her explanation is acceptable to you, and decide whether or not you can feel confident that she is ethical.

Knowing that she knows your friend, you might benefit from additional insight that the therapist will have from knowing the other side of the story.

If you and your friend decide to, you also have the option of an occasional joint session if it would meet your needs.

Of course, deciding not to continue is also an option. But I would get more information first before making that decision. I'm not sure that any ethics breach has occurred here, and this might be a therapist in a good position to help you,

I, personally, think it's inappropriate for her to have used his name. What if it hadn't been the guy you were involved with?

More concerning to me is the way she pushed you. She could have encouraged you to explore your reluctance to name him helped you explore what might happen if you did name him. Her naming him takes it out of your hands, and it's your therapy and your feelings. I know in my therapy, feeling in control is a really big issue; she took the control out of your hands in this situation.

I agree with both those points. Ingomar, I would just ask myself do I really want to continue with a counselor who has done these objectionable things so early in the relationship? If you don't return to see her again, you really haven't lost much time or effort or energy. There are lots of therapists out there. Get one who will not dance on the edge of client confidentiality rights and not force/manipulate you to reveal things you don't want to.

Rapunzel, I believe that the therapist did violate confidentiality to her original client (the male). She revealed his name in therapy with another client. A therapist should never reveal the names of clients to each other unless he has both of their permission. If they give this information up voluntarily (no tricks, no badgering), then that is different. If I were the second (female) client, I would be very concerned at this violation of her male client's confidentiality and wonder if she would also violate my confidentiality so casually at some point in the future.

I just had a first session with a new therapist yesterday. The very first thing he discussed was confidentiality. He made sure we both understood the protection I was guaranteed, and this brief discussion gave me confidence in him and his practice. Confidentiality is so important.

Rapunzel,
I get your point about how alway avoiding mentioning the persons name or constantly considering if what you are saying might reveal who he is can potentially impede the flow and openness of the discussion.

HOWEVER...
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She did not reveal any confidential information

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I disagree... she mentioned a name of one of her other clients... What if her guess was wrong? Then she would have disclosed the name of someone that you did not know she was treating.

I just think .... based on what was written here... this situation could have been handled more professionally. Maybe her T could have said..."Look I understand your reluctance to directly identify your friend." "Quite honestly, I'm pretty sure I already know who you are talking about." "If having me know the two of you are connect is a problem, then you need to see someone else." "Otherwise, Instead of us pretending I haven't made the connection between you two, just forget trying to keep his identity secret and use his name."

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Rapunzel said:
It is unethical for therapists to reveal confidential information about a client without the proper consent or appropriate reason. But there is nothing that goes the other way.

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I think this is a very good point that I frequently struggle with in my own therapy. I am not much of a gossip and I really don't like saying a lot of things about someone else. I frequently feel like I am sharing very personal information about other people with my therapist. I don't feel good about this, even though therapy is supposed to be a place were it is OK to do this. Honestly, when I think back to when my H had his one and only session with my T, it was his unrestricted unloading of very private and detailed information about me that sent me into a total rage. Even though it was therapy, I didn't expect him to do this. I didn't expect my T to encourage and probe him for as much detailed information as she did. I felt REALLY violated and seriously strained the relationship with my H and my T.

I had something happen to me here goes I was in group Therapy and a lady in there see's the same Phychricast (how ever you spell it)
So when I saw Phy I said hey someone in group also see's you and I told him her name and he said I can't tell you if I see her or not because it breaks client HIPPA rights! My Psy owns the practice which has over 50 Psy DR.'S and 100 Therapists. So I think he should no the law's. He has a Lawyer who is employed for the practice for law suit issues. This is infact a law suit issue and I would tell your friend! Lets say you had a hunch he was going to this Therapist and you asked you and he denied it for what ever reason and so you make an appointment yourself with her and try to get her to tell you a name of a patient she see's by saying you were refered etc.. afair etc.. and she reveals his name wouldn't that be breaking the law? Heck yes. Or if you were his wife and thought he was having an afair and so you go in pretending to be his mistress ans the t blurts out his name it is like she is guesing because the male client has told t he had an afair. So Therapist wouldn't guess a male client who has never mentioned having an afair. Best of luck to you. IMHO I would feel not so safe to tell her scarey things about your past.

Bump

1. She should not have blurted out a patient's name no matter what. I've been in this situation - the same therapist as a friend - and all three of us knew it - and we all knew that we all knew it and STILL the therapist never indicated knowing the friend when I mentioned his seeing her. Because she didn't have his permission, nor was there any reason to ask for it. That's the way it should be.

2. If she felt that it would be useful for her to know the name - she could just have said so and made a case in general terms ("I thought it might help me understand such and such blah blah"). She could have explained the general principles of confidentiality and how she thought it did or did not apply here. Pressuring you and trying to "analyze away" your understandable reluctance is a big red flat you're absolutely right. That, to me is the biggest red flag, because it's a real mind game.

3. I have had one psychiatrist refuse to take a family member of mine as a patient because he thought it would be complicated to deal with possible conflicts of interest. AFAIK there's no ethical guideline against treating friends or family - but I thought that was a very proactive, reasonable position. i.e. It *might* make it difficult to be honest about your feelings about a family member if you knew that you were talking to that person's psychiatrist and it might affect their relationship. You might just want to say nice innocuous things. And it sounds like you're experiencing just that internal conflict.

My pnurse won't even let me glance at her appointment book, just incase I see one of the names.

I am shocked that your therapist would ask who referred you. It is none of her business, and a huge breach of confidentiality.

I would find someone else, fast.

Not too surprisingly, my friend was also puzzled as to why the T insisted on knowing who referred me; and was just as shocked as I that the T had intuited / guessed his name. However, the really interesting part is that he still had a good opinion of her, based on his previous work with her. He also spoke of a co-worker who was being helped.
Credit to Rapunzel for an accurate and intelligent read on the T's stated intentions, which was to clear a block that would interfere with therapy. I have tried to avoid a knee-jerk reaction here, because I could be clinging to unhelpful patterns. A detached consideration is important.
To make a long story short, I concluded that I need a new therapist, as this one has shown herself to be at least impulsive, possibly reckless and willing to violate her own stated code of ethics. The damage to my trust is irreparable.
Another client might not feel the same way, of course, and benefit from this T. In my case, one reason I will steer clear is because of a bad brush with an aggressive doctor, who misdiagnosed my condition and put me on a drug that came close to killing me. I also knew a psychologist socially, who had a weak grasp of ethics (dropping name of famous client, for example) and is now facing jail on unrelated federal charges. Not a good example there. So where another client might feel the need to be taken in hand, I have reason to distrust such an approach.
The code of ethics of the Association of American Counselors, to which she claimed to subscribe, states: "Counselors do not share confidential information without client consent or without sound legal or ethical justification." And also "Counselors maintain awareness and sensitivity regarding cultural meanings of confidentiality and privacy. Counselors respect differing views toward disclosure of information."
While actual disclosure did not occur, the fact remains that it could have -- as others have pointed out -- I could have been lying, on a fishing expedition, whatever. And she disregarded my vehemently-stated need to keep information private.
Of course, the T can say the demands of treatment necessitated a breach-- but in only the 2nd 45-min. session? I doubt the ethics panel of her association would agree. This was simply a power play. Everything about her methods screams "my way or no way", from her telling me off the bat that all "analysis doesn't work" and that she would "eradicate" my "bad behaviors." It's not like I was forced to go into her office. I came in asking for help, open to new ideas. She didn't need to force any issues.
So, lesson learned, gold found in the dross (a steer toward investigating ADD).
I will always wonder if this T did my friend more harm than good. Would he still be married (he speaks of his divorce with great regret) if he had chosen another T? I don't believe it's my place to suggest this to him, at least at this time. I will not discuss the T with him anymore. I just hope she doesn't discuss ME with HIM.

Ingomar, this sounds like the decision you need to make for yourself. Good luck finding a new T.

Recently, I went to a family counselor who my individual therapist had recommended. The family counselor was very respectful when he asked me who had referred me. He said, "may I ask who you got my name from? you don't have to tell me if you don't want to." This guy is very respectful and even that little interaction helped build trust between us.

Ingomar, will you tell this T why you are dropping her?