Sep 14

Confidentiality: Keeping Secrets (Or Not) In or Out of Therapy

Most people, whether ever in therapy or not, are aware of the code of confidentiality. As therapist Daryl states to a client in my novel Minding Therapy, “Keeping secrets about you not keeping secrets is one of the therapist’s main obligations…”


Confidentiality includes not just the contents of therapy, but often the fact that a client is in therapy. For example, it is common that therapists will not acknowledge their clients if they run into them outside of therapy in an effort to protect client confidentiality. Other ways confidentiality is protected include:

    • Not leaving revealing information on voicemail or text.
    • Not acknowledging to outside parties that a client has an appointment.
    • Not discussing the contents of therapy with a third party without the explicit permission of the client.

For licensed mental health professionals, confidentiality is protected by state laws and the Health Insurance Portability and Accountability Act (HIPAA)

One of the main reasons it’s so important not to breach confidentiality is because therapy may be the first, maybe the only, place one’s confidences are disclosed. And people need to feel their secrets are in good hands.

This is not to say that everyone divulges all their private thoughts to their shrinks. For good or for bad, often there are things kept out of sessions. What to divulge is an individual choice based on any number of factors.

Even therapists in therapy might hold back. Andrea Rosenhaft for one. She’s a clinical social worker who calls her own years of omission “living heavy” and states on her Psychology Today blog:

I regret all the deceit, the secrets, and the manipulation. The blatant lies, the lies of omission have come back to hurt me in the form of the hands of the clock making endless rounds. I alienated psychiatrists, therapists and nurses with my calculating actions designed to mislead.

If I had been forthright, as difficult as that would have been, if I had simply told the truth, my treatment would have progressed much faster and perhaps I would not still need to be in therapy.

The jaunty song “Secrets” by singer/songwriter Mary Lambert (of Same Love and “She Keeps Me Warm”), on the other hand, is about things she would appear not to be keeping under wraps. These include personal tidbits involving such matters as the status of her mental health, her family issues, and her personality weaknesses.

She’s saying, in fact, that she doesn’t care if the whole world knows her secrets. (Which makes them no longer secrets, of course!)

The first verse and chorus of “Secrets” by Mary Lambert are as follows. See the rest at or watch the lyric video above.

I’ve got bi-polar disorder
My shit’s not in order
I’m overweight
I’m always late
I’ve got too many things to say
I rock mom jeans, cat earrings
Extrapolate my feelings
My family is dysfunctional
But we have a good time killing each other

They tell us from the time we’re young
To hide the things that we don’t like about ourselves
Inside ourselves
I know I’m not the only one who spent so long attempting to be someone else
Well I’m over it

I don’t care if the world knows what my secrets are (secrets are)
I don’t care if the world knows what my secrets are (secrets are)So-o-o-o-o what
So what
So what
So what

Nov 24

“After Life”: If You’re Wondering About That Therapist…

I recently finished both seasons of the British TV series After Life, a dramedy conceived by and starring Ricky Gervais. A  review excerpt from Jyotsna Basotia,, feels like an apt setup:

Ricky Gervais has hit the right chord with his latest show on Netflix, ‘After Life’, which is packed with a pinch of sarcasm and dollops of humor. The series revolves around Tony Johnson, who is depressed after his wife’s death. Soon after he loses the love of his life, he adopts a devil-may-care attitude and calls it his ‘superpower’. He decides to do what he wants and say what he feels with the final plan to kill himself when he gets tired of it all.

Warning: this post is particularly for those who are interested in major spoilers.

Therapy scenes are plentiful in both seasons of After Life. In Season One Tony knows the psychiatrist (played by Paul Kaye) is totally insult-worthy but hangs in there anyway, painfully too long. It’s such a relief when Tony eventually decides to fire him. Indeed, by the end of the first season, our protagonist “finally finds out that even simple conversations with Anne, an older widow, and Emma, his father’s forgiving nurse, have better healing powers than his traumatic sessions with the therapist.”

But then in Season Two it’s another main character who regularly meets with this shrink! The writer at What Culture makes a sharp observation:

As odious and offensive as Tony’s psychiatrist was last season, there could be an argument made for his existence because at least he served a purpose. The egotistical narcissist was a sounding board for Tony, yes, as the grieving man could tell him how he was feeling about the world, why he hated people and, in the process, ultimately realise that the man sitting in the chair opposite him was one of those people.

The funniest thing about the character was Tony’s bewildered reactions to the dreadful stuff he spouted, so the mind really does boggle as to why he needed to return for the second offering when Tony had left him behind.

This time, he’s paired off with Tony’s brother-in-law Matt and the result is far less appealing, resulting in boring monologues with offensive commentary that might (at a stretch) have been funny in the first episode. We didn’t need the five that followed.

So, what exactly are this psychiatrist‘s transgressions? Dan Peeke, Screen Rant, lists ten areas of fault, spanning both seasons. They include the following:

  • not paying attention
  • describing “a brutal description of exactly what he would do to Hitler if he had the chance”
  • telling Tony “just stop feeling sad” and Matt (dealing with marital separation) “don’t worry about it”
  • prescribing “sleeping around” to help the grief process
  • no apology or remorse when he gets the axe from Tony
  • open and crude obsession with sex
  • breaking confidentiality

Basotia ( also takes on the “clumsy and dim-witted” shrink in her piece titled “Paul Kaye may be funny, but here’s why he’s everything Tony’s therapist should NOT be.”

Furthermore, critic Matt Roush, TV Insider, labels this unappealing guy “the world’s most inappropriately vulgar psychiatrist,” and Allison Shoemaker,, nails it when she says he’s “one of the worst mental health professionals in television history.”

Other than After Life‘s off-the-charts caricature of the therapist from hell? Actually, this poignant series is well worth seeing. (And earns an 8.4 on IMDB.)

Sep 26

Psychiatrist Jokes: Have You Heard These Before?

Whereas yesterday’s post featured a visual caricature of a psychiatrist (on The Big Bang Theory), today’s takes a look at psychiatrist jokes. Why are therapist jokes more often about psychiatrists than other kinds of mental health providers? Is it because there are more stereotypes about psychiatrists than psychologists, social workers, mental health counselors, psychiatric nurses, etc.?

Quick—what do you picture when you think about these possible openings to jokes: “A psychiatrist walks into a bar…” or “One psychiatrist says to another…”

Did you think male, older, bearded, white, rich, stuffy…? Any or all of the above? Any others?

So many stereotypes, so many stereotypical shrinks to knock down a notch or two or three.

Whatever the case, read the jokes below—all found on the Web—and, if it fits for you, feel free to substitute any other type of shrink your heart desires.


I. Two psychiatrists pass in the hall. The first says, “Hello.” 

The other thinks, “I wonder what he meant by that.”

II. Two psychiatrists meet on the street. One says to the other, “You know, I thought I’d been completely analyzed, but yesterday I experienced the most remarkable Freudian Slip.”
The friend nods and waits to hear more…
The first psychiatrist continues, “I was having dinner with my mother, and I meant to say, ‘Please pass the butter’, but instead I said, ‘You miserable bitch, you’ve ruined my life!!!'”

III. A patient is seeing his psychiatrist for the first time and is undergoing the Rorschach test. After each ink blot the patient exclaims that it is a couple copulating. The psychatrist stops the test and observes, “You appear to have a preoccupation with sex.” And the patient replies, “You’re the one showing the dirty pictures.”

IV. A group of psychiatrists were attending a convention. Four of them decided to leave and walked out together. One said to the other three, “People are always coming to us with their guilt and fears, but we have no one that we can go to when we have problems.” The others agreed.

Then one said, “Since we are all professionals, why don’t we take some time right now to hear each other out?” The other three agreed.

The first then confessed, “I have an uncontrollable desire to kill my patients.”

The second psychiatrist said, “I love expensive things and so I find ways to cheat my patients out of their money whenever I can so I can buy the things I want.”

The third followed with, “I’m involved with selling drugs and often get my patients to sell them for me.”

The fourth psychiatrist then confessed, “I know I’m not supposed to, but no matter how hard I try, I can’t keep a secret…”

V. I told my psychiatrist that everyone hates me. He said I was being ridiculous – everyone hasn’t met me yet. (attributed to comic Rodney Dangerfield)

VI. Patient: “Doctor, doctor, nobody understands me.”

Psychiatrist: “What do you mean by that?”

VII. What do Psychiatrists say to each other when they meet?”

“You’re fine, how am I? “

VIII. Patient: Doctor, I get the feeling that people don’t give a hoot about anything I say.

Psychiatrist: So?