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…”

From GoodTherapy.org:

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 Genius.com 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

[Pre-Chorus]
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

[Chorus]
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