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

Sep 23

What Therapy Is Like “From Both Sides”

Reading these fascinating, no-holds-barred essays, it’s sometimes hard to tell who is “crazier” – the patients or the therapists! Author Lee Woodruff, reviewing How Does That Make You Feel? True Confessions from Both Sides of the Therapy Couch, essays about what therapy is like

Therapist Sherry Amatenstein, who’s edited a new collection of 34 subjective essays representing “both sides of the therapy couch,” reportedly actually wanted readers to realize that therapists are neurotic too.

While some of the presented writers have been “shrunk,” some have been the “shrinks“—and some, similar to the lead character in my novel Minding Therapy, have been both. All the contributors, many of whom have written professionally, are listed on the book’s website. (Scroll down to find them.)

Just a sampling of titles by those describing what therapy is like from the client’s perspective:

  • Beth Sloan: “I Really, Really Hate You”
  • Jenine Holmes: “Therapy Is For White People”
  • Charlie Rubin: “Why I Didn’t Enter Therapy Sooner”
  • Janice Eidus: “The Therapist of My Dreams”
  • Pamela Rafalow Grossman: “With Some Gratitude to My Asshole Former Therapist”

Some brief details about other pieces in this category follow.

Susan Shapiro, author of the 2009 comic novel Speed Shrinking, is “a self-described ‘shrinkaholic’ and ‘therapy-lifer,’ who describes lining up a UN of advisers—an Indian psychopharmacologist, a Middle Eastern hypnotherapist, a Jewish Jungian astrologer—to meet with shrink-seekers for three minutes to exchange numbers à la speed dating” (per Dorri Olds, Tablet).

On the other hand, Beverly Donofrio relates what she’s learned from her experiences with 10 “serial therapists” over the course of decades.

Anna March‘s “Lies I Told My Therapist” confesses to six years worth of big falsehoods—because she couldn’t trust that her therapist would really care about her actual life.

Estelle Erasmus was placed in therapy at the age of 16 by parents who could never have suspected the potential damage. Nancy Szokan, Washington Post: The unethical “…Ron ‘(name kept the same to protect no one)’ told her he was going to help her ‘become a woman’ by getting in touch with her sexuality — and she’s explicit about things he said and asked her to do. But then she relates how he led her to insights that rescued her troubled relationship with her family.”

At least a couple pieces deal with therapy termination: Allison McCarthy‘s “How About a Hug?” and clinical social worker Martha Crawford‘s “Back Into the Wild.”

Therapists’ essays also include one by the book’s editor. A few of the others:

  • Juli Fraga: “When the Therapist Cries”—About dealing with therapist-patient boundaries.
  • Dennis Palumbo: “A Long, Strange Trip”—“…(A) mystery novelist and Hollywood screenwriter,” says Szokan, [Palumbo] “describes how he left a successful career and launched himself into six years of training to become a licensed psychotherapist. His friends said that proved he’d lost his mind. ‘I pretty much thought the same thing’.”
  • Nina Gaby: “I’m Not Supposed to Love You”—As she states in her own blog, “…I wrote about a kind of transparency, a kind of love…Not romantic love, not familial love, but a love that helps us do the work we do, a word that is often taboo in our profession.”

And in the grouping of essays penned by therapists who’ve also been in therapy:

Mar 06

“LA Shrinks”: Over-Exposed On Reality Television

LA Shrinks is “…the kind of show that could kill talk therapy.” Mark Perigard, Boston Herald

The new reality TV show LA Shrinks, about three upscale therapists, premiered Monday night at 10 P.M. on Bravo. MSN describes this series, which was actually taped last spring: “This new reality series follows the personal and professional lives of three very different Los Angeles therapists. Venus Nicolino, Ph.D., is a sharp-tongued life consultant and mom to four boys. Gregory Cason, Ph.D., is a psychologist specializing in cognitive therapy and living a ‘monogamish’ life with his partner of 23 years. Eris Huemer is a relationship therapist dealing with issues in her own marriage.”

The clients seen by the therapists on the show were selected by the producers and weren’t known to them until the series began filming.

Good Idea or Not?

The criticism began before LA Shrinks even aired. Goal Auzeen Saedi, Ph.D., expressed her distaste in a Psychology Today blog post. Her conclusion: “Even if a few rebels from our field decide to completely disparage and taint our reputations as a profession, we still prevail. How does that work? The knowledge of those two magical words in our lexicon that communicates volumes among us. Axis II.”

Axis II is the DSM‘s category for personality disorders.

Psychology prof Thomas Plante also weighed in via a Psychology Today post—not just about LA Shrinks but about all reality show therapy:

Since effective psychotherapy depends upon confidentiality, privacy, and the trust of and belief in the professional provider, it seems hard to justify psychologists participating in reality show therapy. The risks of exploitation seem just too high. Additionally, there are many negative unintended consequences that are likely to unfold with reality TV therapy as well. Finally, many of the professionals who participate in these shows are not licensed mental health professionals at all and are thus being deceptive about their credentials. For example, in the new Bravo show, only two of the three featured therapists currently have a license to practice as mental health professionals in California.

Selected Reviews of the Premiere Episode

Robert Lloyd, LA Times, reports that sex figures into it big-time. And “…almost everything that happens on camera here, outside the therapy sessions, feels uncomfortably contrived — the therapy just seems edited for effect…”

Mark PerigardBoston Herald, wonders about the clients/patients. Are they real or hired from “an improv troupe?” He points out that each therapist “happens to” see clients who have issues that seem to mirror or be pertinent to their own issues. “Where’s Dr. Melfi to call bull when you need her?”