So, the most recently viewed entry of mine was ‘Why I don’t do free consultations’. Interesting. Perhaps it’s time to switch topics, write another blog in the spirit of…what? Consumer advice? Secrets from inside the therapist office? Well, maybe this entry will be along those lines, sort of.
If you’ve ever been in therapy (or if you are one) then you’ve probably come across the norm/ethos that therapists can and should work together with other professionals–doctors, other therapists–to provide optimal care for clients/patients. It’s a collaborative approach, a team approach. “Let’s see if we can get on the page”, someone might say, prefacing a discussion. There are procedural elements to navigate: each professional must obtain a signed consent form, from the client/patient, to speak to another professional, divulging confidential information, and must define the parameters of disclosure, such as categories of information, and a time-frame for the exchange of information (most consent to exchange information agreements don’t last longer than a year).
Given that a top priority, both legal and ethical, for any therapist is that of maintaining confidentiality, you might wonder the following: what are the specific pretexts for recommending an exchange of information with another professional? We surely can’t just employ the “isn’t is good to get on the same page” rationale with everyone, can we? Answer: of course not. So, what are the conditions that merit the so-called collaborative, or team approach? And when is it contraindicated (as we say in the biz) — as in not appropriate?
Well, to take the first category, I’ll start with one rule of thumb: I ask, ‘is this professional going to be working directly with my client?’. Meaning, are they the treating physician, someone who is overseeing medications, attending to physical needs, withdrawal symptoms from substances, for example. When working with someone who is either in an active phase of drug abuse or addiction, or in early recovery from substances, I will often agree to consult with a client’s physician, partly to determine if that client is compliant with their regimen, medically safe (BTW: I would have that reasoning understood by my client so as to avoid an air of secrecy or gamesmanship). Secondly, I would consult with a fellow professional if that person were working with my client in another format of therapy, say, couples’ therapy. In that situation, it may be helpful for the other treating professional to have my impressions of my client from an individual therapy, for example–impressions that may facilitate the progress of the couples’ therapy (again, for similar reasons, this would be explained to my individual client, who could of course block any such communication if having reservations). Finally, there are structural realities which determine whether therapists communicate with other professionals: if you see your therapist in a hospital-based setting, or as part of an agency, or if your therapist is a pre-licensed clinician, you should expect that he or she regularly consults with doctors, supervisors, peers, even teachers, as part of an established, collaborative team set-up.
But this is not the case in private practice, generally, and while private practice therapists often employ consultants so as to not be isolated in their thinking, they (including myself) don’t always agree to consult with another professional who wishes to exchange information about my client(s). A typical scenario is the following: a therapist for a partner of my client calls up, wanting to exchange information, having obtained consent from his or her client to speak to me. However, I don’t have a corresponding consent from my client, so I don’t return the call. I address the situation with my client, who may or may not object to the prospective exchange. I determine if my client is seeing the other professional in another context, such as couples’ therapy, or a doctor’s office, if a physician. If not, then the prospective exchange has not met the first criteria: the other professional is not working directly with my client. Secondly, I consider if there is a critical reason for such an exchange (like the aforementioned substance use issue, or another crisis that requires management). If that also is not clear, then that other professional’s call may remain unreturned, because confidentiality is more important than professional courtesy, basically.
When the value of a professional exchange is not clear to me, then I suppose the following: a savvy partner, and sometimes estranged parent, is looking to circumvent confidentiality barriers in order to infiltrate the therapy of my client, and effect an influence, by using their therapist, plus that zeitgeist ethic of collaboration. After years of facing such situations, I decided finally to articulate my opposition to these kinds of subtle gambits, which do more damage than good. If professionals don’t practice good boundaries–if their sharing is too profuse–then individuals are provided with backdoor access to the private process between a therapist and a client, which in turn will damage trust sooner or later. As for that popular and sometimes insidious phrase, “Lets see if we can get on the same page”: as often as not, I find that invitation is not quite as collaborative as it may seem. The phrase might be translated as “would you please read the same page as me.”