Graeme Daniels Psychewriter

A funny, perhaps illustrative story. During a worryingly lengthy gap between sessions, two therapists, myself one of them, walk along a strip mall, drinking coffee, fretting over a pre-holidays downturn in business. I turn to my right to see a car roll away from its parking spot—nothing unusual in that, I’d think if I were to give this event the headspace to generate such words. My eyes turn upwards to the driver, in this case a dog—a Doberman, I think—staring back at me, undisturbed. I scroll my gaze about the animal, in search of a human being. What? The dog appears to be saying with its stolid expression. Is there a problem?

“Holy shit!” I say usefully. I point to the car, now rolling silently into traffic, its emergency brake having been released by the dog, it seems. My friend does more than exclaim, he responds. Launching himself into the lot, he wades into the area behind the vacated spot, a space of about fifteen yards, and begins waving his arms to alert drivers, pedestrians crossing the stretch to enter the mall. Thankfully, there is no one moving behind the car as it pulls out. As I follow my friend, a woman behind me, shepherding two children, shrieks in horror at the disaster in progress, only it isn’t that exactly. Moving about one mile per hour, the car rolls backwards onto a curb and rather anticlimactically comes to a halt, bumping up against a vehicle fronting another row of cars.

Despite the absence of crashing sounds, the spectacle of a driverless car rolling a curb has drawn a crowd. A handful of voices stand behind me making plaintive sounds, nothing constructive. “What kind of car is that?” I ask aloud, collecting my wits. I’ll need to poke my head into shop doorways, call out for the owner. “A Mini Cooper,” someone responds. Moments later, this woman and I are making brief rounds of the local stores, making announcements, being confronted with more stolid expressions, though not those of dogs. Soon I give up this endeavor and return to the car, now perched atop a curbed island, its driver, the dog, still looking out at me, wondering what the fuss is all about.

By this time, my friend has ventured farther afield, towards the supermarket across the way, where the search for the Mini’s owner may yield better results. I take out my cell phone and call local police, and within moments, as a store manager approaches looking inconvenienced, I am talking to a dispatcher, describing the event. Meanwhile, I ask the manager a stupid question: “Are you the owner?” He frowns. “Of course not,” he replies irritably. Away from the store, the customers are not always right. He gets out a pad, takes down a license plate and heads back to his store, resolved to find the car’s owner should he or she be in the market. Thereabouts, the owner of the struck vehicle, a genteel, elderly woman, appears behind me, scrutinizing her car. The front of the offending vehicle is fused to her right anterior headlight, leaving at least one visible scratch, but the elderly woman seems quite grounded, her priorities more humanely focused.

“Is anyone hurt?” she asks, apparently not seeing the dog in the driver’s seat. “I don’t think so,” I say, after which I explain about the dog, the rolling; my slow response to the unfolding of this, uh, accident.

A minute later the bad-tempered manager, flanked by an anxious looking woman, returns. I feel poised to ask if she’s the owner, as if I’m in charge of the situation, but I hold my tongue, as if not wanting to risk being wrong again, thus eliciting more ridicule from the manager guy. “Oh my God,” says the anxious woman, though more in common surprise than shock or horror. She looks inside the compartment of her car, sees that her dog is unharmed, and still unperturbed. By this point the crowd has dwindled. The spectacle, absent its comic, supporting narrative, is suddenly unremarkable. It just looks like a car parked really badly, with a few onlookers studying the problem. For the next few moments I go quiet, having intuited the brittle defenses of the rolling car’s owner. They begin with the elder woman’s innocent query: “Are you the driver?” The other woman flicks her head about, as if fielding a cat-calling. “I’m not the driver, I’m the owner,” she retorts. I suppress a smirk and flippant rejoinder. Technically, she right. The dog is the driver, the culprit, I want to say. My friend, determined to intervene, affects a sober voice and tells the story from the witness point of view. His explanation of averted consequences befits his style as a therapist: “Someone could have been badly hurt,” he says.

“I don’t need to be counseled,” the woman replies tersely. My friend denies trying to counsel—a lie, albeit a well-advised one at this stage. He turns away, not wanting to deal with her further. Shortly, the Mini owner woman turns to the elder woman, who visibly recedes, not wanting a fight, it seems to me. The other woman inspects the back of her Mini Cooper, gives a cursory look at the elder woman’s vehicle. “That’s not so bad,” she comments presumptively. She gives me a glance as I am positioned centrally—appearing significant, if quiet. I turn to the elder woman, feeling protective, and deciding to make implicit my importance. “I may have to leave soon, but I can give you my name and number if you want a witness.” The elder woman thanks me. At that point the Mini owner asks what’s happening and I explain that police are expected soon. “What did you tell them?” she asks suspiciously. I give a brief, just-the-facts description, which she rewards with the words, “of course it rolled. I didn’t drive it”. Duh, she exudes.

Later I reflect upon a few meanings, about denial, projection, even codependency (the owners of the two cars hugged as my friend and I moved away—conflict avoidance, we thought). I thought further about my own denial: the seconds of disbelief, regarding the surreal time-suspended roll of the dog-driven vehicle. I thought of the Mini owner, that anxious, embarrassed woman, who acted punchy when feeling surrounded, her possible neglect evident to several witnesses. In retrospect, it’s not clear that she acted neglectfully. Accidents happen, or dogs are smarter than we think, and eager to drive. Who knows whether that event could’ve happened to anyone? But it’s the persecutory anxiety that really strikes me: the impulse to defend, deflect, even find fault with those observing problems. Minutes prior to this happening, my friend had been explaining that he’s powerless over his clients, whether they will let him help them. His exchange with the Mini owner mirrored his earlier commentary. Whether or not that woman felt lucky to have avoided disaster, we’ll never know. At the time she couldn’t deal with the feedback, let us help. She couldn’t acknowledge what might have happened.

Walking by an antique store, looking at the old and discarded yet preserved, I happened upon faded signs with oblique aphorisms: sing though you are not heard; speak though no one listens. Were they antique notions, these calls to action? I was reminded of the Paul Simon song, “Sounds of Silence”, with its eloquent, melancholic reference to “people writing songs that voices never share and no one dared”. This appears to be a tragedy: a post-Kennedy death lament about brightness lost, squashed under oppression, the corruption of secrets. That was fifty years ago. Awakened, pop stars and their listeners found their freedom amid their friendly darkness soon enough, with words and ideas that were shared, because people dared.

Over the last year I’ve been writing a new novel, about a psychotherapist who wonders whether to speak out and be heard. The story parallels my own process, of course: my inner rumblings about my role within the mental health community; the role the therapist has within the community at large. It’s a unique, if ambiguous role, straddled between obligations: the duty to hold private or confidential the disclosures of individuals in a safe, therapeutic setting, unfettered by restriction, so that psychological healing can occur. This duty is offset by a sometimes explicit, sometimes vaguer obligation that therapists have towards the broader public: to protect children and the elderly from harm; to protect the imminently endangered from harm; to educate and/or soothe the countless selves that are depressed and suicidal, or paranoid and abusive, or even murderous. The public wants these selves medicated. Or, they want them locked up. Otherwise, they want them spoken to soon, by people who claim to know what’s wrong, not just what’s true.

And it’s not like it was two generations ago, when seeking a therapist meant finding a shrink who didn’t have a long waiting list, or else it meant settling for the pastor at the local church and asking for forgiveness, if not so much understanding. Nowadays, psychiatrists dispense pills and supervise hundreds of cases, but otherwise leave the detailed talking and listening to others: social workers, marriage and family therapists, psychologists, behavioral technicians; life coaches, certified alcohol and drug counselors, pastoral counselors with clinical education and training; specialists in everything from trauma, eating disorders, autism, to sex addiction—all these conditions that seem to have exploded in frequency. There’s a whole lotta sadness and crazy around, so business is booming, but there’s almost as many types of counselor as there are diagnoses, so not to worry: there are plenty of us ready, willing, and able to listen to the words, hold your secrets…most of them.

See, when I listen to Simon’s words—“people talking without speaking”, “people hearing without listening”, or “but my words like silent raindrops fell”—I consider different meanings, depending on my mood, or the pressure, internal or external, that I feel. Does the singer fear that his words will be punished? That his daring will lead to annihilation? Or does he fear neglect, a narcissistic wounding born of others’ misunderstanding, or indifference? For many who step into our offices, privacy is either a promise or a curse: the office is where the words spoken are kept. The office is where the words spoken are kept. When the session’s over, the frustrated speaker ventures away from the closet and witness, deciding whether to speak further, share in contexts of presumed lesser safety. Meanwhile, the professional has decisions to make: was there anything disclosed that must be shared, or should be shared, for the protection of society? Is there a victim to warn, or a hospital bed to make ready? Should police be contacted? If the issue is less critical, should family members, a partner, or a would-be collaborator be included? Should the individual’s thoughts and feelings be dealt with in isolation, held like a precious gift? Or is there a ‘system’ to attend to, with a village or team ethic invoked?

To varying degrees, people who enter therapy want the same things: to find space and acceptance for their distinctive selves—while reconciling these needs with a need for others’ proximity or acceptance. It’s the strategies that truly vary, depending on the conditions of being in relationship. In negotiating the psychic economy, some people hide in therapy while hoping to not hide in life—hoping that at some point someone will accept them and understand. Some are frustrated soap-boxers, profuse in their disclosures, treating the therapeutic space as a place for treasures to be taken out of the trove, gazed at and pored over, but taken no further. At the end of each hour, those thoughts and feelings, once delicately removed, are returned, ever to be kept safe. For some, words that are spoken mustn’t be retold. For the like-minded writer, the thought-provoking book, nurtured like a precious stone, must likewise be protected, and thus edited. Its original draft/self must be burned, actually, because its words cannot be read. They are raindrops.

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.”

Got a phone call last Monday morning. A woman saying she was a producer for KFI Talk Radio in Los Angeles asked if I’d be interested in going on the Bill Carroll Show an hour later.

“Uh, I’m on my way to work,” I said dully, half thinking this was a crank call. Days earlier I’d been quoted in an LA Times story about AB1775, the controversial child porn law that I’ve skewered so much on this blog it’s become my own kind of abuse victim. Following this media exposure, invites to talk shows were at least plausible, but if you were a self-published author suffering junk solicitation on a weekly basis, you’d be a little skeptical too. So given the short notice, I was a little indignant and a whole lotta skeptical. Still, I asked my wife to check out the show to which I’d been invited to see if it was legit, and indeed it was. In fact, it was so legit that it featured Melissa Melendez, the assembly woman who sponsored AB1775, in cozy discussion with host Bill Carroll, a Howard Stern-lite type who on the Monday show seemed sympathetic to Melendez’ bill, and fairly skeptical of what therapists do, especially with anyone who looks at child porn.

I sent that producer a snarky e-mail later in the day. Fuming at the one-sidedness of the day’s show, and further annoyed at gratuitous digs at my profession, I asked if Melendez was also given an hour’s notice before appearing—turns out she was. Anyway, the producer called back saying I could appear the next day during the same time slot, and rebut what I’d called the “anti-therapist drivel”. So, I was going to be on the radio. Specifically, I’d be on a station billed as the most popular in Southern California. I’d be on with Bill Carroll, talking about AB1775. It was on, I thought, sitting nervously in my home office, on hold with my cell phone pinned to my cheek. I was introduced as a therapist upset with the new law, and even more upset at being given short notice to appear the day before. Before uttering a word, I was set up as a self important clinician, clueless as to how the rough and tumble world of radio works. Bill Carroll warned me that if I spent time arguing about my precious need for adequate notice, I’d miss my chance to excoriate AB1775. I pictured my colleague Don Mathews, a plaintiff in the case seeking injunction against the bill, upon telling him I’d had a chance to make our case to God knows how many listeners, but squandered it railing against the media’s disregard of a professional’s time.

“I’m over that. Let’s talk about the law,” I said, like I was inviting a fellow gunslinger to draw. Moments later, I was deflecting Bill Carroll’s first ill-considered question, instead complaining that Melissa Melendez and others had misrepresented the issue. You see, they keep saying that because child porn is illegal, the new law is simply ‘clarifying’ matters related to reporting requirements, or updating language because of the internet phenomenon. Therefore, the law simply asks therapists to perform what has always been their duty.

Wrong. Or bollocks, as my nephew likes to say.

I pointed out to Carroll that this explanation doesn’t make sense. If the existing Child Abuse and Neglect Report Act stipulated that therapists and other mandated reporters reveal to authorities those who view child porn, then why was it necessary to ‘clarify’ this for supposedly confused mental health professionals, and thus re-write the law with the excuse that advances in technology had enabled more users? If viewing child porn—in addition to producing and distributing child porn—is and was understood as sexual exploitation, then what difference does it make to that understanding how many more people are able to do it? Are we to believe that some therapists started hearing words like “download”, or “streaming”, and became confused as to whether this constitutes watching child porn? No. What happened was this: some people noticed that the pre-existing law, which is over thirty years old, did not stipulate that viewing child porn is reportable by therapists. Thus, they sought a change, one that would sneak in behind a technological cover, a conflation of child porn use into existing abuse definitions.

The lawyers promoting AB1775 obfuscate on this point, repeatedly complaining that child porn use has always been illegal, and thus reportable. But illegal and reportable are not interchangeable concepts, as some appear to think, and lawyers in particular should know better. If therapists reported everything said to them that is illegal (and the list of things illegal but not reportable might shock you), we’d be little more than glorified informants for a police state. Does it not seem like common sense to point out that the most anti-social elements of our society don’t choose to enter psychotherapy, and even if they did—or were ordered into therapy—would they not simply avoid telling therapists about their child porn use if they knew such information would be passed on to police?* Lawyers. If this law sticks, lawyers may be the only ones left talking to child porn users–that is, advising them not to share their truths with therapists.

So I read out the new law on the air, which, as I promised, took about a minute of the radio show’s precious time. I pointed to the spot in the California penal code—section 11165—wherein the new deed was done: the words, “downloading, streaming, accessing, though any electronic or digital media, material that depicts minors engaged in obscene sexual conduct” (FYI: the latter term is defined rigorously elsewhere in the penal code) were inserted into a subsection of the code defining sexual exploitation, thus altering it from a matter of production and distribution, to include the more commonplace act of viewing. I then pointed out to Bill Carroll that the language of the law also implicated “sexting”, which is often practiced by teens (minors), over electronic or digital media (computers and cell phones), displaying their so-called junk (examples of obscene sexual conduct). Carroll was at first evasive, saying he didn’t think teens would bring this matter to therapy.

“I disagree,” I said. “Teens go to therapy. They talk about sexting, and because of how this law is written, therapists will have to report them to police.” The argument scored a hit with the host, and Carroll finished the show calling for a ‘tweaking’ of AB1775, thus, in effect, rebuking Ms. Melendez, who had earlier stated she was not interested in making changes. The show continued, with Carroll challenging my thoughts as to whether sex offenders could be treated at all; about whether they could be treated by circumventing the facts of their child porn use, by talking about feelings relating to porn use instead (surely not the intent of the prosecutorial AB1775 supporters). To his credit, Carroll seemed like he was trying to see things from a therapist’s point of view, which was refreshing given the previous day’s rhetoric. For the last five minutes, Don Mathews joined the show, demonstrating the flexibility of which Carroll had boasted, and spoke more pointedly about AB1775 harming instead of protecting children. Time ran out. Regrettably, I missed rebuking Ms. Melendez’ semi-informed assertion that priests and other clergy are also mandated reporters—this was partly in response to Carroll’s stated wish to punish those who fail to report if thereafter a child abuse instance or pattern occurs. Actually, neither he nor Melendez were aware that penal code 11166 allows for an important exception for the clergy: if they hear of child abuse in the context of ‘penitential communication’ (i.e.: confession) they actually don’t have to report child abuse.

Would assembly woman Melendez sponsor a bill that rewrites—excuse me, ‘clarifies’—that subsection?

* one more thing to clarify: as a point of law, a therapist must tell a patient of potential benefits, risks, and alternatives involved in any treatment procedure (this includes legal exceptions to the basic confidentiality rule).