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Dear Doctor Robert,
 I have been with my current therapy for nearly three years. Our work has been so/so, but I have been able to make some positive changes in my life. I am writing you because I am seriously afraid to go back to therapy. Several months ago, I mentioned to my therapist that I did not like when his receptionist (who also does his billing) used my whole name when calling upstairs to let him know I was there. Often the small waiting room was populated with other people and it made me really uncomfortable. I should also mention that I live in Vermont, which is 97% white and I am a black female. I am very visible in my community and this adds to my concern about privacy and confidentiality. At the start of my session I asked my therapist if it was possible that his assistant say, "Your 4:30 is here." Instead of announcing my name, a request I felt was reasonable. I didn't focus on the problem and offered a solution.
The next time I came in for a session his receptionist made a point of enunciating, "Scott, your 4:00 is here." and gave me a look which made me feel uncomfortable. In session I asked him if he had offered his receptionist the feedback anonymously or had he mentioned that I had made the request. He said he had told it her that I did. I thought this seemed like a confidentiality breach, as this was something I said to him during our session. He then explained that she was part of the staff and bound by confidentiality. I realize that legally he covered his behind, but I feel sick inside thinking that I don't have any way of controlling what kind of information he discloses about me. I have brought the issue up several times and (just typing this is making me cry) and each time he just reminds me that I signed the confidentiality policy and he has done nothing wrong. I am at a loss as to what to do. I feel helpless and as though I have no recourse.



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Hello, Ange--
Although your therapist probably is correct technically, as a practical matter has handled this situation unskillfully to say the least. In the first place, he should have told his receptionist to announce all patients in the same way, just as you imagined he would, without specifying to her why she was to do so. The "why" is none of her business. In the second place, replying to your very real concerns about your privacy in the legalistic way that he did  speaks poorly for his intentions, sensitivity, and honor as a therapy professional. His chief concern should have been about you and your feelings, not the legalities of the situation. Your therapist, having made a mistake, should have admitted it to you immediately, apologized for his error, and assured you that it would never happen again. Instead, when you repeatedly tried to make him understand that he injured you by his insensitivity, he beat you back with legalisms, further injuring the place in you which already feels a bit too visible. Perhaps if, by some magic, he could be forced to spend a few days walking around with black skin in Vermont, he would be a bit more able to understand.

You are absolutely correct in saying that his receptionist should not know anything about what happens in his consulting room, and, despite what he told you, she is not bound by confidentiality in the same way that he is. If she violated your privacy by telling someone, for example, that you are a patient who likes to complain, she could be fired by him, but that is all. If he did the same thing, he would have to face the Vermont authorities, could lose his license to practice, and possibly face a lawsuit. Those two situations are not equal, and he knows it very well.

Since you say that your work has been only "so-so," I would suggest leaving this second-rate guy behind, and finding a new, better therapist. That is your recourse. I understand that the idea of beginning again with someone new could seem daunting, but I imagine that in the event you will find it not too difficult, that you will not have lost anything already gained in your therapy with your current therapist, and probably, once you connect with a better practitioner, will find that you should have left this therapist long ago. He is not worthy of you.

Be well.

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page last modified December 1, 2007

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