Therapists Should Be Allowed To Write About Patients

Therapists, like those in many other professions, walk a fine legal line with their clients  Every time a psychiatrist or psychologist shares a piece of information about a patient's condition with someone other than the patient, they are violating the patient's right to confidentiality.

And yet, it happens. Therapists are human, and they cross ethical lines just as humans in other professional endeavors do. But a slight breach of patient confidentiality, such as mentioning a patient's condition to a group of colleagues or non-professional friends, is much different than writing about a patient's condition on a medium that the entire world can access and read.  

This is precisely what happened to psychotherapist Gary Greenberg, as he explains in a recent piece in The New York Times. Greenberg discovered that even though one may have a legal ability to write about a patient -- on the condition that it is highly disguised and does not utilize any of the patient's personal information -- the patient may still be able to recognize when he or she is being written about. And thus, the doctor-patient trust is forever broken.

For example, Greenberg's most recent book, "The Book of Woe: The DSM and the Unmaking of Psychiatry," contains several accounts of interactions between Greenberg and his patients.

In the Times article, Greenberg explains that he edited the book so as to sufficiently disguise his patients' identities; however, what he did not consider was the possibility that one of his patients might still recognize themselves in his work.

And that is precisely what happened. An angry patient confronted Greenberg about being featured in his book, showing Greenberg how fragile -- yet essential -- doctor-patient trust truly is.

Long story short: If psychiatrists are going to write about their patients, they need to obtain consent first.

The need to protect a patient's trust and confidentiality sometimes conflicts with the professional goals of psychiatry. Sigmund Freud was writing about his patients more than 100 years ago and maintained that analysts have a duty to publish what they learn from treating patients, as a blog post on The Psychiatric Times notes.  

In the modern world, personal privacy is highly valued and compels therapists for a variety of reasons, both legal and ethical, to obtain consent from the patient before publishing his or her case history.  Dr. Ronald W. Pies of The Psychiatric Times notes that the act of asking for an in-treatment patient's consent to include them in a piece of writing arguably violates psychiatric ethics in itself, as the conversation between patient and therapist becomes centered around an issue of the therapist's, rather than the patient's.

But the professional truth remains: If psychiatrists want to advance an understanding of certain types of conditions and methods to manage patient needs, they are inevitably going to talk about patients' conditions with colleagues and write about them in contexts other than simply meeting with these patients.  This is what doctors do, after all.  Psychiatry is slightly different since therapists are often dealing with intimate personal secrets of their patients, and that aspect of the profession carries with it the need to obtain consent.  

There is no easy fix; therapists have to carefully balance the interests of their patients with those of their profession. But the risks of writing openly about a patient outweigh the benefits, and therapists should value doctor-patient confidentiality above all else.  Therapists should therefore obtain consent from the patient before writing about their conditions, and use proper discretion if a patient does not want to be written about -- even in heavily-edited form.

Click here for the opposing view on this topic.

Sources: The New York Times, Psychiatric Times / Photo credit: John Sloan/Flickr via Psychology Today

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