DH’s therapist refused to talk to our marriage therapist

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:What is there to coordinate, though? Marriage therapy uses a different muscle, and has a different focus, than individual therapy. I wouldn’t necessarily think to have a marriage counselor consult with my individual therapist. I imagine you have specific circumstances that makes it more of a necessity?

Interdisciplinary healthcare is standard of practice. I don’t even consider couples therapy and individual therapy different disciplines, so this example is even more egregious; imagine if, say, someone’s PCP refused to talk to their ophthalmologist because it’s their “policy.” This situation is no different. As a therapist (I’m the psychologist PP), you’re darn right I want information from other healthcare professionals treating my patients, if there’s consent. It only improves my care - I’m one person and I only see this person in one context. When I worked inpatient, we had interdisciplinary rounds daily and at every single one of those, someone in one discipline, e.g., occupational therapy, shared information that a healthcare provider in a different discipline, e.g., psychiatry, hadn’t known about the patient and which was *relevant to their care*. Refusing to talk to any other healthcare professionals about anything is unethical care.

And what would you do if your long-time client cane to you with a consent to discuss his treatment with a marriage counselor, but told you that he signed it to placate his wife and he really didn't want you to have any discussions with the counselor?

Generally, I think it’s helpful in those cases to (1) examine why someone doesn’t want information shared and (2) see if we can come to an agreement on sharing some information. Some people seem to have a misunderstanding about what this kind of information sharing looks like. No one’s handing over audio recordings of any session or even progress notes from every session. It’s about two healthcare professionals having a phone/video call to discuss general issues of relevance, e.g., differential diagnosis, areas of treatment focus, etc.

To the PP who appreciated my earlier post about therapy being healthcare: thank you for your response. I’m glad you understood the point I was trying to make.

To the PP who thinks therapy isn’t healthcare: you’re wrong. Mental health is health. Licensed therapists are healthcare professionals just as much as are physicians, nurses, physical therapists, occupational therapists, audiologists, speech therapists, etc. Societal stigma around mental illness is problematic, but it doesn’t dictate, legally, what healthcare is, thank goodness.

Wow, you are really clueless. OP said her husband has a history of childhood trauma. Insisting, suggesting, coercing, or pestering a client to share confidential information is awful. Your stance shows you cannot be an effective therapist if you are incapable of understanding.

I hope you disclose your stance to your clients before they start seeing you. I would rather see the therapist who was adamant they won’t ever share. Which therapist are people with childhood trauma going to be more comfortable trusting and disclosing information?

You and others need to learn to read before slandering me. I never, ever, used words like insist, suggest, coerce, pester, or pressure. It’s also impossible to provide anything beyond a general response without knowing the individual patient and the situational specifics. Generally, though, it’s good clinical practice to communicate honestly with your patients. That goes for therapists and physicians, etc., alike.

This thread is a painful exhibit on just how deeply stigma around mental illness is entrenched in our culture. It’s heartbreaking. It sure as hell doesn’t help anyone.

Oh stop with the dramatics. You slandered yourself when you suggested you would try to “come to an agreement” about sharing when a patient doesn’t want to share.

Having a conversation and trying to come to an agreement is a bad thing? Trying to understand why someone doesn’t want information shared is a bad thing?

I never said I would disclose without a patient’s consent.

No one on this thread knows what’s going on with the OP’s husband, not really. But the fact is that competent healthcare professionals can and do talk with other competent healthcare professionals about patient care *when granted consent to do so*. Mental health is health. Mental healthcare is healthcare.

[Anonymous]

^^also, thank you, LCSW, for writing out the relevant issues so clearly and thoughtfully. Informed consent is an ongoing process!

[Anonymous]

The above has it right. In addition to HIPAA, there are additional disclosure restrictions that apply to mental health services, treatment, diagnoses, case notes and records (and even more restrictions for substance abuse treatment and services). These are governed by federal, state, and local laws, laws governing educational institutions, payer policies, provider practices, licensing bodies and professional standards. A mental health provider does not need to disclose to a third party any information that isn’t required by law (e.g., mandated reporter, serious immediate risk of harm that can be ameliorated by disclosure), and doesn’t need to provide a good reason or one that third party thinks makes sense.

OP, you’re not entitled to know, and you should take a look at why you feel so angry about it.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:What is there to coordinate, though? Marriage therapy uses a different muscle, and has a different focus, than individual therapy. I wouldn’t necessarily think to have a marriage counselor consult with my individual therapist. I imagine you have specific circumstances that makes it more of a necessity?

Interdisciplinary healthcare is standard of practice. I don’t even consider couples therapy and individual therapy different disciplines, so this example is even more egregious; imagine if, say, someone’s PCP refused to talk to their ophthalmologist because it’s their “policy.” This situation is no different. As a therapist (I’m the psychologist PP), you’re darn right I want information from other healthcare professionals treating my patients, if there’s consent. It only improves my care - I’m one person and I only see this person in one context. When I worked inpatient, we had interdisciplinary rounds daily and at every single one of those, someone in one discipline, e.g., occupational therapy, shared information that a healthcare provider in a different discipline, e.g., psychiatry, hadn’t known about the patient and which was *relevant to their care*. Refusing to talk to any other healthcare professionals about anything is unethical care.

And what would you do if your long-time client cane to you with a consent to discuss his treatment with a marriage counselor, but told you that he signed it to placate his wife and he really didn't want you to have any discussions with the counselor?

Generally, I think it’s helpful in those cases to (1) examine why someone doesn’t want information shared and (2) see if we can come to an agreement on sharing some information. Some people seem to have a misunderstanding about what this kind of information sharing looks like. No one’s handing over audio recordings of any session or even progress notes from every session. It’s about two healthcare professionals having a phone/video call to discuss general issues of relevance, e.g., differential diagnosis, areas of treatment focus, etc.

To the PP who appreciated my earlier post about therapy being healthcare: thank you for your response. I’m glad you understood the point I was trying to make.

To the PP who thinks therapy isn’t healthcare: you’re wrong. Mental health is health. Licensed therapists are healthcare professionals just as much as are physicians, nurses, physical therapists, occupational therapists, audiologists, speech therapists, etc. Societal stigma around mental illness is problematic, but it doesn’t dictate, legally, what healthcare is, thank goodness.

Wow, you are really clueless. OP said her husband has a history of childhood trauma. Insisting, suggesting, coercing, or pestering a client to share confidential information is awful. Your stance shows you cannot be an effective therapist if you are incapable of understanding.

I hope you disclose your stance to your clients before they start seeing you. I would rather see the therapist who was adamant they won’t ever share. Which therapist are people with childhood trauma going to be more comfortable trusting and disclosing information?

You and others need to learn to read before slandering me. I never, ever, used words like insist, suggest, coerce, pester, or pressure. It’s also impossible to provide anything beyond a general response without knowing the individual patient and the situational specifics. Generally, though, it’s good clinical practice to communicate honestly with your patients. That goes for therapists and physicians, etc., alike.

This thread is a painful exhibit on just how deeply stigma around mental illness is entrenched in our culture. It’s heartbreaking. It sure as hell doesn’t help anyone.

Where is there a stigma around mental illness in this thread? Many people have said that the individual therapist may be acting pursuant to her patient's interests. No Stigma there. Also, a PP asked you a simple question, and you won't answer it. You now fall back on the tried and true “impossible to answer without specifics” response, which is code for “I don’t really want to give the answer I will have to, but I don’t want to lie, so I’ll just refuse to answer.”

I also note that you previously wrote, “Refusing to talk to any other healthcare professionals about anything is unethical care.” So your inability to opine on something without specifics seems a bit situational, and convenient.

[Anonymous]

Anonymous wrote:^^also, thank you, LCSW, for writing out the relevant issues so clearly and thoughtfully. Informed consent is an ongoing process!

You should read and take to heart what your LCSW colleague wrote. She’s spot on. You are not.

[Anonymous]

Why does OP/the marriage therapist need this information? What coordination of care is necessary? I don’t think that was ever answered.

[Anonymous]

I’m a betrayed wife attacked by I’m guessing cheaters or OW a few pages back- it was my husband’s therapist that wanted to speak to me every couple of months to see what he was doing at home and what I was seeing as part of the ongoing evaluation and accountability for this particular mental health diagnosis. And, he was very transparent with everyone during this process. He wanted to get healthy.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:What is there to coordinate, though? Marriage therapy uses a different muscle, and has a different focus, than individual therapy. I wouldn’t necessarily think to have a marriage counselor consult with my individual therapist. I imagine you have specific circumstances that makes it more of a necessity?

Interdisciplinary healthcare is standard of practice. I don’t even consider couples therapy and individual therapy different disciplines, so this example is even more egregious; imagine if, say, someone’s PCP refused to talk to their ophthalmologist because it’s their “policy.” This situation is no different. As a therapist (I’m the psychologist PP), you’re darn right I want information from other healthcare professionals treating my patients, if there’s consent. It only improves my care - I’m one person and I only see this person in one context. When I worked inpatient, we had interdisciplinary rounds daily and at every single one of those, someone in one discipline, e.g., occupational therapy, shared information that a healthcare provider in a different discipline, e.g., psychiatry, hadn’t known about the patient and which was *relevant to their care*. Refusing to talk to any other healthcare professionals about anything is unethical care.

And what would you do if your long-time client cane to you with a consent to discuss his treatment with a marriage counselor, but told you that he signed it to placate his wife and he really didn't want you to have any discussions with the counselor?

Generally, I think it’s helpful in those cases to (1) examine why someone doesn’t want information shared and (2) see if we can come to an agreement on sharing some information. Some people seem to have a misunderstanding about what this kind of information sharing looks like. No one’s handing over audio recordings of any session or even progress notes from every session. It’s about two healthcare professionals having a phone/video call to discuss general issues of relevance, e.g., differential diagnosis, areas of treatment focus, etc.

To the PP who appreciated my earlier post about therapy being healthcare: thank you for your response. I’m glad you understood the point I was trying to make.

To the PP who thinks therapy isn’t healthcare: you’re wrong. Mental health is health. Licensed therapists are healthcare professionals just as much as are physicians, nurses, physical therapists, occupational therapists, audiologists, speech therapists, etc. Societal stigma around mental illness is problematic, but it doesn’t dictate, legally, what healthcare is, thank goodness.

Wow, you are really clueless. OP said her husband has a history of childhood trauma. Insisting, suggesting, coercing, or pestering a client to share confidential information is awful. Your stance shows you cannot be an effective therapist if you are incapable of understanding.

I hope you disclose your stance to your clients before they start seeing you. I would rather see the therapist who was adamant they won’t ever share. Which therapist are people with childhood trauma going to be more comfortable trusting and disclosing information?

You and others need to learn to read before slandering me. I never, ever, used words like insist, suggest, coerce, pester, or pressure. It’s also impossible to provide anything beyond a general response without knowing the individual patient and the situational specifics. Generally, though, it’s good clinical practice to communicate honestly with your patients. That goes for therapists and physicians, etc., alike.

This thread is a painful exhibit on just how deeply stigma around mental illness is entrenched in our culture. It’s heartbreaking. It sure as hell doesn’t help anyone.

Oh stop with the dramatics. You slandered yourself when you suggested you would try to “come to an agreement” about sharing when a patient doesn’t want to share.

Having a conversation and trying to come to an agreement is a bad thing? Trying to understand why someone doesn’t want information shared is a bad thing?

I never said I would disclose without a patient’s consent.

No one on this thread knows what’s going on with the OP’s husband, not really. But the fact is that competent healthcare professionals can and do talk with other competent healthcare professionals about patient care *when granted consent to do so*. Mental health is health. Mental healthcare is healthcare.

In this context, yes it is. Coming to an agreement means there are two divergent viewpoints that need to be reconciled. Here, one is the husband, who doesn't want his therapist (let's assume that's you) to discuss him with his marriage counselor. The other is . . . who? The wife? Who is not your patient? You're taking her position with your patient? Or is is the marriage therapist? Again, you are trying to get your patient to moderate his views because a third party wants information about him?

Or is it that *you* believe that therapists should talk to each other, and you are trying to convince your patient to change his position based on what your think? And you really don't see that is problematic?

Finally, stop repeating "mental healthcare is healthcare." We know. One person suggested is was different than medical healthcare (nowhere to the degree you are suggesting) and you are not using that as a shield because you don't want to honestly interact with other questions.

[Anonymous]

Anonymous wrote:I’m a betrayed wife attacked by I’m guessing cheaters or OW a few pages back- it was my husband’s therapist that wanted to speak to me every couple of months to see what he was doing at home and what I was seeing as part of the ongoing evaluation and accountability for this particular mental health diagnosis. And, he was very transparent with everyone during this process. He wanted to get healthy.

Then it sounds like your situation is nothing like OP’s.

[Anonymous]

Anonymous wrote:I don’t know if it is unprofessional but it sounds lazy to me. It’s entirely possible for two therapists to have a conversation about mutual clients, with client consent, without breaching confidence. The therapist just doesn’t want to do it.

BOOM!

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:What is there to coordinate, though? Marriage therapy uses a different muscle, and has a different focus, than individual therapy. I wouldn’t necessarily think to have a marriage counselor consult with my individual therapist. I imagine you have specific circumstances that makes it more of a necessity?

Interdisciplinary healthcare is standard of practice. I don’t even consider couples therapy and individual therapy different disciplines, so this example is even more egregious; imagine if, say, someone’s PCP refused to talk to their ophthalmologist because it’s their “policy.” This situation is no different. As a therapist (I’m the psychologist PP), you’re darn right I want information from other healthcare professionals treating my patients, if there’s consent. It only improves my care - I’m one person and I only see this person in one context. When I worked inpatient, we had interdisciplinary rounds daily and at every single one of those, someone in one discipline, e.g., occupational therapy, shared information that a healthcare provider in a different discipline, e.g., psychiatry, hadn’t known about the patient and which was *relevant to their care*. Refusing to talk to any other healthcare professionals about anything is unethical care.

And what would you do if your long-time client cane to you with a consent to discuss his treatment with a marriage counselor, but told you that he signed it to placate his wife and he really didn't want you to have any discussions with the counselor?

Generally, I think it’s helpful in those cases to (1) examine why someone doesn’t want information shared and (2) see if we can come to an agreement on sharing some information. Some people seem to have a misunderstanding about what this kind of information sharing looks like. No one’s handing over audio recordings of any session or even progress notes from every session. It’s about two healthcare professionals having a phone/video call to discuss general issues of relevance, e.g., differential diagnosis, areas of treatment focus, etc.

To the PP who appreciated my earlier post about therapy being healthcare: thank you for your response. I’m glad you understood the point I was trying to make.

To the PP who thinks therapy isn’t healthcare: you’re wrong. Mental health is health. Licensed therapists are healthcare professionals just as much as are physicians, nurses, physical therapists, occupational therapists, audiologists, speech therapists, etc. Societal stigma around mental illness is problematic, but it doesn’t dictate, legally, what healthcare is, thank goodness.

Wow, you are really clueless. OP said her husband has a history of childhood trauma. Insisting, suggesting, coercing, or pestering a client to share confidential information is awful. Your stance shows you cannot be an effective therapist if you are incapable of understanding.

I hope you disclose your stance to your clients before they start seeing you. I would rather see the therapist who was adamant they won’t ever share. Which therapist are people with childhood trauma going to be more comfortable trusting and disclosing information?

OP here. I never said this

[Anonymous]

Anonymous wrote:

Anonymous wrote:Your husband is the driver here, not his therapist. If *he* wants her to talk to another healthcare professional who provides care for him, she should do so. I’d argue that not doing so is unethical. That said, her resistance is bizarre and unprofessional - it would make me suspect he’s hiding something huge, frankly.

OP here. This does concern me. I agree - he is totally the driver. He doesn’t seem to get that he is the customer here. (Or client.)

Actually, based upon what you've said, DH wants out and doesn't wantto "get that he is the customer". His counselor isn't getting involved because he's leaving the marriage.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:What is there to coordinate, though? Marriage therapy uses a different muscle, and has a different focus, than individual therapy. I wouldn’t necessarily think to have a marriage counselor consult with my individual therapist. I imagine you have specific circumstances that makes it more of a necessity?

Interdisciplinary healthcare is standard of practice. I don’t even consider couples therapy and individual therapy different disciplines, so this example is even more egregious; imagine if, say, someone’s PCP refused to talk to their ophthalmologist because it’s their “policy.” This situation is no different. As a therapist (I’m the psychologist PP), you’re darn right I want information from other healthcare professionals treating my patients, if there’s consent. It only improves my care - I’m one person and I only see this person in one context. When I worked inpatient, we had interdisciplinary rounds daily and at every single one of those, someone in one discipline, e.g., occupational therapy, shared information that a healthcare provider in a different discipline, e.g., psychiatry, hadn’t known about the patient and which was *relevant to their care*. Refusing to talk to any other healthcare professionals about anything is unethical care.

And what would you do if your long-time client cane to you with a consent to discuss his treatment with a marriage counselor, but told you that he signed it to placate his wife and he really didn't want you to have any discussions with the counselor?

Generally, I think it’s helpful in those cases to (1) examine why someone doesn’t want information shared and (2) see if we can come to an agreement on sharing some information. Some people seem to have a misunderstanding about what this kind of information sharing looks like. No one’s handing over audio recordings of any session or even progress notes from every session. It’s about two healthcare professionals having a phone/video call to discuss general issues of relevance, e.g., differential diagnosis, areas of treatment focus, etc.

To the PP who appreciated my earlier post about therapy being healthcare: thank you for your response. I’m glad you understood the point I was trying to make.

To the PP who thinks therapy isn’t healthcare: you’re wrong. Mental health is health. Licensed therapists are healthcare professionals just as much as are physicians, nurses, physical therapists, occupational therapists, audiologists, speech therapists, etc. Societal stigma around mental illness is problematic, but it doesn’t dictate, legally, what healthcare is, thank goodness.

Wow, you are really clueless. OP said her husband has a history of childhood trauma. Insisting, suggesting, coercing, or pestering a client to share confidential information is awful. Your stance shows you cannot be an effective therapist if you are incapable of understanding.

I hope you disclose your stance to your clients before they start seeing you. I would rather see the therapist who was adamant they won’t ever share. Which therapist are people with childhood trauma going to be more comfortable trusting and disclosing information?

OP here. I never said this

Right. That was the PP who NEEDED her husband’s therapy notes to make sure he wasn’t lying to her.

[Anonymous]

OP, you may not realize this but when you post similar arguments against your DH at 11:52; 11:54, they all come up as posts on DCUM in sequence so we (or DH's lawyer) can tell they are being posted just minutes, one after another.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Your husband is the driver here, not his therapist. If *he* wants her to talk to another healthcare professional who provides care for him, she should do so. I’d argue that not doing so is unethical. That said, her resistance is bizarre and unprofessional - it would make me suspect he’s hiding something huge, frankly.

OP here. This does concern me. I agree - he is totally the driver. He doesn’t seem to get that he is the customer here. (Or client.)

Actually, based upon what you've said, DH wants out and doesn't wantto "get that he is the customer". His counselor isn't getting involved because he's leaving the marriage.

This seems likely. I suspect that you also think this on some level, OP, thus the intensity of your emotional response. Might want to get your ducks in a row, in case.