Reply to DH’s therapist refused to talk to our marriage therapist

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[quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous]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? [/quote]

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.  [/quote]

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?  [/quote]

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.[/quote]

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? [/quote]

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.[/quote]

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. [/quote]

[b]Having a conversation and trying to come to an agreement is a bad thing?  [/b]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.[/quote]

In this context, yes it is.  [b]Coming to an agreement means there are two divergent viewpoints that need to be reconciled.[/b]  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.   [/quote]

LCSW here.

My primary concern would be that my client was telling me one thing and signing paperwork that directly contradicted that with another provider. I would absolutely need to understand why that was happening, regardless of my decision about what to disclose. I would need to talk with my supervisor about it specifically, but my ethical feeling would be that if my client was telling me directly "I am not comfortable with you disclosing information about my work with you to my marriage counselor" my obligation would be to honor that. If that client had signed a release of information with someone else, that would need to be rescinded in order for this issue to be closed.

My professional feelings about coordination of care is that it is often very helpful. It is also sometimes not useful. Frequently, it's hard to get anyone to call you back at all. I do my best to return calls when I receive them, but it doesn't happen very often. I do work closely with the prescriber in my practice and several of our marriage counselors. We don't "round" on shared clients like would occur at a facility, but I coordinate with our NP because I see people weekly and she sees them monthly and sometimes I notice things before she does. It is care that reinforces itself, but I want to be very, very clear: my clients are ALWAYS aware of this. I don't talk to other clinicians behind anyone's back. I ask if there are things they would like me to communicate. I ask if they want to know what I plan to share. It is always a collaborative process.

THAT is what Psychologist PP meant when she said she wanted to have a broader discussion of the issue. She was seriously misinterpreted and got defensive, as people tend to do when they are attacked. Everyone can simmer down. We are all in agreement that the husband is hiding something here :)[/quote]

… and husband is perfectly entitled to hide whatever he wants. Right?

OP’s problem is that she has refused to say exactly what information needs to be exchanged. If her DH is schizophrenic and not med compliant that’s one thing. [b]If she wants to find out if he’s still seeing his AP, that’s another.[/b] What I strongly suspect is that she believes her DH is the  bad guy in the marriage and hopes that the DH’s therapist will “prove” that to the marriage therapist. [/quote]

She can hire a private detective for that.  But, seriously, I think I would want to know that if I were ever going to even attempt reconciliation.  If the therapist knew it and was going along with couples therapy---whew talk about taking your already dead trust issues with everything after betrayal even lower.  Serious ptsd would ensue.[/quote]

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