Anonymous wrote:OP here. My wish or expectation for the two to connect is simply to coordinate and perhaps some information could be shared with the MFT that might accelerate our treatment plan. My assumption is that after 6 years, his therapist would have some information that could be helpful to our therapist in moving us forward. I worked in mental health a long time ago and even then, this was a pretty standard request. And the fact that our MFT seemed surprised and said she had never been told no before seems to underscore how strange it is.

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Anonymous wrote:Yes he signed a release.

He did it for show. He doesn't want his therapist talking to the joint therapist. His therapist is being the "bad guy" by refusing, but is doing so at your dh's request.

If the therapist says it's her policy not to speak to other therapists, but that's not actually her policy and she is covering for a client, that would be dishonest and wrong.

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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.

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

… 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. If she wants to find out if he’s still seeing his AP, that’s another. 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.

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.

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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.

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

Thank you for getting it and for clarifying. I very much appreciate both. Yes, I'm defensive and also, frankly, weary of being attacked by people who were responding to things I never wrote. Why should I try, again, to explain myself to people who are openly hostile towards me because of things I didn't actually write?

I will clarify something, though: one of the examples in this thread of stigma against mental illness is the idea that psychotherapy isn't "real" healthcare. It is. Healthcare professionals licensed to provide psychotherapy (e.g., social workers, psychologists, etc.) are just that: healthcare professionals.

LCSW, thanks again. OP, hang in there.

What you wrote is that you needed to come to an agreement. If that wasn't what you meant, that's on you. It is nice that you are being bailed out by a fellow therapist who is both more measured and more articulate than you are, though.

But: AGAIN with the "real healthcare" talking point? You have a serious chip on your shoulder; that isn't all pertinent to this subthread. I for one believe therapy is healthcare, when provided by a competent professional. Your writing here leave me (and others) to wonder whether you fit that description.

DP and not either of the professionals you're discussing, but why is personal insult something that you feel obliged to do here? Why the compulsion to be ugly and make this into a slam at one PP's professionalism? And by the way, highfalutin' statements about your own belief that "therapy is healthcare" do not make it OK to then turn and get personal. This is some of the worst of DCUM: People who post from on high about how enlightened they themselves are, just before they insult other PPs. If you're not OP, you could have just let it go, but you made a choice to snark, instead.

Is it insulting to point out that someone own statements cast doubt on their capacity to be a professional? Really?

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Anonymous wrote:OP here. My wish or expectation for the two to connect is simply to coordinate and perhaps some information could be shared with the MFT that might accelerate our treatment plan. My assumption is that after 6 years, his therapist would have some information that could be helpful to our therapist in moving us forward. I worked in mental health a long time ago and even then, this was a pretty standard request. And the fact that our MFT seemed surprised and said she had never been told no before seems to underscore how strange it is.

He doesn't want her to talk.

Seriously, this is patently obvious. OP, how do you not get this?

I guess I am just wondering if it is at all likely that this is a plausible story. That the therapist “never” talks to other therapists about patients (with a consent form of course).

You know the truth. What you do with it is up to you. Hanging on to the idea that the therapist is the one withholding info is a means of denial. I wish your dh would tell you the truth, because you're spinning in circles. This seems like gaslighting by your dh and supported by the therapist and your marriage counselor is giving you false hope.

Anonymous wrote:

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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 please. Outside of severe mental illness (not clear if it exists here) there is ZERO reason to be so insistent that a patient has to give up confidentiality. The more you insist on it, the more reason I have to believe you don’t deserve it. Trust has been imperative between me and my therapists - I don’t think it would be appropriate for them to share any impressions with anyone else unless I was in some sort of severe crisis. In this case the marriage counselor seems to have some blurred boundaries. Possibly colluding with OP to turn the DH into the “identified patient” in the family, which I have seen happen before.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:OP here. My wish or expectation for the two to connect is simply to coordinate and perhaps some information could be shared with the MFT that might accelerate our treatment plan. My assumption is that after 6 years, his therapist would have some information that could be helpful to our therapist in moving us forward. I worked in mental health a long time ago and even then, this was a pretty standard request. And the fact that our MFT seemed surprised and said she had never been told no before seems to underscore how strange it is.

He doesn't want her to talk.

Seriously, this is patently obvious. OP, how do you not get this?

I guess I am just wondering if it is at all likely that this is a plausible story. That the therapist “never” talks to other therapists about patients (with a consent form of course).

Anonymous wrote:OP here. My wish or expectation for the two to connect is simply to coordinate and perhaps some information could be shared with the MFT that might accelerate our treatment plan. My assumption is that after 6 years, his therapist would have some information that could be helpful to our therapist in moving us forward. I worked in mental health a long time ago and even then, this was a pretty standard request. And the fact that our MFT seemed surprised and said she had never been told no before seems to underscore how strange it is.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:OP here. My wish or expectation for the two to connect is simply to coordinate and perhaps some information could be shared with the MFT that might accelerate our treatment plan. My assumption is that after 6 years, his therapist would have some information that could be helpful to our therapist in moving us forward. I worked in mental health a long time ago and even then, this was a pretty standard request. And the fact that our MFT seemed surprised and said she had never been told no before seems to underscore how strange it is.

He doesn't want her to talk.

Seriously, this is patently obvious. OP, how do you not get this?

Anonymous wrote:

Anonymous wrote:OP here. My wish or expectation for the two to connect is simply to coordinate and perhaps some information could be shared with the MFT that might accelerate our treatment plan. My assumption is that after 6 years, his therapist would have some information that could be helpful to our therapist in moving us forward. I worked in mental health a long time ago and even then, this was a pretty standard request. And the fact that our MFT seemed surprised and said she had never been told no before seems to underscore how strange it is.

NP. It's weird that you keep banging your head against this wall. Your husband doesn't want to share information to "accelerate our treatment plan." He signed the marriage therapist's form because you pressed hiim. Then he told his therapist not to share.

Blame the "old lady therapist" all you want. Your DH is just less interested in making the marriage work than you are.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:OP here. My wish or expectation for the two to connect is simply to coordinate and perhaps some information could be shared with the MFT that might accelerate our treatment plan. My assumption is that after 6 years, his therapist would have some information that could be helpful to our therapist in moving us forward. I worked in mental health a long time ago and even then, this was a pretty standard request. And the fact that our MFT seemed surprised and said she had never been told no before seems to underscore how strange it is.

He doesn't want her to talk.

Seriously, this is patently obvious. OP, how do you not get this?

Anonymous wrote:

Anonymous wrote:OP here. My wish or expectation for the two to connect is simply to coordinate and perhaps some information could be shared with the MFT that might accelerate our treatment plan. My assumption is that after 6 years, his therapist would have some information that could be helpful to our therapist in moving us forward. I worked in mental health a long time ago and even then, this was a pretty standard request. And the fact that our MFT seemed surprised and said she had never been told no before seems to underscore how strange it is.

He doesn't want her to talk.