<p>I know that a person (who is not a minor) has to give their therapist permission to discuss them with another person.</p>
<p>However, what if a concerned family member has information for the therapist that they feel will be helpful? Case in point - a friend’s spouse is in therapy; the friend feels that the therapist should have knowledge of some behaviors that the spouse may not be forthright about. Is it a breach of ethics (solely in terms of the therapist - the issues re: the spouse are a whole other story) for the friend to inform the therapist, accepting the fact that the therapist will not respond?</p>
<p>I don’t know about spouses but a relation of H (“Bunny”) has serious mental health issues and her sister (also her primary caretaker) cannot discuss Bunny’s behavior in the home with her doctors due to HIPPA laws. It makes no sense, since Bunny cannot be treated effectively due to lack of knowledge regarding her condition. </p>
<p>I believe this to be a rousing example of the Law of Unintended Consequences.</p>
<p>The therapist can listen, but cannot even acknowledge that friends husband is a patient. But I would hesitate to handle it like that. I would encourage spouse to see if she can come into session with patient.</p>
<p>Hmm… Not a HIPPA breach,as long as therapist does not let friend know spouse is a patient, but most still won’t want to handle it that way. Is the therapist supposed to keep the information or the source a secret?</p>
<p>The friend knows that the spouse is a patient of the therapist - and the therapist knows that the friend knows. The friend is just providing information; it will be the therapist’s decision what to do with it and whether to reveal it or not. Friend is actually hoping that the therapist will.</p>
<p>The friend can write a letter explaining whatever it is that they feel the therapist should know and send it to them; but the therapist can’t even acknowledge if the person is a patient. Be prepared for the friend to be upset though if they find out.</p>
<p>From my personal experience having been to the therapist with family member on several occasions and felt the need to tell the therapist information that I was not sure was being revealed in therapy. I spoke and the therapist listened. She obviously knew I was a family member and treated me as she always did in past sessions. However, I also understood that I did not want to put her in an uncomfortable position regarding the laws. I said what I had to say and I left. If what you need to do is provide information than do so, but don’t expect any feedback or talk regarding the patient.</p>
<p>If a person wanted to mail a letter to a threapist, there is nothing to prevent that. If a person called and wanted to talk to the clinician about a patient, the clinician, without a release, would not likely take the call, as he/she could not, due to privacy laws, acknowledge if that person was a patient , even if the person calling believes that the clinician “knows” who he/she is based on priviledged communication between the clinician and the patient.</p>
<p>Listen to Shrinkrap, she knows exactly what she’s talking about. The therapist can listen to the information but then what is he or she to do with it? For example, let’s say the friend discloses the information to the therapist. Then what? Is the therapist suppose to say, 'John, I know you’re cheating on your wife, or drinking too much, or gambling now." How is that going to help John? In all likelihood, John will feel picked upon and decide to quit therapy, so that doesn’t accomplish much except to drive the patient away. In order for therapy to work there must be a lot of trust between the therapist and the patient. </p>
<p>Furthermore, how will the therapist, who has no relationship with the friend know he or she is being given credible information. Perhaps the friend has their own agenda.</p>
<p>I just think it’s a bad idea unless the friend has knowledge that the patient may physically harm himself or someone else. Otherwise, I think it puts the therapist in the uncomfortable position of having a piece of information about the patient that may or may not be truth and then having to decide if and how they will act upon that information. Just my two cents.</p>
<p>Exactly-
How is one to know if the information is accurate (everyone sees the world though their own lens) and the patient-therapist relationship could be seriously damaged if the patient were to discover that there was any kind of communication outside, even with the best of intentions and even if only one way. It is a matter of trust. The friend should encourage the patient to tell the therapist- not tell the therapist for them.</p>
<p>The therapist can listen, and may probe this area with the patient. However an experienced therapist takes the info with a grain of salt, knowing that in many cases the info is just another’s perception, which may be clouded due to their own interests in the situation.</p>
<p>It is a slippery slope to even take the call. Without a release of information, I’d probably not do so. There are just too many potential problems. The relationship is between the doctor and the patient-- not interested third parties, even with the best of intentions. The clinician can’t address these issues without acknowledging at some level that confidence has been breached. Every risk management seminar gives these examples and advises against it.</p>
<p>My experience is that if any contact is made with an over-18 year-old’s therapist in conjunction with that patient, the therapist will tell the patient that someone from the outside has contacted him/her about the treatment or patient.
It seems to be protocol for the patient to be informed about these outside breaching communications.</p>
<p>A letter would work, but in MY office, anyone could leave a voice mail. But to be frank, if for whatever reason I found myself talking to “friend”, I’m pretty sure I’d be suggesting to tell it to their OWN therapist .</p>
<p>Hopefully, a therapist with experience will have an approach to eliciting important information. There are exceptions of course, but in those, treatment might be of limited utility anyway.</p>
<p>When I anticipate the information will be useful ( i.e.history of paranoid or grandiose delusions), I set up a plan for a “trusted informant” at the onset.</p>