The burden of confidentiality

On 12/28/04 there was an interesting article on the blog, DB Medical Rants, about the importance and burden of maintaining confidentiality. The author talks about the burden to physicians and it reminds me again of the importance of confidentiality for therapists. For most of my career I lived in the same town that I worked in. My kids went to the same school as some of my clients. I often felt like a Pastor might feel raising a family and making a life in the midst of a congregation.

What is not mentioned in this article is that the burden is also heavy for the family of the professional. The partner or children of the professional realizes that the professional has a secret life. When they see people of mutual acquaintance, they notice when the professional is being discreet. They learn to respect the boundaries, but it is a burden of sorts nonetheless.

Patients often don't understand the seriousness of the ethical requirement for confidentiality and ask inappropriate questions at times, and at other times tell their secrets to the professional's family members assuming that the professional must have told them which to their discomfort or horror they are just finding out for the first time.

While it takes energy to maintain appropriate boundaries I can't say that I ever found it much of a burden. While I care for my clients and their problems, I rarely take them home with me. As I get older I find it increasingly difficult to remember my clients and their stories which can be embarrassing. However, I have so many life stories in my head after 35 years of practice, that I don't trust myself to keep them all straight any more, and when I am having difficulty leading my own life, I sure don't want to have to take responsibility for anyone else's.

Having said that, I believe I am as compassionate, considerate, and sensitive as ever, just less voyeuristic and intrigued. The satisfactions from the work have changed. The stories don't scare me or challenge me so much any more because I have heard them before. They sound more familiar and predictable and while every person is unique and every situation somewhat different, I am more confident that I can help the person get through this. "Been there and done that" as they say and so the work becomes a little easier.

I am grateful to my clients who have taught me so much. They deserve their privacy and dignity. It is a small price to pay for the honor and privledge of being of service.

Link: DB's Medical Rants ? Sometimes we cannot really talk about our jobs.