It was the end of the day at my internship, and one of the patients was discharging. At some time during one’s final wrap-up group, the concept of acknowledging each other outside of the treatment setting comes up. As confidentiality ethics and laws (thanks HIPPA) stipulate that a therapist cannot disclose any information about a particular patient without their consent, I always go into the standard, “if you see us in real life, say hi because we can’t legally say hi to you first” spiel.
Whenever I have given this speech, it is usually met with one of three responses. One is the eye roll/blank stare/”there’s no way in hell I’m saying hi to you if I run into you” glare. As angry as I would expect to be with this response, I can legitimately appreciate the honesty of these individuals, as I’ve struggled to fully internalize the fact that clients lie (another post for another time). The second is something along the lines of, “oh my goodness of course I’ll say hi if I see any of you!” Some have been stated genuinely, where others have been as phony as…a telephone? And then there’s the hesitant, “if I say hi, will you say you’re my [teacher/family friend/distant cousin/classmate/circus performer I met once]?”
I have yet to run into a current or former client outside of a therapeutic setting, but considering many of them live in the city, it is a very distinct possibility that we will cross paths. As strange as it may be to consider that your therapist has a life outside of the office, we sometimes choose to leave our apartments/homes/caves and go out and live relatively ordinary lives.
When a client asks me to lie for them, I usually refuse. I reiterate that I will not tell anybody any information I am not authorized to tell, but will not completely make up a story. Generally, this happens in the context of family therapy when a patient attempts to hide something from his/her parent/significant other and the parent attempts to dig too deep. In instances such as those, I say, “I think that’s a question you should be asking your daughter/son/significant other.” Within the context of therapy, the boundaries are usually more clearly established. But what about outside of therapy, when HIPPA states I can’t reveal anything without consent but my own ethical codes make me feel guilty about lying?
I sometimes recall the scene from Silver Lining’s Playbook in which Bradley Cooper’s character sees and approaches his therapist at a Philadelphia Eagles game. He promptly introduces his therapist to the group, and they all enjoy a few beers and (initially) engage in the harmless debauchery that defines tailgating at an Eagles games. But what would the therapist have done in the event Bradley Cooper’s character didn’t approach him? Would he have ignored BC’s presence? If Bradley Cooper introduced the therapist as an old classmate, would the therapist have gone along with the lie?
When someone asks if I can introduce myself as someone else, I’ll usually say something along the lines of, “I won’t introduce myself as anything, but I’ll go along with your introduction.” It’s a way to further establish trust and a positive therapeutic relationship, even after termination. But there’s also an uneasiness I get about being asked to lie for anyone, particularly for current or former clients, and I dread the day I run into an old client that introduces me as a family friend. The “right” answer is the one that won’t get you fired or sued, but it doesn’t quite feel right.
That same day, another patient said, “it must be kind of hard to be a therapist and keep secrets for so many people.” She hit the nail on the head – being the secret-keeper sure ain’t easy.