“Before we go any further,” Dr. Smelt says, “I want to tell you a bit about confidentiality.”
“No need,” Fred interrupts, “I know that bull shit. You tell me you’re like a priest, but if the judge wants to know something, you’ll tell him. That’s the real world. All this stuff about confidentiality is a way for you to get me to spill my guts. But, I’m not telling you anything that could get me into more trouble with the law than I already am. How’s that for a start?”
“Wow, you sure do have some strong thoughts and questions. Let me see if I can answer some of your concerns. First, since you have been ordered into therapy by a court, confidentiality rules are a bit different. The judge can ask me to provide information about your attendance in therapy, which he probably will. He may also ask if you are making a good faith effort in therapy. The consent form I gave you gives me permission to answer those questions. Furthermore, like with all of my patients, if I believe that you are at serious risk of hurting or harming yourself or somebody else, I am obligated to report that information. This is especially true if the person that might be at risk is a child or an incapacitated adult. Otherwise, everything you say will remain confidential.”
“Really? I don’t believe you. What if I told you I was going to have an affair or get high or something like that?”
“The rules of confidentiality are quite clear. I might try to talk you out of doing something like that, but unless there is a clear threat of imminent harm I would not share that information.”
Fred asks, “So you expect me to believe if you were on the stand and the judge asked you a direct question about me you would refuse to tell him the truth?”
Sr. Smelt replies, “You know Fred, if I could predict the future with 100% accuracy, I’d be rich. But I can tell you that this judge has always respected confidentiality in the psychotherapeutic relationship as have I. I’ve never been put in the position of having to break confidentiality other than for the exceptions I told you about. But, Fred, more important than you knowing these facts is that right now, you don’t trust the rules or that I will protect you. That’s what we need to work on. I won’t be asking you to reveal anything yet that makes you too uncomfortable. And you can just tell me that you don’t want to talk about something. Ok? Deal?”
“So, if I don’t tell you the truth, it’s gonna be pretty hard for you to help me, right?” Fred argues.
“That might be right eventually, but let’s put that issue on hold right now. Do you have any other questions about how this therapy works?” Dr Smelt asks.
“Yeah, do I have to really come every week?”
“We all have times when weekly sessions won’t work, but especially in the beginning, I really like to see folks once a week. That way, we can get to know each other and I can get a better understanding about what’s going on.”
Fred groans, “So you’ll be calling the judge if I don’t show up once in a while?”
“Oh sure,” Dr. Smelt laughs, “The judge has a cruiser right outside that I can call to pick you up. Just kidding; let’s be practical. A couple of cancellations is pretty normal over the course of therapy. But I expect you to come to your sessions and be on time. And if you need to reschedule, just like anywhere else, show the office respect by calling a couple of days in advance. Of course, there may be a very occasional emergency—but not very often. That is one piece of information the judge will want to know: if you show for your scheduled appointments.”
“Alright, so you say that if I show up and just sit here without telling you the truth for a few months, that’s all I need to do?”
“You know Fred, I think you’re a fine character and we’re going to get along just fine. I’ll see you next week, same time, OK?”
“Oh we’re done, is it time already? We’re just getting started.”
Dr. Smelt looks up at the clock, “You don’t realize it Fred, but you’ve been in the office about 55 minutes. We need to call it a day. Next time I’ll get a bit more information about your current situation. It was so nice meeting you. Thanks.”
Dr. Smelt stands and holds the office door open. Fred looks at her and seems a bit uneasy. He’s not sure how the time flew by. He’s surprised to find himself anxious to return.
Photo Credit: Brenda Bono