Anonymous counseling?
January 27, 2010 5:55 AM   Subscribe

Do I have any option for getting real, professional counseling/psychological help while remaining anonymous? Further details inside.

I would like some advice on how to address my peculiar situation.

I suffer from a very malignant sort of personality disorder (for lack of a better term, it is the most accurate of which I am aware). Without going into detail, I will say that I endure compulsions toward behavior that is unequivocally dangerous. To be clear, I should say that I have not, nor do I plan on doing anything illegal or harmful. I just want to and feel it is prudent to prepare for possible future situations in which I may be less likely to resist.

There are certainly psychologist/psychiatrist/etc. professionals who deal with this sort of thing. However, I have avoided this because I am afraid their only conclusion is that I must be incarcerated in some way.

Do I have any option for getting real, professional counseling/help while remaining anonymous? Payment is not a problem.

Thank you in advance for any help you may be able to offer.
posted by calyx to Health & Fitness (13 answers total) 2 users marked this as a favorite
It would help if you could tell us which country/state or city you are in... services vary from place to place. Wherever you are there will be a solution but to get good answers from askme a little bit more info please...
posted by evil_esto at 6:03 AM on January 27, 2010

If payment is no option, maybe you could pay out of pocket and provide a first name only to the therapist.

And call them first and ask whether they are ethically required to report a hypothetical patient who feels a compulsion to commit a crime but does not have an intent to do so.
posted by A Terrible Llama at 6:08 AM on January 27, 2010

Response by poster: Sorry, I'm in Atlanta, GA.
posted by calyx at 6:15 AM on January 27, 2010

Best answer: You write that you are hoping for an anonymous therapist "because I am afraid their only conclusion is that I must be incarcerated in some way." I'd suggest looking into whether that fear is justified.

In general, therapy is a context in which people can talk safely and confidentially about their thoughts and feelings. This would often include thoughts and feelings that might be negative, destructive, etc.

These is an exception to that (what your fear is based on I’m guessing), if the therapist believes someone (the patient of someone else) is in danger.

My own impression is that if you have feelings of wanting to do something dangerous, but have no intention of acting on those feelings in the near future, and have never acted on them in the past (which I’m inferring from your post), this would likely fall pretty squarely into the normal realm of “talking about negative feelings” that people safely do in the therapy sessions. Lots of people, I think, have urges toward various sorts of antisocial behavior, and talk about them in therapy, and don’t get locked up.

Not to un-ask your question, but I’d like to suggest that you might want to examine the assumption behind it. Maybe you don’t need *anonymous* therapy (which might be hard to find). Maybe you just need therapy where you can feel safe talking about these destructive urges (which might not be as hard to find as you think).

(On Preview – Terrible Llama’s suggestion might be a good one: Meet with someone for one session paying cash and using just a first name. Express your concerns about the danger, ask them what they think. You may be surprised to learn that the regular protections of patient confidentiality are enough for you…)
posted by ManInSuit at 6:41 AM on January 27, 2010

"the patient of someone else" = ""the patient OR someone else"...
posted by ManInSuit at 6:42 AM on January 27, 2010

You may be over thinking this. It may be illegal to conspire with another person to commit a crime, or to threaten harm to someone, or threaten to commit a terrorist act. But (and, IANAL) I do not believe it is illegal, nor could you be incarcerated, for "thinking" about something illegal. Hell, I do it every day at a number of stop signs, and I seriously considered beating the crap out of someone yesterday.
posted by HuronBob at 6:44 AM on January 27, 2010

I am currently seeing a counselor and while I did give her my name, it could have been any name, she didn't check my ID or anything else. I paid cash for our meeting.
posted by chromatist at 6:54 AM on January 27, 2010

In the meantime, I suggest you read the wikipedia article about "intrusive thoughts". You will see that almost all people have unsavory thoughts regarding violence, sexuality, and cruelty from time to time. These thoughts can be related to their own children, siblings, parents, or loved ones. Even the elderly are not spared.

It might help to think of it like Big Blue, IBM's chess playing computer. This computer considers a large number of possibilities for its next move, abandoning some branches almost immediately because of disastrous and inevitable consequences. Our brain does the same thing. If some of the search paths you indulge in your thought processes scare or disturb you, a therapist can help root them out.

For what its worth, my own therapist has no trouble distinguishing between the violent thoughts that I associate with anger, and actions that I am intending of planning. He doesn't have any trouble because I neither intend or plan to do anything dangerous to myself or others; it sounds like you don't either.
posted by chrillsicka at 7:01 AM on January 27, 2010

Nthing the intrusive thoughts ... every time I cross a bridge on foot I have a terrible compulsion to/fear that I am about to throw my purse in the water. I HAVE NEVER DROPPED OR THROW MY PURSE IN MY LIFE, but the compulsion/fear makes it hard for me to cross the bridge even! I do not have this problem except on bridges, and only with purses (not backpacks or anything else). That's a terribly silly example, but these kinds of thoughts are terribly, terribly common.

If you read a little bit on post-partum depression, it's not uncommon for new mothers suffering from PPD to have thoughts of hurting their baby (accidentally or intentionally); such women hardly ever act on those thoughts. It's so rare that there is almost never an intervention w/r/t custody and care. They're simply intrusive thoughts, and the problem can be treated.
posted by Eyebrows McGee at 7:27 AM on January 27, 2010

If you have no intention of harming yourself or others there is no problem. Pay cash and use an assumed name.
posted by RussHy at 10:02 AM on January 27, 2010

Best answer: In addition to helping clients with their problems, therapists have a duty to protect the public. This duty isn't exercised by arresting anyone - it's more in the form of reporting to authorities. Once notified, the authorities (police or child/dependent adult protective services) conduct their own investigation to determine if a client has broken a law. For the most part, thinking dangerous thoughts isn't against the law (yet) - it's acting on those thoughts that authorities are concerned about.

In California, in terms of preventing violence, therapists have a duty to report if "the patient has communicated to the psychotherapist a serious threat of physical violence against a reasonably identifiable victim or victims." The key issues here are what constitutes a "serious threat." For child and elder abuse, the wording is that the reporter must have a "reasonable suspicion" of abuse.

Different therapists have different thresholds as to what would constitute a "serious threat" or a "reasonable suspicion." Some therapists are very risk averse and will report all kinds of things. Others have a broader sense of the range of fantasy and how it differs from actually acting some threat out. Different therapists will have different thresholds in terms of what would trigger a report, but in all cases, the therapists are trying to comply with reporting laws, prevent violence from occurring, and protect themselves from incurring liability.

I think it's safe to say that all therapists presume that if you come to them voluntarily, you're asking for some help with a problem. Sometimes it seems that clients are unconsciously asking therapists to report them as an external control to help them not act out some kind of awful impulse. If a therapist is convinced that you are troubled by these impulses and are not going to act on them, they have no motivation to report. If the therapist believes you *might* act on them, he or she might report as a way of preventing you from doing so and protecting the target of your impulse. You and a therapist probably need to get to know each other to get a sense of how the trust issues will work around these impulses. But if they report, it's not for it's own sake - it's in the service of helping prevent the client from committing some awful act.
posted by jasper411 at 11:11 AM on January 27, 2010

If you go to a therapist, I would honestly tell them "The reason I'm seeking therapy is that I have thoughts about doing illegal things. I have never done them and don't intend to do them--what are your criteria for reporting these sorts of thoughts?"

No therapist is going to report you just for ASKING.

(c.f. my experience: "The reason I'm seeking therapy is that I constantly think about killing myself. I've never done it [obviously], I don't intend to do it; at what point would my explanation of these thoughts cross the line, i.e. when will you report me/call the police?")
posted by saveyoursanity at 10:37 PM on January 27, 2010

Response by poster: My apologies for replying so late. Thank you, everyone, for taking the time to respond. You've all given me quite a bit to think about.
posted by calyx at 10:50 AM on February 4, 2010

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