How do I process my emotions when I'm bound by confidentiality rules?

February 15, 2014 2:31 PM

How do I process my emotions when I am bound by confidentiality rules and can't talk with anyone about what happened?

I apologize in advance for the vagueness and lack of details, but...well, confidentiality.

Recently I was part of a group that made an important decision. It was the culmination of a long, grueling process that has taken a lot out of me emotionally. I am absolutely exhausted at the moment. My spouse knows I was part of this process, and can guess that I was unhappy with the outcome. I'm having trouble sleeping, eating, and being "normal" right now, and I know he can tell and is concerned about me, but we can't discuss the specifics.

This decision will seriously affect me, my family, and my community. It was done by a majority vote, and I was part of the minority who voted against it. Part of the problem is that for the foreseeable future, the ramifications of the decision will be part of my daily life, so it's not like I can just forget about it and move on in that way. There is also a 90%+ chance this decision will part of a legal challenge, which means I will have to go through this whole thing again in a courtroom. (This has already been discussed as a likelihood and is not just me catastrophizing.) The thought of this fills me with dread, even though I would actually be glad if the decision were overturned.

What I need right now is to be able to process my feelings emotionally. I am having a very hard time with this, because the way I would normally process this is to talk to my spouse, or close friends, or other professionals in my position. None of these options are open to me. (I'll admit I'm not sure if confidentiality rules apply when speaking to a counsellor or therapist.) There will also be no further discussion with the decision-making group.

This is really the first time I've ever been in this position and I am lacking coping skills in this arena. Have you ever been in a position like this? What did you do?

posted by anonymous to Human Relations (26 answers total)

confidentiality rules DO apply when speaking to a therapist, (assuming you're in the US)

Speaking from my own perspective as a licensed psychotherapist in Michigan, I am bound to confidentiality unless someone indicates they are a danger to themselves or someone else. Without a signed, specific release, I can not share anything I learn during a session.

That said, a therapist might be a good idea.
posted by HuronBob at 2:40 PM on February 15, 2014 [14 favorites]

I'm not sure that you should keep things confidential from your spouse if it will damage your mental health to stew on your own without support (and provided telling him won't break any laws).
posted by killdevil at 2:40 PM on February 15, 2014 [1 favorite]

I'll admit I'm not sure if confidentiality rules apply when speaking to a counselor or therapist.

Obviously, anything you say to a therapist/counselor/psychologist remains in strict confididence. And the only way anyone would know that you spoke about this to a counselor is if they got a court to order the counselor to break confidentiality. And that would take some serious lawyering to convince a judge to do so.

My counselor wife thinks you should be ok if you go to counseling. Which you absolutely should,
posted by Thorzdad at 2:41 PM on February 15, 2014 [1 favorite]

I am not a lawyer, but I think counseling would be appropriate, and as someone who has received counseling, I can vouch that my counselor/therapist took patient privacy very seriously. I'm also not sure why talking to your spouse about this is not an option. Unless you're working on something so high-profile that there would be temptation to go public, and where any public whisper of anything will immediately get repeated/go on the news, I can't imagine that talking with your partner, in confidence, would be a problem (laws permitting, of course).
posted by Alterscape at 2:45 PM on February 15, 2014 [5 favorites]

Confidentiality applies for a therapist in the US unless there's a threat of danger to yourself or others.

You can also ask the therapist not to take notes if you're really really really worried that someone could somehow subpoena something; and if you pay out of pocket there's no possibility of anything, even a billing code, getting back to your insurance company.
posted by fingersandtoes at 2:46 PM on February 15, 2014 [1 favorite]

Counseling, definitely. As I move into more senior roles at my organization, I find myself privy to and part of decisions and situations that I really struggle with. Sometimes it is just unbearably awful knowing something that you cannot act on but you know will adversely affect people you care about. And confidentiality makes you feel as if you are complicit, and will be seen as complicit, even if you fought like a banshee against it. And who knows, maybe in the big scheme of things, you might be.

The point is I think sitting with that is like trying swallow a rock - it can feel like choking, or being trapped in a pit filled it ants. It's just hard to sit still with it. Fortunately, our organization as a faculty staff assistance program, for confidential counseling. I have found it helpful, just to be able to lay everything out with a neutral party to sort out how to live with things I wish were different.

Hope it helps you as well.
posted by anitanita at 2:49 PM on February 15, 2014 [1 favorite]

What fingersandtoes said. Also, is travelling out of the area helpful? I ask because I grew up in a small town and there wasn't the confidentiality there that there is in bigger areas.

Another option would be to go to a priest and use the confidentiality of the confession to work through some things. That may not be appropriate for you but for people working through heavy stuff it's been a wonderful resource- many priests will help out in this way even if you're not a regular member of their church.
posted by small_ruminant at 2:50 PM on February 15, 2014

Oh honey, I am so sorry. You can and should speak to a therapist. Confidentiality will be maintained. Sending you good thoughts, I can tell you're struggling right now and I wish you peace.
posted by These Birds of a Feather at 2:52 PM on February 15, 2014

Nnthing counselling, and not talking to your spouse about it if that breaks confidentiality. The point about a counsellor/therapist is that they (should) have a supervisor that they can pass anonymous details up the chain to. If this thing is upsetting you, and you tell your spouse and it upsets him too, who does he tell? You're both kind of trapped together in this difficult thing but not in a way that's good for either of you. Let him know you'll be ok and that you'll offload to someone impartial, seek therapy, unburden yourself and let them carry it from there. Good luck.
posted by billiebee at 2:55 PM on February 15, 2014 [1 favorite]

In addition to therapy, I'd recommend keeping a journal; I know that's helped me at time to process and keep my thinking in order. Best of luck.
posted by kimota at 2:59 PM on February 15, 2014

I have a close friend who served on a school board that was forced to make heart wrenching decisions on a regular basis and was bound by similar confidentiality rules. She was not supposed to talk to anyone about the process, but confided in my that she did trust her husband and for similar reasons as it appears you are facing would discuss it with him. I have known both of them for years and not once, even while highly intoxicated and being prodded did he give up any information.

Yes, talk to a therapist, but you know your spouse well I assume. If your spouse is the type of person that can be trusted to keep a secret, I would talk to them regardless of your confidentiality obligations. I would normally second what kimota said about a journal, but if this is facing legal issues, a journal can become part of the documents for the case, and as such I would not keep anything written.
posted by JohnnyGunn at 3:03 PM on February 15, 2014 [8 favorites]

I'll admit I'm not sure if confidentiality rules apply when speaking to a counsellor or therapist.

I think the OP is making a slightly different comment here - they are saying they are not sure if they can tell a counselor about the decision they made (with the decision being confidential and/or having confidential information). What other people are saying here is that the counselor is bound by confidentiality (in general, the counselor can't disclose what the OP tells the counselor). These are separate issues.

You can tell anything you want to a counselor - but every confidentiality agreement I've seen does not provide exemptions for counselors. The question is if you'll get in trouble for it or not. Counselors can be ordered by a court to reveal discussion topics. If this decision is as wide-reaching as described in the OP, it would be prudent to check if it's a crime to break the confidentiality or a violation of a confidentiality agreement. In general, it takes a lot of work to order a counselor to provide information; that said, it's a lot more likely to occur if the confidentiality breach is a crime rather than just a breach of a confidentiality agreement.

This article provides very specific information on when a counselor is required to provide information.
posted by saeculorum at 3:08 PM on February 15, 2014 [5 favorites]

This is a little off-the-beaten path, perhaps, but you could talk about your feelings by using metaphor. Instead of "the school board voted to fire the principal. I was against this and I feel angry with school board member X, and deeply sorry for the principal" you could tell a story about how the inhabitants of Orion-7 exiled the head of their town council, because of a cruel member of the council who made up lies and persuaded enough people to believe him. And character Y felt angry and powerless and did not know how to fix things.

That's an awkward example, but you might find something that works for you.
posted by bunderful at 3:35 PM on February 15, 2014 [3 favorites]

Confidentially is one thing. Your mental health is another.

I happen to go by the marriage lines that "two shall be as one." Unless your husband has a tendency to blab, or you think this may be too much for him, talk to him.

or
Talk to a licensed psychologist. Not some counselor or rinkydink social helper type, but a full blown doctor.

or
Talk to a priest.

I don't have much respect for confidentially when it winds up screwing people over. The way this sounds, you, your family, and your community may be impacted negatively, and someone (thing) will benefit. I'd almost bet money is involved. You were sworn to keep this on the QT, but that doesn't mean you have to agonize over processing this with help from one of the three above.
posted by BlueHorse at 3:37 PM on February 15, 2014 [10 favorites]

I'll admit I'm not sure if confidentiality rules apply when speaking to a counsellor or therapist.

If you are bound by a confidentiality agreement, you should know its terms. If you don't know, then find out. It matters. Having said that, there is almost certainly a way to discuss your circumstance with a licensed therapist, whether or not that includes divulging specific details.

Have you ever been in a position like this? What did you do?

Yes. I'm an attorney, and I keep secrets. Some of them aren't easy. I'm not sure I have much insight to offer. I'm not an especially introspective person, and my honest feeling is that some people's constitutions are better suited to this part of the work than others'. It can be psychologically tolling.

Apart from the advice about finding out exactly what strictures apply to you, I guess that's why I'm commenting. Not so much to suggest a course of action or a coping strategy, because sometimes it's just damn difficult and you plod through. But more to say, "You're not alone." Because I do think that helps me, knowing that my profession and the world around me is full of people who are also burdened with secrets. It is a circumstance that feels alone but in a way isn't.

Good luck. I hope you feel better.
posted by cribcage at 4:06 PM on February 15, 2014 [3 favorites]

I was part of a committee that made a decision that would affect me, my family, and most of my friends (search committee for a new minister). It doesn't sound like it was as huge and broad as what you just completed but it has similar elements. The process was intense, and lasted almost a year. I couldn't talk to my husband, because he was a congregant.

What helped me was finding a sounding board that was not part of the community, but was someone I trusted; in my case, my father. Being able to think through things out loud with someone not on the committee was helpful. I did also talk to my husband about what I could - the structure of the process, funny stories that didn't give away important/secret things.

Good luck.
posted by booksherpa at 4:54 PM on February 15, 2014

If you have a confidentiality agreement, I can almost guarantee it doesn't permit you to disclose to a counselor or your spouse. The right thing to do is to ask whoever is the controlling party if the confidentiality agreement for permission to consult a licensed therapist if the decision or facts on which it was made are bugging you that badly. Unless it is a matter of life and death I can't imagine they would say no.
posted by MattD at 5:40 PM on February 15, 2014 [2 favorites]

Given what you suspect will be a later outcome of this situation, you need a lawyer anyway. Find one now, discuss with that person what your boundaries currently are and whether or not you need them to act on your behalf to ensure your protection so you can get help.
posted by Lyn Never at 6:18 PM on February 15, 2014 [11 favorites]

expanding on lyn never's good advice, you should also ask your lawyer what you can do to undermine the bad decision you just dissented from, so that it can be more easily reversed in court.
posted by bruce at 7:32 PM on February 15, 2014 [1 favorite]

Ask your lawyer to clarify who you can discuss this with. You may be able to draw up a non-disclosure agreement with a psychiatrist if needed. Often married partners are assumed to have confidentiality. And what about discussing this with your lawyer? If it's the weight of carrying this decision and loss alone, would writing down how you feel and what happened and giving it to your lawyer to hold for X years or until whenever the confidentiality agreement ends, so that it's at least on paper and still under client-lawyer protection.

I have people telling me terrible things often, about themselves or other people, and I have had to make horrible decisions about people that I felt I had no ethical authority to make except that no-one else could make that decision.

The only things that have really helped is accepting my own failures and limited abilities, the passing of time, and working to help someone else.
posted by viggorlijah at 2:42 AM on February 16, 2014

Won't this decision come out publicly soon anyway? Especially if a lawsuit, which is absolutely public record, will begin? Is the part that you're not allowed to disclose how you voted? Then don't tell anyone how you voted and talk about what is public. Once it comes out, I don't see why you can't talk about it with your spouse or a counselor, if that's what you need.
posted by AppleTurnover at 3:06 AM on February 16, 2014

You don't say what country you are in. In the UK there's an organization called the Samaritans that exists for these sorts of situations, when you absolutely need to talk to someone about something but don't think you can talk to anyone, and be totally anonymous at the end of the phone. If you don't know of a similar thing in your country but would like to, ask Jessamyn to update the question with your country.

Or if you have reasonably cheap international calling, you could just call them. It might work out cheaper than an hour with a therapist/lawyer in person, and give you total anonymity if that's what you need.
posted by K.P. at 3:07 AM on February 16, 2014 [1 favorite]

It's not clear from your question if you're asking what you can do with regards to your *legal* constraints or your *ethical* constraints?

If you want to know how to find someone to talk to without incurring any potential *legal* troubles for yourself, then you really need to consult a lawyer in your jurisdiction.

If you want to know whether it's *ethically* OK to discuss it with a licensed therapist/counselor (who him/herself is bound by doctor/patient confidentiality) or with your spouse (to whom you have made a prior commitment to share everything), the answer is "yes, of course" unless you're in one of a handful of very specific, special circumstances (e.g. you are a CIA agent or have your own patients you must maintain doctor/patient confidentiality for -- but even in those situations, there are usually allowances for you to speak to a therapist as needed albeit your choice of therapists may be limited).

No one has an ethical right to demand that you compromise your mental health and/or marriage to keep their secrets and thus you don't have an ethical obligation to adhere to such rules even if you initially agreed to them before you had all the information. (However, deciding "fuck their rules" could potentially land you in legal trouble so see above regarding consulting a lawyer in your jurisdiction.)
posted by Jacqueline at 3:10 AM on February 16, 2014

Can't say what's right or wrong, but I know what I'd do...

I sit on a civic board and, while it's mainly honored in the breach and lots of board members blab about all kinds of things we discuss, to the great detriment of the community, I do nevertheless consider myself bound by a confidentiality agreement.

But I talk about any and all of it that I feel I need to talk about to my spouse. I trust her to not go talk about it to others. And yes, that's a dumb idea if you're talking co-workers, most friends, etc. Yes, I'm taking a calculated risk that she'll be somewhere and say something without meaning to, but given the issues involved and her personality, those chances are remote.

I'd talk to a spouse before I'd go pay a therapist and talk to them, unless you are otherwise in therapy for other long-term issues. You're bending confidentiality either way, and I'd like my odds with a spouse better than a shrink.

I've also gotta say - unless this is your livelihood we're talking about, and perhaps even if it is - if it's affecting you this deeply remember to "put on your own oxygen mask first." It's amazing how much shit that volunteer situations can shovel on your soul. It may be time to start looking for a place to bail out.
posted by randomkeystrike at 3:11 PM on February 16, 2014

This question has been digging at me. I'm not a lawyer, but after reading the thread, the thing that resonates with me is the difficulty in pinpointing EXACTLY how your legal rights are constrained and what the possible risks are. Here's something I would consider if I were in your position:

1) Make a copy of the document*

2) Replace all references to the secret activities with something innocuous, like 'work at my candy company with my secret recipes'.

That part doesn't have to be plausible or even coherent. The idea is to preserve as much of the speech-constraining legalese as you can, while scrubbing out anything that could identify the original nature of the work you did.

3) Go to a lawyer with the document. Ask "hypothetically, if I wanted to start a company and all my employees signed this document, would they be able to discuss the details with a therapist?" Basically, the legal version of Blue Horse's suggestion.

Make sure to also ask about what the actual penalties for a violation could be. Are we talking a fine? Jail time? Contracts can specify all sorts of weird penalties that may actually not be enforceable, even if you agree to them.

Depending on what the lawyer says and does, you might feel brave enough to ask "what if I was one of the employees?" Whether or not you take the conversation farther depends on your comfort level.

4) Make further decisions based on your understanding of how the contract has actually constrained you, and what the possible risks are.

Ideally, this will allow you to understand the true legal nature of the NDA without violating either the spirit (don't talk about the things we did) or the letter (don't even talk about the NDA itself). Again, I'm not a lawyer. Additionally, I'm *pretty sure* that by making a new hypothethical agreement with derivative language, you have a very strong defense should news of you investigation ever leak: at worst, I would imagine you could get charged with something like plagarism. Again, I AM NOT A LAWYER. Use these suggestions at your peril.

* Rather than hand-copying, I recommend scanning the document and running it through some kind of OCR tech to get the raw text. A quick google turns up https://code.google.com/p/tesseract-ocr/, but I've never used it.
posted by ®@ at 3:57 PM on February 16, 2014 [1 favorite]

No idea what your situation is. In my job, we have some confidential thingamabobs and very clear language telling us that talking to spouse is a violation.

Not being able to say things - especially when you are surrounded by people who are blathering on and with a nasty and smug tone although they could not be more wrong about both facts and conclusions is wearing. Being suspected or accused of something and unable to defend yourself is horrible.

I enjoy watching Stella Dallas and reading weepy forties fiction.

If you can see a therapist, please do. Even if you don't say exactly what you can't talk about, you can get help managing these feelings and taking care of yourself.
posted by Lesser Shrew at 9:38 AM on February 17, 2014 [1 favorite]