An Issue of Ego versus Ethics

By Shari Schreiber, M.A.


There's an insidious problem in the psychotherapeutic world, and frankly, I'm shocked and dismayed by it. Colleagues/friends are sharing the identities of their clients or patients, and I literally wince every time it happens. Bottom line, it's nobody else's business whom a therapist is treating--and that goes for their colleagues, their siblings, their best friends--or even, their spouse!

Many years ago, a family member (by marriage) grandly announced that his therapy client appeared on the cover of a high-profile magazine that month. My gut twisted, allerting me this was a serious breach of ethics. I had just returned to school in pursuit of my psychology degrees--and my uneasiness about this issue, was later ratified during that course work.

Protecting the privacy and confidentiality of clients, is supposed to be of the utmost importance. I've always placed a high premium on my own privacy, so this issue struck a pretty sensitive nerve with me, and I've taken a hard line in reference to it throughout my entire career.

The foundation of a meaningful, solid therapeutic relationship is built on trust, confidentiality and empathy. Let's just imagine, that the therapist is a public figure who's in treatment; would he/she not be troubled and angry to learn that their clinician defiled their privacy, by telling others about them?

I've assisted a few well known individuals, but my professional relationships have remained just that. No boundaries crossed, no dual relationships--and definitely no disregard for a client's anonymity. My piece on Bipolar Disorder discusses how difficult it is for someone of celebrity status to seek help, due to fears surrounding loss of confidentiality, and how shame sets the stage for suicidal deaths within our film and music industries.

Some therapists play it fast and loose with this issue, no matter how many ethical or regulatory laws the BBS institutes to prevent this kind of boundary violation. It seems they can't resist the temptation to exalt their own egos when a famous individual has enlisted their care--but from where I'm sitting, it's just plain wrong, and I'm disheartened by it. This sort of practice does not raise my esteem for these clinicians, it lowers it--and it's stopped me from referring-out to them. Is their narcissism showing, or just their insecurity? Is there a difference??

Human nature delights in its close encounters with fame--but given this very common tendency, is it actually fair to reveal one's "secret client" to a friend--but swear them to secrecy? Isn't there something very wrong with this picture? Oh, they've only told one person? I imagine it could be surprising to discover how many people now know whom they've been treating, and have spread the word. Shame on them, and their naivety! I imagine that 'fame by association' helps people feel more important or interesting, but when it comes to ignoring every client's right to privacy, it stinks.

Don't misunderstand. I've cared for these colleagues, and have also admired them for years--but the instant they have shared a client's identity (whether famous or not), my trust and respect for them is tainted. They might balk at this, citing that "everyone does it," but just because something has become standard practice, this doesn't mean it's acceptable or right behavior.

We have all engaged in collegial dialogues now and then, but I would never share someone's identity (or even a first name), with my dearest of friends. Strict adherence to ethical, sound and safe practices is a natural outgrowth of emotional and moral development, and personal integrity isn't bound by any rules or laws. Integrity involves an intrinsic sense of right and wrong that's either instilled in childhood--or acquired throughout an existence that's had to navigate some challenging twists and turns, but built character along the way. How many march to the beat of that drum?? Very few, I suspect.

So whether it's De Niro, Oprah or the Prince of Pakistan who phones for help, you'll never hear about it from me. Revealing that somebody's in treatment is solely the right of every client or patient. It's his/her exclusive prerogative to tell others they've sought assistance--not the practitioner's!

So, I'm officially going on record here: To my friends/colleagues, please stop rubbing my nose in your business. If you've just gotta tell somebody, don't let it be me. If you're needing kudos for someone famous seeing you for help, or you're wanting to feel better about yourself, try investing in some solid personal inner work, to fortify your self-esteem. Perhaps then, you can overcome your temptation to gloat, and quit trampling on the sacred rights (and trust) of others. In short, first do no harm.


*The BBS stands for The Board of Behavioral Sciences. If you are aware of a licensed therapist who violates their clients' privacy, it's perfectly acceptable to advise them that you're uncomfortable with their behavior--and that if it continues, you may report this infraction to their governing agency.

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