Wednesday, April 22, 2015

Full disclosure

Well, more like partial disclosure. I have a client who has some form of psychotic disorder and is currently very paranoid. Right now the only people in the clinic he trusts are a part-time counselor, the program director, and myself.

The part-time counselor is an intern who is very wise and has tons of life experience, but was really just an intern a few weeks ago. So as his supervisor, I work very closely with him and his clients. And one of the things we had to work on was getting this client to go back to his psychiatrist, so we met with him together the day before yeesterday.

This was an interesting challenge because I had to stay very, very calm with the client, as he's easily agitated and I'm ordinarily a live wire. Which usually works in my favor but would disregulate this client. I wasn't trying to argue that he needed medication -- I just wanted him to see his psychiatrist again.

The client currently goes to a community health care clinic that provides all services under one roof. Primary care, dermatology, endocrinology, urology, gynecology, dentistry, podiatry -- one-stop shopping. And the program has a coordinator who integrates behavioral health -- psychiatry and therapy -- with their other services. I know because I applied for that job and didn't get it. (Grr.)

"Going to the psychiatrist is just like going to your primary care doctor or any specialist," I said. "The brain is part of the body."

"Do you go to a psychiatrist?" the client asked.

I froze for a millisecond. Personal disclosure is dicey. Revealing too much information about yourself changes the clinician-client dynamic. It ups the intimacy, which can be a serious boundary violation. You have to be absolutely sure you're disclosing to benefit the client, not yourself.

I reveal very little personal information about myself to my clients, and not just because I have a stigmatized illness. On the other hand, here was a chance to be authentic and walk the walk. If there is no reason to be ashamed of going to the psychiatrist, then I should be honest if I go to one.

"Yes, I do," I said. "I go to the psychiatrist, just like I go to the gynecologist -- and it's a lot more comfortable than the gynecologist."

I was hoping to inject some humor and distract him from asking for particulars, and it worked. "Well, you have to go to that doctor, you're a woman..." he said, blushing and averting his gaze.

So we got him to agree to see his psychiatrist again. And now the former intern is the only person at my job who knows I see a psychiatrist. But I'm pretty sure he can be discreet, because he sees one too. I found that out during supervision. Didn't ask -- he disclosed. Which was fine.
Copyright (c) "Ayelet Survivor"

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