Is It Ever OK for Therapists to Talk About Their Patients?

As you might have guessed, the American Psychological Association has outlined a pretty extensive code to guide therapists’ ethical decisions. But you didn’t come here to wade through a long list of jargon-filled bylaws, did you? So I’ll just summarize Section 4 (Privacy and Confidentiality) in layman’s terms:

1. Don’t spill the beans on your clients for no good reason.
2. “Good reason” basically includes pressing legal or safety reasons—with very (very) limited additional exceptions to rule 1. 
3. Whenever possible, get informed consent from your client before spilling their beans.

Now you’re probably wondering what those rare exceptions might be. 

In short: It can be ok for a therapist to employ examples from their practice with the goal of sharing larger truths with the general public for informational or educational purposes. 

But even in these outlying cases, there are some almost-always-unspoken ethical rules that—in my professional opinion—any mental-health professional worth their salt should be following in good faith.

Unspoken Rule #1: Share Not for Your Sake

Especially in the psychoanalytic circles in which I was trained, the most important thing for a therapist to remember is that you never, ever use your patients for your purposes.

Let’s say you’re a therapist. You find some of your current patients’ personalities and problems are jaw-droppingly entertaining. More weeks than not, you catch yourself thinking, “Gosh, these people’s lives would make great source material for a TV show.” 

It’s an extreme example, yes. But believe it or not, there are indeed so-called mental-health professionals out there peddling materials that recount what all goes down in their therapy practice. Many of these books exist for entertainment purposes—which is to say, they exploit patients’ privacy for the express purpose of putting money in the author’s pocket. 

You don’t have to work in mental health to know that there’s nothing ok about this scenario. Such authors aren’t educating potential future patients or teaching therapists how to be better at what they do. They’re using real people’s real pain for their own benefit. That exploitation of patients’ vulnerability should make us all sick at heart.

Rule #2: Share on a Need-to-Know Basis

When I wrote my first book, Emotional Utopia, I wanted to simply describe the process of bioenergetic therapy, without leaning on experiences with past and current patients to illustrate how I do therapy. 

That was all fine and dandy—until my developmental editor was like, “This content is so dry that I don’t know what you’re talking about. Can you give me an example?” Cue me grappling with exactly what (and how much) I had to share to get my message across.

I wrote Emotional Utopia to help prospective clients understand what they’re getting into with bioenergetic therapy. The examples I used there (and in my second book) are purely intended to bring the therapeutic process to life so that process is easier to understand. 

I did my best to include only the information and details that were absolutely essential to illuminate larger truths. I challenge my peers in mental health to aim for the same standard in all of their public-facing work.

Rule #3: Share Only Unrecognizable Information

Seen this disclaimer before? “Some names and identifying details have been changed to protect the privacy of the individuals involved.” 

But here’s the rub: How do you know when enough changes have been made to ensure that everyone is actually protected in a meaningful way?

It’s probably an impossible question. Thinking that you recognize someone you know in a book (or movie, or blog, or whatever) is one thing. But what about a camouflage of identity to the extent that you wouldn’t recognize yourself? 

I’m thinking about a therapist’s anecdote I came across recently. The therapist “dumped” a patient because they found the patient’s personality completely insufferable. (To that patient’s face, the therapist insisted therapy was being terminated for more innocent, made-up reasons.) 

Can you imagine recognizing yourself in that anecdote?! I don’t know about you, but that would not be the most fun day in my life.

Therapists sharing publicly about patients have to be very, very careful that no data (yep, even disguised and altered data) gets shared that would absolutely pinpoint that person—even to themselves. 

My Two Cents

The current trend in public discourse is to be authentic at the cost of literally everything else. But which is the more important north star when it comes to talking about therapy: Authenticity, or privacy?

For therapy to work, a patient has to place their trust in the therapist. The therapist, in turn, has a duty and responsibility to honor that trust by never not acting with the patient’s best interests at heart.

It’s my intent—in my work—and my hope that–in the work of my colleagues–

those best interests will always, always come first.