Counseling Confidentiality


Counseling Confidentiality


your avatar   Samantha, 42-year-old woman

I might have made the deans' list…with my score on Queendom's test for depression. Truthfully, I see my reaction as appropriate for someone in my circumstances. Here's what happened:

I was attacked at work by a patient. The whole thing (including the illegal actions that took place) was swept under the rug because the institution is a favorite political charity. I was tossed out, with a severance of chronic pain & chump change for life. For the first time in my life I was failing at something I really worked hard at. I was left with: A non-supportive environment, illness, major illness of a family member, major unsupportive actions on the part of another family member, having to leave school to take care of the severely ill person, and another household member who insists on his needs being met, including feeding him, cleaning up after him, and verbal abuse - but that's an oldie. I am gradually having myself kneecapped by anything which fosters, aids or abets independence, and for having the responsibility of running a household without any decision-making capacity.

I realize I should get counseling, but three things are stopping me:

  • Confidentiality. I used to work in the psych field. This is a small town, and people do talk, especially if someone who used to be a coworker is now a patient. Even if it's only one psych field person to another, it does get around - in detail, too. I've heard far more than I should have, while working at my former job.
  • Money. From my accident, I have the expansive sum of $226.66 (bimonthly) for income. I am already paying for extensive dental work, a chiropractor, medication, some household supplies, the front end of a car (which is now an organ donor in a junkyard), at 22% interest. My shoes need to be replaced, and there is no extra.
  • Time. The patient I am taking care of is extremely medication-resistant, and I found out recently (when I was bedridden with pain & nausea for 1 1/2 days) that she would not take her medication, nor eat, if I was not taking care of it. I also am charged with preparing dinner, cleaning up after another family member who feels it's beneath him to clean up his dishes and the endless trail of crumbs, spilled food, grease on the carpet, and junk mail torn & left to lie about. He gets verbally abusive if asked to do anything. Plus, there's loads of patient laundry to be washed and rewashed. Some days I don't get to eat my own dinner until 10pm. I already spend 4 hours, twice/week transporting myself to the dentist and chiropractor (and there's a 2-hour wait time there also, but he's the best & inexpensive). I never get to the gym anymore because I can't spare the time (which has its fallout in the pain department).

I hate to sound picky, but is there anything like online or telephone counseling which can swing a descending payment scale?


    Jef Gazley, M.S., LMFT, LPC, LISAC, DCC

Dear Samantha,

The first response that I had to your letter was that you are really quite funny. Of course you worked in psych before because most people who work in the helping professions tend to hide their feelings behind wit and sarcasm, at least before their own therapy. Usually we learn it early and it is a way to survive any pain that was in the family. Unfortunately, it also hides that pain which makes it grow and keeps us more isolated.

It also sounds as if you were the unofficial counselor for the family as well. Not only is this unfair for a child, but it trains a person to treat other people outside of the family in the same way. This is co-dependence par excellence. The tendency is to put others above us and feel responsible for their happiness and well being. Someone exhibiting co-dependence tends to forget about themselves completely and begins to think that they have to take care of others to the exclusion of our own needs and wants.

There are very good reasons to care and help others at times. These reasons would include 1) when you want to 2) when you can afford to do it without undo harm to your needs 3) when you feel that it will be appreciated and that you will still be treated well if you refuse to help and 4) when the other person is helping as well and is trying to become independent in that area with time. No one owes any one anything. We choose when it makes sense to help and when we want to do it. This is what it means to have good boundaries. Boundaries are where one person ends off and another person begins. It is the knowledge that we are responsible for ourselves and that we are responsible for taking care of ourselves.

Often people allow themselves to be abused because when they don't help another person that person tells the other person they are selfish to get his or her own way. This is abusive and the person who used the word is demonstrating the true selfishness. When most people hear the word abusive they tend to think of legal abuse. Legal abuse would be severe physical and/or sexual abuse. However, the definition of abusive means NOT USEFUL. This means that when people are rude, try to hurt, or are neglectful of how another person feels they are acting in an abusive fashion. This is not acceptable between people.

It sure does sound as if you have had to deal with a lot lately. Any two of those stressors would be enough to cause someone great difficulty. It does sound like counseling would be important and helpful. Part of the reason that most of the clinicians started to offer an online alternative to their practices was to address the needs of clients who lived in small towns and rural areas and those people who were very private and wanted anonymity. Many practices offer telephone services, email, chat, and now audiovisual counseling to give clients a choice of venues. Prices range from $15 to $50 for emails and from $45 to $150 an hour for the other mediums. There are a number of sites that I am sure would accept a sliding fee and if you asked the other ones that do not list it as an option they might well accept it.

Take care and good luck.

Jef Gazley

This question was answered by Jef Gazley M.S. Jef has practiced psychotherapy for twenty-five years, specializing in Love Addiction, Hypnotherapy, Relationship Management, Dysfunctional Families, Co-Dependency, Professional Coaching, and Trauma Issues. He is a trained counselor in EMDR, NET, TFT, and Applied Kinesiology. He is dedicated to guiding individuals to achieving a life long commitment to mental health and relationship mastery. His private practice locations are Scottsdale and Tempe, Arizona. You can also visit Jef at the internettherapist, the first audiovisual mental health online counseling center on the net.For more information visit:


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