Steven Kalas is a behavioral health consultant and counselor at Las Vegas Psychiatry and the author of “Human Matters: Wise and Witty Counsel on Relationships, Parenting, Grief and Doing the Right Thing” (Stephens Press). Contact him at 227-4165 or skalas@reviewjournal.com.
Good therapists keep secrets
I promise confidentiality to patients. It’s a promise I consider holy. Sorry if that sounds too dramatic for some folks, but I mean it very literally. I lock the stories I hear in a vault inside of me utterly defended. With the exceptions of children being hurt, or my duty to respond to threats to self or others, I wouldn’t talk even if not talking put me in some jeopardy. Because, if I did betray this trust just to save my own bacon, I’d be violating a value that would bring consequences to me way beyond lawsuits or sanctions from my peers.
See, I don’t maintain confidentiality because health information privacy law, better known as HIPAA, requires it. I don’t uphold this promise because every known standard of professional ethics demands it. I keep it because there is no holier, vulnerable or powerful place to meet human beings than in their suffering. The torments and tortures of the soul. The despair. The losses. The dark, bitter hatred that is harbored in the human heart. The sordid fantasies. Egregious moral failures. Or less egregious but nonetheless corrosive, hidden habits of vice of which we are ashamed. I maintain confidentiality because every human heart contains these things. And these things can only be dealt with in the sacred space of trust.
My early training was as a pastoral counselor. My life as a former priest likely puts a particular spin on confidentiality for me. When you hear a confession, the responsibility makes you tremble somewhere inside. A colleague once asked me, “So, if Timothy McVeigh had stopped in Las Vegas and sacramentally confessed to you that he was on his way to Oklahoma to kill people, what would you do?” I thought about it for a moment and said, “I’d call the police and report him … and then I’d surrender my clerical collar to the bishop and find some other way to make a living.”
I’m saying that doing my duty to stop a great evil would still have consequences for the promise.
Recently, I was trying to explain confidentiality to my 10-year-old. He listened patiently. I asked him if he understood. And, wise old soul that he is, he said, “You keep everything a secret so people don’t make fun of them about their problems.” Just left me shaking my head. Yeah, dear boy, you get it. Exposure of the soul to uninvited, gleeful observers is a potentially lethal humiliation.
He makes me think of the “Facebook suicides.” Now, please, that’s just jargon. I’m not blaming Facebook for teen suicide. I mean the term to point more generally to our world of cyberspace, which at once wraps us in an illusory sense of anonymity yet exposes us without boundaries to the world.
I once acquired a stalker who hacked into my computer, where she sent emails to several women in my address book as if they were from me. I was terrified to read recently that people can hack cellphones. We’ve become a culture of opportunistic voyeurs and unwitting exhibitionists. If someone with power decided to ruin you, well, it’s never been easier.
In graduate school, I read an account of early American Puritans forcing known adulterers to disrobe before the congregation, then marched them naked to the stocks. I remember thinking this behavior was a far greater evil than any adultery could possibly be. It spoke to something sick and twisted in the heart of the congregation. The National Enquirer says, “For inquiring minds.” But they mean prurient minds, and in some cases sadistic curiosity.
Over time, I have developed a kind of “psychic muscle” for confidentiality. It’s a reflexive habit now, rather than a great effort. In some strange way, the confidentiality even keeps the information away from me. I mean that, once the unlovely story is told, I find that I don’t keep track of the unlovely story. When, by chance, I should cross paths with former patients years later, it’s not the mistakes and failures that I’m focused on. I often don’t remember them. What I celebrate is the courageous way patients have embraced those unlovely events and turned them into redemption, humility, creativity, gratitude and commitments to live with integrity and meaning.
You don’t have to be a counselor or a priest to accept a pilgrim’s entrustment of some personal darkness or gaping vulnerability. Real friends do this. Loving family does this. It is our honor to guard these treasures and take them quietly to our graves.
Think about the people who have and are faithfully guarding your treasures, and be grateful.
Steven Kalas is a behavioral health consultant and counselor at Las Vegas Psychiatry and the author of “Human Matters: Wise and Witty Counsel on Relationships, Parenting, Grief and Doing the Right Thing” (Stephens Press). Contact him at 227-4165 or skalas@reviewjournal.com.