Do You Think Your Therapist Gossips About You?

Gawker has a new column featuring a Q&A with an anonymous therapist. In the first installment, the therapist is asked several questions that most of us would surely like to ask our own practitioners: Does a person’s physical appearance ever alienate you? How do you know if someone is going to hurt themselves? Does the financial piece get in the way of the process? The therapist seems like an intelligent and empathetic guy, and his answers are straightforward.

The title of the first column? “The Patient Who ‘Tried to Insert His Penis Into His Dog,’ and Other Confessions of a Therapist.”

Those of us who blog for a living know how important it is to tart up your headline. If we could, most professional bloggers would write, “Enormous Boobs Attached to Downton Abbey’s Cutest Cat Alive Who Starred in Super Bowl.” We all want to hit the keywords. I blogged professionally about mental health for about 10 years, and every time a celebrity went into “rehab” for “exhaustion” I was sort of pleased. More traffic!

In the case of the new Gawker column, the sexytime-Oliver Sacks approach has certainly drawn readers and comments—more than 500 of them. Many of them are from people who are angry that the anonymous therapist is revealing details of sessions with anonymous patients. Isn’t that a breach of professional ethics, they ask. Let’s take a look at the details he offers:

1. “I once had a patient with a port wine birthmark that covered more than 80 percent of his face.”
2. “I had one male patient who sliced his wrists to the bone and survived.”
3. “I had a female patient who intentionally wrapped herself around a telephone pole and survived, but suffered significant physical deformities and brain damage.”
4. “One girl I saw took 50 Ambiens at one time as a teen and is now one of the heads of a large marketing firm.”
5. “I had a post-adolescent male tell me the other day that he tried to insert his penis into his dog’s ass.”
6. “I once had a teen who, between the ages of 11 and 13, was used as a prostitute for drug money by her mother.”
7. “I had a patient who was a football star who is now serving time for armed robbery.”

The therapist also recounts a jail visit with a rapist, though none of the commenters seem especially concerned about the rapist’s rights to privacy.

Of the seven statements above, I see only one that presents a real problem in terms of confidentiality: the “post-adolescent male” and the dog. It raises a question that the therapist, if not Gawker, will have to resolve as the column progresses: how to reveal details ethically while keeping people entertained.

The problem with the boy and his dog is that it’s both the funniest moment in the piece and also the most identifiable. What if the post-adolescent male happened to see this online—the headline, the illustration, the comments making fun of him? He might be mortified, even if his therapist got permission to anonymize him ahead of time. Permission between client and therapist is complex; it’s hard to say no.

I’ve been on both sides of this. I’ve anonymized people when writing about cases, and I’ve been anonymized when written about in case studies and academic papers. The first time I was asked by a psychiatrist if I’d be part of a case study—details changed, of course—my reaction was one of shock: Was I that sick? Did he really see me as a patient? I knew it was ridiculous to have that response, but it was involuntary. Years later, when I saw an anonymized version of myself in an academic paper, I found her—”Sara”—repellent and foreign. It made me feel terrible about myself, and there wasn’t even an illustration to go with it.

If the Gawker therapist chose to anonymize, then the “post-adolescent male” from “the other day” may very well be an elderly man from 10 years ago. In which case, what are we really talking about? Too much anonymizing and you’re writing a novel.

For Gawker readers, the anonymous therapist has created an excellent opportunity for discussion. It’s a little distressing, all the wrong information that’s being batted back and forth (currently, a terrible mix-up over the following words: cognitive behavioral therapy, psychotherapy, psychoanalysis and psychodynamic therapy), but there are also people who are taking comfort in talking to each other about suicide and depression.

For the site, there’s an obvious benefit (traffic), and for the therapist it’s probably a nice change of pace. Nothing illegal has occurred. But I can’t stop thinking about that “post-adolescent male” whose dark confession got turned into a joke. That is the column’s one moral misstep. It’s also the thing that got people to read it.