What are the Limits to Confidentiality in Therapy?

Understanding Therapy Consent Forms Series

Reading over the consent for treatment is such an important step in starting therapy services. We continue our discussion today with the topic of limits to confidentiality in therapy. (Feel free to check out our previous discussions on “No Secrets” policies and the benefits of therapy.)

Pregnant African-american woman laying on couch writing in journal

Most of those outside of the mental health field find confidentiality and therapists to be one in the same. These two things feel synonymous as therapists are only second to lawyers when it comes to professionals who hold secrets for their clients. However, those within the mental health field know that confidentiality is actually our second most important priority. This is due to limits of confidentiality in therapy treatment.

Certain professionals are bound to codes of law & ethics. Doctors and therapists have similar codes when it comes to confidentiality. HIPAA laws require healthcare workers to protect a client’s private health information. Unlike lawyers (who practice attorney-client privilege), healthcare workers are required to breach confidentiality when it comes to safety concerns for clients.

So what exactly are the “limits to confidentiality”? Well, for therapists the limits include four things:

  1. Suspicion of child abuse (any person under 18 years of age) of any kind (physical, sexual, verbal, neglect, etc.)
  2. Suspicion of elder* abuse (any person over 65 years of age) of any kind (physical, sexual, financial, verbal, neglect, etc.). *This can also be applied to those with disabilities of any age.
  3. A credible threat to harm oneself
  4. A credible threat to harm someone else

Therapists are obligated to act on these four things because the #1 most important priority in therapy is the safety of a client and those around them. Therapists will report these things either in the moment, if it is time sensitive, or at the very latest within 36 hours of the disclosure of these occurrences.

We ultimately report these disclosures to authority figures such as the local police or child/adult protective services in order to increase the safety of those involved. If it is a suicidal or homicidal threat, the police will be called to escort the client to a hospital setting to get psychiatric care, and/or the threatened party will be notified for their safety. If it is a safety issue concerning a child, elder, or someone who is disabled, the appropriate protective services agency will be notified so they can reach out to those involved and provide appropriate resources to keep the family safe. This is why you may be asked your address at the beginning of every teletherapy session, so if an emergency arises your therapist can send the appropriate people to assist you in your time of need.

“Limits to confidentiality” is ultimately about safety. No therapist wants to see a client in harms way, or others in harms way due to a mental health crisis. So when you are beginning therapy there is no need to be surprised by your therapist mentioning these limits at the onset of treatment.

simplee therapy sign off. Peace, love, happiness, Lee.

Self Care Needs to Be a Priority

Learning How to Incorporate Self Care in Your Life

Everyone is talking about self care, but what is it really? Well as mental health has become a less taboo topic in many communities, so has the idea that taking care of yourself can be your number one priority.

Black woman practicing self care with her feet up on table and smiling

You’re probably thinking, “What?? I’m allowed to put myself first?!?” YES!

Self care is not equivalent to being selfish. I repeat, self care is NOT selfish. It is simply the term used to describe the fact that if you are in a healthy state both physically, mentally, and spiritually, then you are better able to show up in the many roles you may play in your life. Whether you are a student, employee, entrepreneur, mother, wife, caregiver, etc., prioritizing taking care of YOU means you are putting your best foot forward in all these areas. Ultimately you are serving those relationships better.

So how do I do this ‘self care’ you speak of??”

Well let me tell you, it is simpler than you think. Self care lives on a spectrum from merely meeting your basic needs to full on pampering yourself. It can be free or very expensive, but that is up to you. It is all about partaking in activities and being intentional about doing things that make you feel good.

“Where do I sign up!?”

Hold on. Before you start booking massage appointments and buying face masks, you need to identify what is it you really need. Pause and get in tune with your body. What are the things that would make your soul smile? Taking the time to really get a grip on your needs allows you to be more intentional about your self care.

Maybe you have been feeling really low, and been having a hard time even getting out of bed. Maybe your self care is just opening a window or taking a long shower. Maybe you have been pulling non-stop overtime at your job and what you really need is a vacation day or two. Maybe you are a new mom who hasn’t gotten a good nights sleep in ages and calling a family member over to watch the little one while you nap is what you really need. This is ALL self care!

“Wow. I didn’t even realize it was that deep.”

Yeah. Taking the time to prioritize yourself and shift your mindset can almost be more work than actually doing the things that make you feel your best, but once you figure this all out the relief it brings is so worth it. Consider getting some help along this process by finding a therapist that fits your needs and can collaborate with you on creating a unique plan for taking care of yourself. Having someone to talk to in and of itself can be just the self care you needed.

bath tub with candle and towel laid close by, How to actually implement self care

How to Cope with Racism

Racism is the pandemic that has been plaguing Black people for 400 years. I really wish I didn’t have to write about this, but here I am talking about racism in America in 2020 (the whole year has been trash, so why am I even surprised).

I first want to say…I see you. I see the hurt, pain, anger, sadness, frustration, worry, and every other emotion engraved in your beautiful, melanin rich skin. This deep anxiety within us that at any moment someone could dehumanize us, insult us, degrade us or worst and no one will see it, infringes on our peace and joy daily. From microaggressions to killings in the street, we deal with a myriad of stressors everyday. But how do we cope?

I want to give you a tangible breakdown on ways to cope with racism in your life.

Lean In

Lean in to the uncomfortable conversations. Taking a stand for yourself and others can bring a sense of relief. It may be initially uncomfortable, but it often leads to a release of buried thoughts and emotions. Be honest with yourself and those around you about how you feel. Read about anti-racism, black history, or personal stories of resilience to bring light to the shared experience of dealing with racism in America. Use your voice to speak up for change. Join a protest, sign a petition, donate, write, post, vote, whatever helps you feel heard!

Reach Out

Touch base with your support people. Those who you know will support you and make you feel good. Whether that be a best friend, a coworker, your therapist, or an acquaintance who is sharing in your experience. Speak about your hurt and let out your emotions. If you are unable to speak with close, loved ones try to journal or pray about your grief. Recognize the layers of emotions and let them out.

Shut Down

This may be the most important one of all. Shut down and recharge, so you can show up as your best self in your relationships and life. Take a break from social media or the news. Take some time off from work, so you don’t have to mask the emotions to maintain professionalism. Give yourself the basic fuel your body needs, whether that be some yoga stretches to recenter in the morning, eating a healthy meal to sustain yourself throughout the day, or making yourself a bedtime routine to ensure a good nights rest.

Know that we are in this together. Please take care of yourselves during these difficult times. And use the following resources to access help when needed:

California Warmline: 1-855-845-7415

San Diego Access & Crisis Line: 1-888-724-7240

U.S. Crisis Text Line: Text “TRIBE” to 741741

U.S. Suicide Prevention Hotline: 1-800-273-8255

Identifying Solvable Problems in a Relationship

What’s the Difference between Solvable & Perpetual Problems?

Solvable vs. Perpetual Problems. What type of problem do you have in your relationship? Do these examples sound familiar?

So your spouse forgot about Valentine’s Day again? That is a problem for sure. Is it a deal-breaker though? You know that they are going to forget it because it happens every year, so you’re prepared for their sad attempt to make it up the weekend after with wilted roses and a dinner at your 2nd favorite restaurant. 

What if your partner doesn’t want to get married? That may be a deal-breaker. You may value the union that is marriage, while they never see themselves becoming tied down. That isn’t a problem that is solved very easily. 

concerned black couple sitting on bed in misunderstanding

Let’s clearly define what the difference between the two are…

  • Solvable Problems: aspects or behaviors of your partner that are difficult to handle, but tolerable. There are usually reachable solutions or compromises that can be made for these types of problems.
  • Perpetual Problems: values your partner holds that may be intolerable or in opposition to your own values or beliefs. Things that you may have to “bend” on in order to stay happy in your relationship. These types of problems will always be present in your relationship.

You may go into therapy knowing that there is a problem in your relationship, but you may not know whether it is a solvable or perpetual one. This is an important part of the therapeutic process. Realizing what type of problem you are working to solve will allow you to figure out with your therapist the steps necessary to either solve said problem or learn to live with it.

Using simple tools such as “I Statements”, “Repair Attempts”, or deep breathing can all be ways of approaching solvable problems. See the list below for some tips and tricks on how to handle solvable problems in your relationship.

5 ways to approach solvable problems

If any of these approaches do not seem like enough when it comes to a problem between yourself and your partner, you may have a perpetual problem. This problem is most likely best suited for therapy. Going to couples therapy can be a great place for solvable or perpetual problems because it allows for a neutral space to practice the skills necessary to manage the problem at hand. Going into therapy with an open mind and open heart can be the defining factor in whether solutions are found.

What solvable or perpetual problems have you been able to manage in the past?

sign off

Physical Health tied to Mental Wellness: 5 Ways to Reduce Stress in Your Day-to-Day Life

I recently experienced what so many of my clients come into session concerned about…physical aches and pains.

I woke up one morning with an aching pain in my jaw. It was like having a migraine in my mouth all day long. I tried to think back over the last few days…what had I been doing differently that could have caused this? After some self reflection and figuring out what the pain exactly was, I realized stress was the culprit. I had gotten to a place of extreme stress from working two jobs, being a mom, and managing all the calendars my household had to keep track of. I had begun clenching my teeth while I slept, which caused me to wake up in pain.

The solution to this pain? Physical therapy, mouth guards at night, and pain medication. Um…I don’t know about you, but none of that sounded like a solution or appealing in any way. They sounded more like management, than a cure.

So many of my clients come into session expressing symptoms of depression or anxiety or general stress, then will make a passing comment about chronic back pain, or chest tightness, or other physical ailments that they have been getting evaluated at a physician. They never tie the experience of physical health to their mental health however.

Disclaimer: I am not a physician, and you should always seek out medical professionals to have any physical health symptoms evaluated. This is in no way a replacement for medical assistance/ advice.

Minority women especially, are more likely to experience mental health concerns as physical symptoms in the body. These aches and pains are almost always directly related to your level of stress. In my personal experience, consciously working on reducing my stress enabled me to reduce my jaw pain to zero.

Now this does not mean medical intervention isn’t helpful, but it can work hand in hand with mental health interventions. Utilizing various coping strategies to reduce stress can assist in a speedy recovery.

Here are my top 5 coping strategies for managing stress:

  • 1. Mindfulness Breathing

  • Mindfulness breathing is a tool that can be utilized at any moment in your day and requires nothing more than the ability to breathe. Pausing in a moment of stress to take a deep inhale and slow exhale allows for your body to experience a sense of calm. It slows down your heart rate and reduces the idea that your body needs to go into “fight or flight” mode. If you want some assistance in practicing this technique try searching for “Guided Mindfulness Breathing” on YouTube, or download the “Calm” app on your mobile device.
  • 2. Journaling

    Journaling can be a great way to get thoughts out of your head and practice letting go of stress. Writing about your emotions whether it be grief, anger, joy, or a plethora of other emotions allows you to release these thoughts and reflect on how they are affecting you. An important aspect of journaling however is practicing to write about gratitude. Expressing gratitude for various aspects of your life provides balance to the challenges and emotions that occur on a daily basis. Nobody wants a book of sorrow, so incorporate both the good and bad.

    3. Skincare Routine

    This may seem frivalous, but hear me out. A regular skincare routine not only benefits your skin, but it gives you time to yourself. Depending on the type of skincare routine you implement (it could be as simple as rubbing some lotion on or as complex as a multi-step regimen) you can give yourself 2-30 minutes of “me time”. Being intentional about this time each day guarantees that you take a break and attend to your own needs even if only for a few minutes.

    4. Low-Impact Exercises

    Depending on your physical symptoms and with approval from your physician, try low- impact exercises such as walking or yoga. Walking is such an underrated exercise regimen. Taking time on your lunch break or before/after work to take a walk outside allows for more time in the sun, increased blood flow, and an overall mood boost. This physical activity kills two birds with one stone as it benefits your physical and mental health at the same time.

    5. Sleep Hygiene

    Last, but certainly not least, ensure you are getting enough sleep. How you feel when you wake up determines how well you’ll manage your stress throughout your day. The National Sleep Foundation recommends adults get 7-9 hours of sleep each night. Take a look at your daily schedule. Where is time wasted? And what could be moved around to create room for a decent bedtime? Also, take a look into what you are sleeping on. Maybe that futon from college isn’t cutting it anymore, or your mattress could use a new topper for support. Nobody has ever applauded themselves for having a late night and waking up groggy in the morning. Elevate this basic need to ensure a brighter day ahead.

    All these coping strategies can be used on a day-to-day basis to reduce the stress that is likely contributing to those physical ailments. Incorporating and practicing these stress-reducing skills will allow you to live a happier and healthier life. And if these things aren’t enough, try attending therapy!