Sylvia Cary, LMFT

Is It Okay to Write About My Patients?

Loose lips sink ships. — World War II poster

I wear two hats; one as a psychotherapist and the other as a book editor. Occasionally one of my therapist colleagues will approach me because they want to write a book — maybe an academic book about their specialty, or a how-to, or a memoir, novel, or even a children's book. They may have been sitting on a book idea for years and finally want to get it off their bucket list; or they want that instant credibility that comes from being "the author of . . ." a book on their specialty; or they may just want to have a carton of books in the trunk of their car to sell at seminars, workshops or conferences, or give away to colleagues, clients, friends and family as gifts.

No matter what the book's topic or genre or what the therapist's reason is for wanting to get published, the first questions I usually get asked is: "Is it okay to write about my patients? What if my patient reads it? How do I not get sued?"

Let me reassure you that licensed mental health professionals definitely can write about patients. Thousands do it. But there are some Do's and Don'ts involved. That's what we'll look at here.

Confidentiality All writers, not just therapist writers, should concern themselves with the possible consequences of what they say in print, just as we should all think before we speak. Blabbing off can get anybody in trouble. However, unlike "regular" writers, licensed mental health professionals have to be particularly vigilant when it comes to writing about clients because we have some extra legal and ethical restrictions. Our main concern is always the issue of confidentiality.

"Protecting patient confidentiality is the bedrock of psychotherapy," says Gerry Grossman of Gerry Grossman Seminars, a company that provides California mental health professionals with exam preparation and continuing-education courses. "Breaking this trust . . .puts the therapist at risk for losing his or her license."

Yikes! Agreed! Nobody wants to get sued! That's definitely not a perk of getting published. So let's go over a few guidelines before you hop on the computer. If you follow these hints and tips you should be just fine.

The Art of Disguise This is standard. When you write about patients, always disguise their identities. This doesn't mean just changing their names! Changing a name is never enough, especially if the other details or situations in the piece could help readers identify them. For example, stating that a wealthy female patient is "married to the Chicago-based CEO of XYZ company" doesn't work for obvious reasons. It wouldn't take a rocket scientist to do an Internet search to find out the name of that CEO and know immediately the identity of Mrs. CEO. So also change the name of the company. Change the location. Change the nature of the company's business. Change their adult son to twin teen daughters. And if any of these things are really just fluff and not crucial to the story, leave them out.

Rule of Thumb Danielle Ofri, M.D., physician and author of the books Incidental Findings: Lessons from My Patients in the Art of Medicine, and Medicine in Translation: Journeys with my Patients, commented in an article ("Harnessing the Winds of Change") that as writers we of course have to change names and identities of patients, but that's not all: "My rule of thumb is that the description must be different enough so that it will be tough for anyone, other than the person being described or close associates, to recognize them."

Psychoanalyst Judy Kantrowitz, M.D., interviewed 141 fellow analysts on the subject of writing about patients and found there wasn't consensus on exactly how to disguise patients, only to do it. Kantrowitz came up with a similar conclusion to Ofri's above, only she went a step further: "Disguise a patient so when they read it even they don't recognize themselves."

Self-Disclosure What about a licensed therapist who wants to write about themselves, not their clients? A memoir perhaps, or a novel that's obviously based on them? While it's not illegal or unethical to do this, not all therapists think it's a good idea. It often depends on the therapist's training. A psychoanalytically-trained therapist who believes in the "blank screen" approach is probably never going to write a memoir or disclose anything personal in a book. On the other hand, a therapist with a personal recovery story (addiction, e.g.) that's related to their specialty may feel quite comfortable writing about it, seeing it as an appropriate self-disclosure, which can be an asset to the therapeutic process, even inspiring some clients: "If my therapist can beat the problem, then I can beat it, too." The yes or no choice is up to the writer.

Informed Consent An alternative to mastering the art of disguise in writing about patients is to get signed releases from them ("informed consent") prior to making their identities known for some specific purpose or event, such as a case presentation at a conference, a teaching video in a classroom, or the publication of an article or book in which the patient might be identifiable.

A psychologist friend of mine who has published four books and is fairly well-known in her specialty area of weight management, has been a guest on many of the big daytime TV talk shows where she has talked about her private practice cases. Sometimes she will even have a client join her on camera. Advance discussions with the patient and signed releases are what make this possible.

Be Kind The play Tea and Sympathy by Robert Anderson was a hit on Broadway in the 1950s and later became a movie. It's about a shy young man in a boarding school who has an affair with the wife of the headmaster. At the end of the play the wife tells the young man, who is about to leave school, "Years from now when you talk about this, and you will, be kind."

When writing about patients (ditto friends, family and neighbors), do the same thing — be kind. You can rarely get into trouble for saying something nice about somebody. Leave the mean digs alone. In your description of your pudgy client, say "slightly overweight" not "fat" if weight is relevant. If it's not relevant, skip it. Just don't throw anyone under the bus. Remember, "First, do no harm" as it says in the Hippocratic Oath. And in the Twelve-Step recovery groups, such as Alcoholics Anonymous, members are encouraged to be forthcoming (if they wish) about their own shortcomings (referred to as "taking your own inventory"), but it's frowned upon to "take the inventories" of others. No loose lips!

Fearless Writing Don't let these legal and ethical restrictions on writing about clients scare you, just be aware of them. Basically, it's just common sense. Put yourself in your client's place: How would you feel if this or that were said about you? Abide by the guidelines of our profession. And then write on and prosper!

Sylvia Cary, LMFT, whose specialty is addiction, is the author of The Therapist Writer and has an editorial business, Cary Editorial & Book Consulting (sylviacary.com) and can be reached at sylvia@sylviacary.com.