In our latest series of articles, we’ve been addressing some of the most common concerns, fears, and misunderstandings law enforcement officers have about their confidentiality when seeking or being referred--or ordered--into counseling. Understanding your confidentiality rights--and when and where those rights may have limits--is extremely important should be a priority for you. Having unsubstantiated fears and misunderstandings dispelled should be equally important. What follows are some important questions you should ask before and during counseling.
As you ask these questions of your therapist, do so with the respect due a professional whose job and goal is to serve and protect you. Be inquisitive without being confrontational, as in DON’T INTERROGATE YOUR THERAPIST! The rapid fire questions and looking for an angle or chink in their answers may be second nature, but remember that they are on your side.
Give the respect you’d want to be given. And beware of being seen as a difficult or combative patient; you can’t be served if you get yourself thrown out of the office! Frankly, cops can sometimes be particularly “challenging” clients. Don’t be that client!
Otherwise, be curious. Be informed. Ask questions. You can start with these…
“What is the purpose of this EAP referral/visit?”
If you have been referred to counseling through your EAP by a supervisor, the department administration, or Human Resources, this may be a very important question to ask, and foundational for some of the questions that follow. Referrals may be prompted by a variety of circumstances and whether you follow through may voluntary or mandatory depending on the individual circumstances of your case and department policy.
As we pointed out in our third article in this series, The Psychological Fit for Duty Exam, the difference between counseling and a Fitness for Duty (FFD) examination is not merely semantics, they are very different in purpose and process.
The problem arises when that difference is not understood or clarified at the time of referral. Similarly, whether the referral is to mandatory counseling, based upon either circumstances or policy or both, or merely a suggestion may not be clearly explained. It is up to you to have absolute clarity about what you are being referred for.
So ask: “Is this referral for counseling or is it a fitness for duty exam?” “If it’s for counseling, is it mandatory I go, or is the ultimate choice up to me?” and “What, exactly, is prompting this referral?”
“What expectations can I have about my confidentiality?”
Since ongoing worries, misunderstandings, and misconceptions about confidentiality are what prompted this series of articles in the first place, this should be one of your first things you have clarified once you are in the therapist’s office.
If your counselor doesn’t fully explain confidentiality and what you can expect, ask. If you are uncertain about any points and want or need clarity, ask. And if you wonder what are the limits on confidentiality (if, for instance, something you say indicates you are a threat to yourself or someone else and the therapist needs to take action to ensure the safety of you or them), ask.
Be upfront and direct--but polite!--about your concerns and questions and the professional will be upfront and direct with the answers. Ask about the state and federal laws of confidentiality that govern therapists’ actions, and what they mean to you.
There are still cops who know they should be getting help but refuse because of misperceptions they hold, and outright falsehoods they’ve been told, regarding confidentiality. If you are one of them, make an effort to know the truth. Taking just a couple minutes to seek clarity can put your fears to rest and let you get on with the process of getting better.
“What are these documents I’m signing, and what do they mean?”
At the onset of therapy you’ll be asked to read and sign a battery of documents. Take time to read them carefully. Most will be self-explanatory and may answer a lot of questions you have up front but, if there are any you don’t fully understand, ask for clarification.
“What are my rights and responsibilities in the therapeutic relationship?”
Very often, these will be clearly outlined on one of the forms you sign at the outset of therapy and they help establish the “rules” of the relationship. And yes, therapy is a relationship-based treatment modality; as in any relationship, there are rules and expectations of each partner that must be followed to ensure success. Knowing what to expect of your therapist, and what are you rights, are important. Likewise, knowing what is expected of you is equally important.
Your counselor will certainly have expectations of you, and knowing what these are – and complying with them – will be very important for successful treatment. The problem for many cops is that they do not like to give up any control, or acknowledge they may not be the expert in the room, or do things that make them emotionally uncomfortable. The expectations of therapy might run counter to these traits and require you to let down your guard and trust.
“What do you see as our treatment goals and what is your plan to help me achieve them?”
Since therapy is a relationship it follows that there be an openness in communication and expectations each person has of the other. This is a question that you’ll probably want to ask a few sessions in, after the therapist has time to get to know you and your particular issues and personal goals, and then revisit periodically as treatment progresses.
Ask this question with an open mind. Listen carefully to the answers and ask questions if you do not understand or agree with something, but trust that your therapist has your best interests in mind and the experience and training to work for them. Again, be willing to trust and relinquish some control, and you might just be very pleased with the result!
“How do you keep records, what goes in them, and how are they used?”
Like report-writing in police work, report writing, treatment planning, and record keeping “charting” in the parlance of medical and mental health professionals--are the critical behind-the-scenes necessities of the business of therapy. Since a chart is being produced about you, it’s your right to know and understand the “what,’ “why,” and “how” behind those records and how that fits into your confidentiality.
Most therapists chart “medical necessity” for the purpose of treatment justification and for insurance reimbursement, and the many details of personal minutia are generally not kept or reported to any other person or entity. It is your right to know how your records are kept and what will be done with them, and learning this will probably put your mind at ease over confidentiality concerns.
“What is my diagnosis?”
Surprisingly, many patients never think to ask this very basic question! Ask it, and then ask why and what that means for you. Understand your diagnosis, how it was arrived at, what your counselor’s plan to address it is, and the prognosis for getting better. And understand that, in a lot of cases, a diagnosis made today is made for today; they generally do not reflect chronic, long-term, irreversible problems.
“What will you do if you ever receive a subpoena for my records, or your testimony about our work together?
Since it was the fears cops have about this very issue that prompted this series, why not ask the question right up front? Know the exactly what to expect of your therapist before it ever becomes an issue.
With this series of articles, we’ve tried to provide you with a basic framework for understanding your rights under the law and ethics that govern mental health professionals. Of course, laws may vary state-to-state, but the basic rights you enjoy are established and supported by federal case law.
Many individual states have, as is their right, extended protections even further. If you need help, please don’t let unfounded fears keep you from getting it. Being an informed patient is your responsibility.
Conclusion
Stay safe, and be well!
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