Should I disclose to all of my patients some of my patients have engaged in some form of sexual assault or abuse? I would feel irresponsible not telling new potential clients who may have been survivors of sexual abuse themselves.
I currently see about fifteen patients. Most of them, two or more times a week. A few of those have engaged in assaultive or abusive behavior. None of my treatments is court-mandated. Several of my patients have ego-dystonic desires, and/or desires which, if acted on, would be criminal. None poses a threat to “the general population.”
Without going into too much detail, I simply have no reason to imagine that any of my current patients might, in a hypothetically functioning waiting room, were my office to resume normal operations, pose a realistic threat to anyone they might encounter there. My waiting room seems (in their cases) unlikely to be a locus of any such threat. For this reason, I’ve never considered saying to other patients, “Hey, you should know that from time to time I work with people who’ve been accused of or committed crimes, crimes that include sexual assault, child abuse, etc.” Just because – well, none of the behavior that has troubled my patients ever has seemed especially salient to the people they might hypothetically encounter in a waiting room.
A couple of things to add to that:
1) I have had patients come on to other patients in my waiting area, occasionally quite inappropriately or aggressively. This has never been patients with a history of being charged with crimes. This has produced, on occasion, all sorts of material for us to discuss in session. (Think of Alex and Laura in In Treatment.) But it hasn’t triggered in me an impulse to disclose anything to my other patients. Nor have I felt that I exposed my patients to threats different in kind or magnitude than those they had already encountered on their way to my office.
2) I work in a group practice. There are three offices in my suite. Not all the patients passing through are my patients. Not all the patients my patients encounter in the waiting room are my patients. That said, I have on occasion either managed my own schedule, or consulted with colleagues about their schedules, as it relates to certain of my patients. For example: I said to one colleague at one point, “I have a patient who comes in at these times. If it’s possible, I might suggest not scheduling sessions with female patients at times between y and z, if possible, just so as to avoid any unnecessary encounters. Not that it would be a disaster, but it might simply be better for all.” On two other occasions, I have said to colleagues, for very different reasons, about different patients: “These are the times I see a particular patient; I think it might be best if you were not to encounter that patient, so if you can be mindful of being in the public areas of the office in the 5-10 minutes around those sessions, I’d appreciate it.”
3) This stuff all is nuanced and difficult. The onus is on me to manage things so I don’t have to disclose anything about my patients that they might not wish disclosed. It seems to me problematic to label people unnecessarily in the eyes of others (“sex offender,” “sex addict,” etc.). My patients all are people. I strive to create a context in which they are free to be the people they are striving to be, and not simply the sum of previous behaviors or decisions.
In general, I try to manage things as much as possible with the schedule, and within the frame, rather than with disclosure. And/but, I can imagine, at the edges, a circumstance in which some other approach might be necessary.
