Tuesday, July 15, 2014

Transparency in Therapy?!

I started going to therapy a few months ago, so my interest was piqued when I ran across an article about therapy patients being able to see their therapist's notes. My thought process went a little something like this:
Huh, that's interesting. But no!!!
I cannot express to you how much of a bad idea I think this is. Now, don't get me wrong, I don't have an education in psychology or anything even remotely related to psychology. I don't have any sort of professional ideas about why this is a bad plan. I just feel, to my core, that it's not a good idea. It's an instinctual idea that knowing what a therapist really thinks of me would make me feel worse about myself than I already do, which is counterproductive. For me, at least.

There are 700 patients at a medical group in Boston that're trying it out as a part of an experiment. Some psychologists there consider themselves medical trailblazers for making this sort of transparency a reality. They think it will foster an environment of trust between patients and doctors. That it will lessen patient anxiety about therapy and help them to understand their progress.

I get all that and think that would all be awesome, if I really thought it would work like that. It's my pretty heavy doubt that it would actually work that way that fuels my skepticism. This isn't the eye doctor, psychiatry can really harm a person if it's not done well. For me, it would cause more anxiety, not less. With all my worries and anxiety, it has never occurred to me to worry about what she's writing while I'm talking. That's not to say that others with anxiety might not, but I never have. Until now, and even now that it's occurred to me, I'm still not worried about it--which is a feat for me, because I worry about absolutely every. single. thing.

But more than that, these doctors should feel free to make notes without worrying about how their words/thoughts might be interpreted by sensitive patients (and every mental health patient is a little bit sensitive, right?). They should be free to write "What a colossal nutbag!!" if that's how they feel and it helps them do their job well. But with the knowledge that what they're writing will be visible to patients, they can't do that. It's not even a conscious thing, subconsciously they'll change or adjust their method to make it more digestible/desirable to patients. It will happen.

It's similar to what happens when I grade student papers. Maybe I want to stamp some of them with a big ol' "WTF," but do I do it? Of course not. It's not fair to my students, even when it's honest. Instead, I work my analysis in such a way that they will be constructively criticized while being simultaneously encouraged. I tailor my notes, carefully, so that my students won't feel put down. If I could keep their papers to myself, and write whatever I wanted, it might be different. Therapists will do the same knowing that patients will see their notes... even when they don't mean to.

When I mentioned this whole thing to my therapist, she didn't seem too keen on the idea either. As we discussed it, she said she would prefer I didn't see our session notes because she thought it would do more damage than good with my anxiety issues. I agree with her 1,000,000,000,000,000,000,000,000%. Way, way more damage than good. And, so far, I think therapy is helping me quite a lot. I just hope this thing doesn't become a thing, that it remains an experiment and then things go back to a sane place where therapists remember that they're dealing with people who're mentally and/or emotionally compromised. I mean, really, who wants to know exactly what their therapist thinks of them? No, thank you!


  1. This reminds me of an issue I have with parent-teacher conferences at my work. When I first started at the Ranch, I remember I was excited for my first parent-teacher conference, because now I finally had a chance to tell the parents what was REALLY going on with their child. I could explain to the parent that I thought the workload was too demanding and the reading level too high, and that I believed their daughter needed to be dropped down a level where her needs could be better met. So imagine my surprise, for that first conference, when the child in question was WITH US in the meeting. Yep. It turned out that is is our school's policy to have students present during parent-teacher conferences. So there I was, fumbling to say the "right words" that would convey to the parents what I needed to say, but without coming across as insulting the poor girl. Nothing like having your favorite teacher sitting there, telling your parents that you're dumb (which was so NOT what I was saying, but to a 12 year old girl, it's easy to construe it that way). So I feel like I know how those therapists would feel, having the patients look over their notes. Inevitably, they would have to curb their notes to be more sensitive to their patients, in the same way I have to curb my conferences with parents in a way that's more sensitive to the child. But the notes-thing is even worse, I think, because those are PERSONAL. Notes are little blurbs to help people remember bigger things, and are never designed to be delineated by others.

    1. Oh my gosh, children do not belong at parent-teacher conferences! When I was in school, there would be ISP meetings between parents and teachers for students enrolled in special education programs (I don't remember what they were called in high school because I wasn't in them, but in elementary the programs were called RSP). I'm pretty sure the students weren't invited.

      But I can imagine how awkward that must be for everyone. My students are entitled to talk to me about their paper grades once they've looked them over. I get some very difficult questions that're, frankly, unfair. Like, "But, I've always been good at English, how could YOU give me this grade?!" They're not asking me anything specific about their performance, they're blaming me, to my face, for the grade that they EARNED. It's hard to look at a distraught 17 or 18 year old freshman and try to explain why they made what they did when they're not willing to take ownership for THEIR work. Very frustrating and awkward. The difference, of course, is that they're adults.

      Anyway, I agree with you about the notes. You hit the nail on the head with your assessment about why notes shouldn't be open like that!

    2. We have IEP meetings for students with special needs, and yes, the kids are there for those meetings too. Soooo awkward. I mean, I get the idea that kids should be involved in their own education, but at least split the difference--discuss the issues first WITHOUT the child, and then bring him or her in the room when you're ready to discuss a plan of action.

      Your second paragraph...I can SO relate. When kids earn a bad grade, there is a definite "the teacher did this to me" mentality, rather than "I should have worked harder." How sad to hear that this continues on to adulthood.

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