Public diagnosis and the therapeutic relationship

In an online story published by US News and World Report, a psychotherapist is quoted as saying that Donald Trump suffers from an incurable mental illness that makes him "temperamentally incapable of being president." This person admitted that he has never met Mr. Trump. He said that he makes his diagnosis based on what has appeared in the media.This pronouncement caused quite a flap.

Politics sometimes comes up in my psychotherapy sessions. If it is important for my client to discuss, I am very willing to do so. I rarely, however, disclose my own feelings on such topics. This is not because I am embarrassed about my political views; I am not. However, if my views do not align with those of my client, and that upsets my client, it could damage our relationship. A damaged relationship is not the best context for conducting therapy. I take the same approach with religious topics: we can talk about such things, but I usually keep my views private.

Also, if I heard my therapist talking publicly about the diagnosis of another person, I might wonder if s/he talks about me outside of our sessions. That would feel like a betrayal of confidentiality. I make sure my clients understand about confidentiality - and its limits - so they know what they can expect from me. Hopefully I conduct myself in a way that engenders trust; then they will feel more comfortable sharing information with me.

The Need for Medical and Mental Health Care Providers to Collaborate

In a recent online survey of physicians from several countries, 27% or respondents answered “no” to this question.

The US Preventive Services Task Force recommends that all adults be screened for depression. Do you feel comfortable discussing mental health issues with all of your adult patients?

This is concerning because many people who are experiencing behavioral health problems seek help first from their physician. The Centers for Disease Control and Prevention noted in a 2015 press release that about half of the people who visit a physician for mental health problems see someone other than a psychiatrist.

In another finding by the same organization, the results were even more discouraging. 

I believe most of my patients are honest with me when discussing…

• 23% – Tobacco use
• 19% – Eating & exercise habits
• 13% – Alcohol use
• 13% – Sexual history
• 10% – Drug use
• 4% – Domestic abuse
• 18% – None of the above

These problems involve choices people are making that negatively impact their physical and emotional lives. And the results suggest that these important issues are not being discussed, or are not being discussed honestly, by a sizable portion of patients.

Polls sometimes fail to reflect reality for a variety of reasons. Even if twice as many people are honest when talking to their doctors about issues, that still means fewer than half are being honest about tobacco use, and fewer than 10% about domestic abuse.

Both of these survey items point to the need for better communication – between doctors and patients, and between doctors and providers who specialize in mental health treatment. I work hard to keep in touch with the other people who provide care to my clients. Many of them appreciate these efforts, and many of them reciprocate.

Although it sometimes appears that members of different health care disciplines work hard to protect “territory”, our clients and patients are always better served when we collaborate.