Don't Ask Don't Tell & Military Psychologists

[Shatani]

so, i have mentioned being interested in military pscyhology before on this board and i was wondering how dont ask dont tell impacts the work of a military psychologist. i guess a specific question that comes to mind is, can a service member safely come out to his/her psychologist? what are the boundaries of confidentiality in situations like this?

it occurs to me that the high stress environment of combat added to the high stress environment of living in the closet/holding on to a secret such as this, would be extremely psychologically detrimental (to put it lightly)

thoughts?

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[Therapist4Chnge]

MOD NOTE: I changed your title to be more descriptive of the topic. -t4c

I recently saw a talk on one of the news stations about DADT and the official and unofficial policies being enforced. Per the news report, Robert Gates (Defense Secretary) called off aggressively pursuing gay and lesbian service personnel. He said that they would still discharge anyone who actively outs themselves, though they would otherwise back off enforcement.

I will defer to active members in the military (we have a few that post on here), though I believe the stance is that the psychologist works for the military, and their confidentiality begins and ends with them...not the soldier.

 

[deleted176373]

so, i have mentioned being interested in military pscyhology before on this board and i was wondering how dont ask dont tell impacts the work of a military psychologist. i guess a specific question that comes to mind is, can a service member safely come out to his/her psychologist? what are the boundaries of confidentiality in situations like this?

it occurs to me that the high stress environment of combat added to the high stress environment of living in the closet/holding on to a secret such as this, would be extremely psychologically detrimental (to put it lightly)

thoughts?

Well, as a military psychologist in training... I think I feel comfortable giving the answer to this one.

1. You are bound by APA ethics to maintain confidentiality.

2. You are bound by Oath and Law to report violations of the UCMJ.

Violation of number 1 can result in the forfeiture of your license.
Violation of number 2 can result in the forfeiture of your commission.

You are in a double bind, you are screwed if you do and you are screwed if you don't. So what to do as a psychologist yet manage to:

1. Provide care to the client.
2. Maintain your ethical commitment as a psychologist
3. Not violate your oath of office.

Well?

The answer lies in carefully going over the informed consent with the patient and informing them of what, by law, you are REQUIRED to report. We are required to report violations of the UCMJ. Discussions that are NOT a violation of the UCMJ or lack the specificity to act are NOT reportable.

To answer your question clearly: No. A service member cannot come out to their psychologist and expect that information to remain confidential.

There are other concerns as well, for instance, in the military we have to first determine who is our client. Is it the Government or is it the person before us? Sometimes it is the government, other times it is the person before us, and this makes a HUGE difference in how the information we receive is treated.

The reality is that many military psychologists have techniques to work around these limitations to confidentiality. The level of comfort and desire of a military psychologist to work at the edges of what rises to reportable information is quite variable. I know that many psychologists in the military are looking forward to an end to the don't ask, don't tell policy. However I don't think it is a tremendous barrier to care among those psychologists who wish to work with sexual minorities (whether it be homosexuality or some other form of sexual activity.) However it can still be a huge barrier to those service members who are unsure of whom they can or cannot talk to. The ONLY people in the military with 100% confidentiality are Chaplains and Defense Lawyers.

This is MY opinion and IS NOT the opinion of the UNITED STATES GOVERNMENT, THE U.S. DEPARTMENT OF DEFENSE, OR ANY OTHER GOVERNMENTAL ENTITY.

 

[Shatani]

thanks to both of you! Mark, thats exactly the kind of information i was looking for...

 

[Casey407]

I was enlisted active duty a few years ago. Coming out to a psychologist is a violation of DADT and you can be reported. I had a friend experience emotional problems because he was concealing his sexuality. He told his therapist and he was discharged.

Very sad.

 

[loveoforganic]

That is stupid.

 

[Ollie123]

That is stupid.

Agreed.

While a bit off topic, I've always what would have happened to this policy if a draft became necessary. While it is a good bit dysfunctional even with a volunteer military, I imagine a draft would turn into an absolutely epic disaster with this policy in place.

 

[Shatani]

That is stupid.

i thoroughly agree....its pretty infuriating to me.

 

[mixolyd]

Didn't a federal judge recently say that the military can't do that anymore?

 

[stigmata]

We are truly in bizarro world when PC pressure takes precedence over the lives of real people who have volunteered to serve in the military.

 

[O Gurl]

That is stupid.

Yep. It was the major reason the AF internship sites I considered were dropped to the very bottom of my list. They offered solid training and great benefits. I also come from a military family. However I simply could not reconcile the idea of practicing with such constraints on the therapeutic relationship. I really need for my client to be my client. Not the organization.

 

[deleted176373]

Yep. It was the major reason the AF internship sites I considered were dropped to the very bottom of my list. They offered solid training and great benefits. I also come from a military family. However I simply could not reconcile the idea of practicing with such constraints on the therapeutic relationship. I really need for my client to be my client. Not the organization.

What are you perceiving as constraints? Personally, I have not had any problems with the issue of my client not being my client... When the Government is my client, it is clear... When the person in front of me is my client, it is also clear and my instructions and protection of that person is foremost in my mind. I will do my best to stop my patient from saying anything that would require me to report them.

The limits of confidentiality are critical and helping the patient to understand what is reportable and what is NOT reportable is key. That however has never been a barrier to providing quality treatment.

I have had clients that have had concerns regarding the confidentiality that I can guarantee, once briefed, they had no problems discussing the issues they wanted to discuss without me having to report violations of the UCMJ. It's not a barrier really.


Mark

 

[O Gurl]

What are you perceiving as constraints? Personally, I have not had any problems with the issue of my client not being my client... When the Government is my client, it is clear... When the person in front of me is my client, it is also clear and my instructions and protection of that person is foremost in my mind. I will do my best to stop my patient from saying anything that would require me to report them.
Mark

That's where I had trouble. I certainly agree that defining the limits of confidentiality on the front-end does a lot toward establishing a foundation for therapy regardless of setting. It is not unlike the general spiel that imminent self-harm, homicidal intent, child abuse, and vulnerable adult abuse (elderly and disabled) must be reported in practically any therapeutic context. However, I never feel any pressure or pull to prevent my clients from endorsing these things. I suppose my ultimate trouble with the military-specific constraints is that it is essentially a technicality. With the other issues, it is about safety. In the case of DADT it is archaic bigotry. I have far more trouble having to work around that I suppose. :-(

 

[deleted176373]

That's where I had trouble. I certainly agree that defining the limits of confidentiality on the front-end does a lot toward establishing a foundation for therapy regardless of setting. It is not unlike the general spiel that imminent self-harm, homicidal intent, child abuse, and vulnerable adult abuse (elderly and disabled) must be reported in practically any therapeutic context. However, I never feel any pressure or pull to prevent my clients from endorsing these things. I suppose my ultimate trouble with the military-specific constraints is that it is essentially a technicality. With the other issues, it is about safety. In the case of DADT it is archaic bigotry. I have far more trouble having to work around that I suppose. :-(

I don't really want to get into the specifics of how I handle this, because it's really not appropriate here. I can just tell you that my experience working in this context has been that I have not had a problem with DADT or other reportable offenses because I make it very clear on what is reportable. I do look out for my clients and if we DO get on a topic that is reportable I remind them of the limits of confidentiality.

I should be specific and say that I don't try to really prevent them from saying something reportable but rather I remind them of the limits of my confidentiality... while it really does in fact prevent them from saying something reportable, I am not preventing them, I am just reminding them of the limits I operate under.

My role is not that of investigator or police officer... I try to avoid having situations that I will be put into either role. Not my job, I am a psychologist.

Mark