eTherapy Health care How to Seattle Uncategorized Washington

Medicine In The Express Lane

I don’t know many professionals who do what I do: hold dual positions as a Triage Nurse and a psychotherapist. For the past eleven years, there’s only been a few seasons where I’ve worn both hats simultaneously. For the most part, Triage Nursing is fast paced, problem centered, and focused on what is happening right now. Psychotherapy is typically slower paced, person centered, and focused on the effect of the past on the present and immediate future. While these descriptions sound diametrical, they actually describe how my training and current work helps me deliver good medicine in the express lane of life.

Busy people need medicine that meets them where they are at.

Modern Life: You Are Too Busy

Most people are too busy to slow down. Their jobs don’t allow them as much leisure time if they are sent home with emails and smartphones. Lunches and breaks often turn into work time relegated for “catch up”. I can’t tell you how many times clients have told me that the only time they can call for help is after hours, when most clinicians have gone home. By the time many call in for help, they are already stressed, fatigued, or ill.

You Need It Now

Getting same-day appointments can be difficult. As a Triage Nurse, it’s my job to assess who needs to be seen by a PCP today versus tomorrow, and who needs education for good home care treatment. Similarly, counseling clients often wonder if their problems are urgent enough to warrant home care (rest, time off, medication), or the attention of a therapist.  For example, if you’ve never been clinically depressed, a few days of feeling down can easily be mistaken for feeling run down, and many clients misdiagnose their own symptoms for something somatic (body) versus emotional/mental.

Regardless, when you feel you need to be seen by someone, you want to know if you can be seen sooner than later.

Is This OK?

Often times, people are simply wanting to know what they should do with a situation. Is that pain in the chest something serious, or is it acid reflux? Can I just take a few antacids for this, or is that tingle in my shoulder worth reporting? I encourage all people to listen to their instinct for survival and health. Something that is new, unusual, painful, and/or persistent is usually NOT something to dismiss. Calling your PCP’s office is a good idea, and many providers have personnel to triage your call so that you know if you should be seen by your physician.

How To Get Medicine In The Express Lane (without getting run over)

If you want to access medical care appropriately, here’s what you should do:

1. For medical emergencies: dial 911. That’s what’s going to happen anyways if you try to call your doctor’s office with your true medical emergency. Trying to walk-in on your PCP office, which runs by appointment, will likely result in a trip to the ED.

2. If you’re not sure you’re having a medical emergency, and your HMO has a triage line, call it. The representative on the other side of your call is trained to ask a few questions that will help direct you to speak to the appropriate person, or help book an appointment for you in a reasonable timeframe. This will often save you time and grief, because delaying vital care is often more expensive than doctor’s visit.

3. Don’t try to call a triage center on a mobile phone while driving. Not only is it distracting and unsafe to you, it is often very difficult to hear because of ambient noise. Pull over, park in a safe area, and make your phone call. Give your full attention to the call and what is being asked of you. Dont’ be afraid to repeat yourself.

4. For mental health issues, it’s imperative that you report any signs of suicidal thinking, changes in medication, and any unusual circumstances, such as exposure to chemicals, a concussion, electrical shock, or a sudden change in your mood that you cannot account for. Many HMO triage lines accept mental health inquiries as well. Behavioral health specialists are there to assist you if you cannot wait to book an appointment with your therapist.

5. Don’t keep asking for what isn’t available. If your doctor isn’t available to see you, your medical record can be seen by a qualified PCP in the same group. It’s more important to be seen by a doctor in the right timing, than to wait too long to see your doctor when your problem may have significantly worsened. If you’re asked to see another clinician, there’s usually a reason.

Since a lot of medical services are being delivered over the phone, fax, and email these days, it’s important to remember that triage isn’t perfect in these formats. However, they allow professionals like myself to help you get the help you need, when you need it most.

What do you think? Is fast medicine just what you do when you ask Siri a question about your health, or Google a question about your medications? Have you ever tried to use a triage telephone number of your HMO when you’ve been sick? What was your experience?

Health care Relationships Seattle Therapy

What Is Confidentiality?

While the world of Social Media is repeatedly rocked by cries of the masses regarding the loss of privacy, one of the lynchpins of psychological counseling is the promise of confidentiality. When a therapist reminds a client that whatever is shared in a session is confidential, the therapist is referring to a legal concept that protects the rights of the client against the release of what is shared within a specific circle of professionals. Without confidentiality, clients would live in fear that their personal stories could be shared with others without their permission. If you are seeking counseling for the first time, take a moment to understand what confidentiality is, and when it can be broken.

Do you know what confidentiality means? Your therapist knows how to keep a secret, and when to break it.


In the counseling office, confidentiality is a legal term designed to protect client content during sessions. Without the promise of confidentiality, clients may be extremely reticent to dig deeply into their rational and irrational conflicts and fears; with confidentiality in place, clients are more motivated to overcome their potential resistance to confront and explore these fears. In an excerpt from Legal Issues in Mental Health Care by Barbara Weiner and Robert Wettstein, the problem is outlined clearly:

Many of those who recognize a need for mental health services also recognize the potentially negative career, social, and economic consequences of seeking that assistance if it became generally known. The consequences can include the inability to obtain a job or promotion;  inability to obtain disability, health, and life insurance; and social ostracism. 

Legal confidentiality binds a therapist to keep content shared in the therapeutic setting private, and a good therapist is transparent about how this is done. It includes an explanation of what confidentiality is, when it can be broken, and what its functions and limitations are in terms of providing an environment of safety and growth for the client.


There are several circumstances when confidentiality can be broken:

* The client reports harming a child, elder, or vulnerable adult. State laws require helping professionals to report such crimes to the appropriate authorities with a certain time period.

Reporting confidential material from sessions includes the Tarasoff Law. This law is referred to a “duty to warn”, and it is used when the therapist learns of the real or serious threat to harm an identified person. This allows the therapist a legal reason to break confidentiality when the client has shared evidence of his/her intent to harm another person. A common example of this would be an angry spouse in the midst of a custody battle, who mentions the intent to kill his/her estranged spouse in order to not be deprived of visitation rights to the children. The Tarasoff Law puts the burden on the therapist to warn the intended victim of the threat of harm, identify police, or take other reasonable action to protect the intended victim.

* The client physically and/or verbally threatens or assaults the therapist.

*The client is a minor, under the age of consent, and the guardian of the child needs to be notified of relevant information regarding his/her care.

*The client has transferred his/her power of attorney to another adult individual. In this case, the designated adult who has power of attorney usually signs the contractual agreement along with the client.

* If a client has failed to pay for his/her sessions, the therapist may send the name of the client to collections, and this information can become public.

* If a client reports misconduct from his/her therapist, the therapist has the right to divulge identifying information as well as pertinent information from the sessions in the defense of the charges.

* A third-party payor (health insurance company, for example) receives identifying information, including a diagnosis of treatment, of the client before paying out on the client’s visits. Third-party payers are prohibited from releasing diagnostic information to employers or outside parties.

* Written consent from the client is given to associated health professionals in the coordination of his/her care. A therapist may request HIPAA (Health Insurance Portability and Accountability Act) release forms to be signed by the client in order to share relevant information to the client’s designated care givers.

All those who become a part of the client’s care giving group form what is called a circle of confidentiality. Within the circle, information can be shared; outside of the circle, these professionals cannot share information, including whether or not you are even a client at all. 



Apparently, even celebrities need privacy. While many believe that the cost of fame is a loss of privacy, that belief should stop cold in regards to seeking mental health counseling. You should have the assurance that your very private thoughts can be kept confidential, whether you think anyone cares to know those thoughts or not.

Recently, a business associate mentioned that he wanted to refer a potential client to me. The client was a friend with whom he had worked with in a business environment, but the work arrangement ended because of personal conflict. At the end of the referring phone call, this associate asked if I would notify him when the former employee called and started therapy sessions with me. I thanked the person for the referral, but then I kindly reminded him that while I could see that he was genuinely concerned, legal confidentiality bound me from identifying my clients to anyone without the express permission of the client.

While I’m not going to speculate as to the motives of the business associate for being notified, I’d like you to note that even if it was a man referring his spouse to therapy, unless the identified client (i.e. spouse) releases the right to share information, the therapist is bound by the law to not share ANYTHING  (with only the above exceptions) regarding the therapy sessions, including her presence in my office as a client.

Well, no wonder so many people like hiding holes, secret places, and whispering in the dark! But with confidentiality working for you, you can know that whatever you need to discuss gets professional, unbiased attention.

By the way, if you believe your privacy has been broken in the therapeutic setting or by your employer,  report those violations to your state’s Department of Health or your employer’s Human Resources department.

What do you think? Do you think confidentiality helps people seek mental health care because they know they can share their secrets privately? What issues do you think are a problem as the nation considers the idea of having a single electronic medical record for every person? Share your thoughts.