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Unread March 5th, 2006, 04:42 PM
William Reid William Reid is offline
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Join Date: Jul 2004
Location: Texas
Posts: 105
Default Re: When the therapist screws up

I don't understand how you "screwed up." Perhaps it has something do do with "logging it in"? I also don't understand how you may have breached confidentiality. Two general things come to mind, though:

First, as you may know (but it bears repeating), "contracts for safety" are not an effective way to prevent suicide. They should never be relied upon to reassure the therapist, take the place of other monitoring, or reduce risk by themselves. They may be helpful in a context of sharing one's concerns with a patient or enlisting the patient's participation in the therapeutic work, so long as there is already a good clinician-patient relationship and the patient doesn't get the idea that one is using the "contract" in place of really caring about the patient.

Second, when one is concerned about suicide, the concept of confidentiality must take a back seat to safety considerations. Confidentiality is important, but it is not cast in stone when the clinician is worried about either the patient's safety or that of someone else. When in doubt, consult with a senior colleague. (You do not need the patient's permission to do that.)
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