Wednesday afternoon, 1:12 pm. Your phone rings.

Good afternoon, ABC Counseling.

[Counselor] I need to see you right away.

What's going on Miss Jones?

I received this letter today and my anxiety is extremely high now. They are talking about discontinuing my insurance due to some new bill in the state. I am so stressed out that I do not know what to do.

I am sorry to hear about this experience Miss Jones. I do not have an availability today, however, I could see you tomorrow morning at 8:00 am. Can you come in then and we can talk through your situation?

Yes. I will see you then.

Thursday morning 7:45. Frantic knock on your front door.

[Counselor] this is the letter I was telling you about on the phone!

Dear Mr. Patient,

The [company] is proud to provide you with financial assistance for your health insurance through our Health Insurance Premium Program (HIPP). We are writing today to give you an important update that may effect our ability to provide you assistance in the near future.

The California Assembly recently passed a bill, AB [xxx], that would force [company] to discontinue its HIPP program in the state. This bill will be voted on in the Senate within the next several weeks. If the bill passes and is then signed into law by Governor Newsom, [company] will no longer be able to pay your health insurance premiums.

I don't know what to do! My husband's health insurance could be cancelled cause we cannot afford his insurance premiums. His premium is over $500 a month, and he barely receives $700 from his Social Security. We can't afford this. My anxiety is so high I am about to lose my mind!

This scenario is a real scenario. What would you do to set your client's mind at ease? 

In today's society where insurance premiums can be high for some people, especially if they are living with a life threatening illness, as therapist's we need to consider how we can comfort our client's and their families. 

We all know we cannot help them write their letters if they choose to send a letter to their state Senator, however, would you have them write that letter as a homework assignment? As a therapist, I would probably encourage the client to participate in the writing to their Senator to express how this can affect them. I also would encourage them to talk with their family to help them understand how this increases their anxiety. Each of us could use a variety of techniques to assist Miss Jones in this situation. The difficult part for many of us is, we are in a caring profession and those therapists that I have met in the community and through CAMFT, would find it hard not to be empathetic and want to help. This is one of those fine lines we need to walk. This begs the question, what else could we do?

In this scenario, Miss Jones brought in her letter. You were willing to help her understand all that needed to be done to write her letter as her homework assignment. This included showing her where to go on the internet to write this letter. Since you now know where this website is, you could also write a letter to your state Senator through the link that you found in Miss Jones letter; however, this now begs the question, how do you identify yourself? If you put in there that you know someone, even if you do not include your patient's identity, you have now opened yourself up to that being a potential issue of breaking confidentiality, all be it, it is highly unlikely. How could this break confidentiality you might ask?

Miss Jones husband has a terminal illness. His insurance premium is being paid for by a specific company that only cares for people with that specific illness. Let us look at the numbers and how it COULD open up that breach of confidentiality.

People with this illness in California: 140,000

California Counties: 58

Number of patients per county average: 2400

How many of those patient in that county have the same name: 5

You identified yourself as knowing someone with this illness. Process of elimination, someone could potentially find out that Miss Jones is your client.

Should we risk this by stating that we know someone with this illness then? Unless we actually have a friend or family member with this illness, we should sign these online letters as a concerned citizen. 

I know that the chances of us getting a scenario like this is slim. Yet, it is possible. Just remember, sometimes, that process of elimination can come into play and it could become a potential Law & Ethics issue. 

~~~~~~~~~

Michael Crile, MA, MA, is a registered associate marriage & family therapist and organizational leader. He currently is on a break from working as a Student Counselor with Comprehensive Youth Services, under the supervision of Lisa Brott. He takes the challenges and experiences from life to assist the clients he has worked with, to provide the best therapy for each client. He has worked in forensic environments working with individuals who had been in the state mental hospitals and with sex offenders on parole and probation. He enjoys a variety of therapeutic techniques, being extremely eclectic in the therapy room. He is scheduled to take his Clinical MFT Exam in August to become fully licensed. In his off-time, he serves on the CAMFT-CSJV Chapter board as Secretary and on the Visalia Toastmasters board as Sergeant-at-Arms. He enjoys a plethora of music, cooking, writing speeches, is a Disneymaniac, and loves nature, walking and jogging.