My husband and I talk about having counseling but I am frightened that it will uncover some personal secrets I have about our marriage.

It’s not uncommon for personal secrets to be uncovered during the course of couples counseling but you have the right to allow your own secrets to come out in the open or not and to decide if and when the timing is right for you.

It might benefit you to talk with a therapist on your own about what your concerns are regarding the secrets being revealed. Your therapist can help you consider the implications of revealing or not revealing, help you develop self-care strategies, and can facilitate your having more clarity about whether or not to pursue couples counseling.

I am currently in therapy but feel that my therapist is not taking me seriously. Is it ethical to start with someone new?

It’s important to work with a therapist you feel comfortable with and one who takes what you say seriously. If you wish to extricate yourself from therapy you can tell the therapist in person that you are leaving or leave a phone message.

From the standpoint of getting the greatest benefit from your treatment (whether or not you choose to move on to another therapist) in most cases it would be best to speak to your therapist about whatever dissatisfaction you are experiencing regarding your therapy. Your therapist should take your complaint seriously and invite you to explore the issue with her in a way that fosters awareness and personal growth. Generally we become stronger by developing the capacity to express our thoughts and feelings and to work through conflicts in our relationships. It’s common for uncomfortable issues to arise between therapist and client as they do in other important relationships, and often these issues mirror the issues you have had with significant others in your family, personal or professional worlds. In therapy you have the opportunity to explore the personal significance of the issue in the safety of the therapeutic environment and hopefully come to new understanding and new ways of being that will serve you in your relationships outside of therapy. For the client this process takes courage, the capacity to experience uncomfortable feelings and a strong desire to learn and grow. The therapist should be knowledgeable, respectful, and in service of the client’s growth and development.

From the standpoint of ethics the therapist is expected to take her clients seriously and treat them with respect. It’s ethical for a therapist to treat a client who has recently left another therapist and good practice to explore with the client what led to the termination of her/his last treatment. The client’s personal ethics come into play regarding the best way to leave relationships that are not serving her needs.

If I tell you about illegal conduct or illegal drug use are you obligated to report it?

No.

How private is my therapy? Do you take notes and who else would have access to them?

Your therapy is private in that your therapist is mandated to keep all that goes on (including notes) confidential with a few exceptions:

• If you are using insurance to pay for your therapy your insurance company is always privy to your diagnosis, dates of treatment and information regarding whether you are being treated individually, as a couple, or in a group. This information must be on every invoice your therapist sends to the insurance company or reimbursement will be denied. Your insurance company can request access to your records in other situations as well, for example, if your therapist is being audited by the insurance company your records may be scrutinized to see if the therapist is in compliance with insurance guidelines.
  
• If your mental health is being called into question in conjunction with a lawsuit you are involved in your records and/or your therapist's testimony may be subpoenaed. Your therapist should notify you if your records are requested.
• If you are a danger to yourself or to other people your therapist is mandated to notify the proper authorities so that you or anyone in danger from you can be kept safe from harm.
• Your therapist is mandated by law to report situations where children or elders are being abused. Your therapist would most often inform you before a report was made and talk to you about the process and possible repercussions.
• Your therapist may be invoved in ongoing consultation with other therapists about the diagnosis and treatment of clients. Identifying information about the client is always kept confidential and the focus of discussion is on how the therapist can continue to provide her clients the best treatment.

How does therapy work and how will I know if I’m getting better?

Psychotherapy is a process in which the therapist and the patient discuss a myriad of issues, events, experiences and memories. This process creates the opportunity for deeper self-awareness and understanding of current problems and paves the way for connecting with and building on existing strengths, developing new self-care strategies, and making choices that lead to feeling good about oneself and creating a more satisfying life.

You will know you’re getting better when the problems that brought you to therapy have been resolved or have lost their hold on you and you are feeling better about yourself. During the course of therapy you should be having an ongoing dialogue with your therapist about your progress.