Insights and inspiration from A Burden Shared

Even in a bigger town or urban area, it is always possible that a client will encounter their therapist in a public space. It is easy in the city context to step away from such encounters with nothing more than a glance of recognition. The client is free to smile and say hello. No one who is with the client is going to know that the encounter was with their therapist unless the client tells them so. I remember seeing a therapist of mine in the Public Library in Guelph. I was with my daughter, who knew that I was in therapy. I said, "That's my therapist," to my daughter. In a small and friendly community like Tobermory, running into your therapist is inevitable. My clients see me at the spaghetti dinner, at the cardboard boat races, and of course, at the grocery store! Having an encounter like this in a small town without a smile, a wave, and a friendly greeting is likely to be seen as rude!  Does anyone else in attendance at this public encounter know that you are "in therapy" with this small town professional who is known to be a therapist? That is up to the client. Since it is likely to be seen as rude if you do not greet people that you know, the fact of saying hello to me does not identify you as a client. Many psychotherapy clients are completely okay with having others know that they are in therapy, while others prefer more privacy. The therapist is, of course, bound by ethical practice and regulations to protect clients from any such disclosures. This means that I won't tell anyone that you are in therapy. 

In terms of the private encounters that take place in a private room of a public building, clients need to be comfortable coming and going from that public building with the awareness that they may be seen entering and leaving, and it may become known that they are seeing the therapist. Again, for many clients, this is not a problem. They, just like everyone else, are dealing with some difficult issues and problems in their lives, and they are not embarrassed or ashamed of this normal human condition. Nor are they ashamed to have it be known that they have chosen to seek professional help. Many others who are also not embarrassed or ashamed just prefer a greater level of privacy. Virtual online and telephone therapy is just as effective and sometimes even more so for clients who prefer to process their difficult emotions with an empathetic listener who is not visually observing them. They may also prefer therapy that is done in the comfort of their home.

One of the biggest challenges for small-town therapists is that it is highly likely that clients will be processing difficulties that they have with other members of the small community. The client may need to process old wounds that are associated with his parents, who are also members of the small community. They may be working on current relationship issues when the partner they are living with is also known to the therapist. The therapist needs to be able to maintain the client's trust by behaving professionally. Anything a client tells a therapist in session is held in complete confidence. There are rare exceptions to this rule, such as if a client discloses plans to harm themselves or discloses that a member of a vulnerable population (child, elder, disabled person) is at risk. You can tell me about your parents' health or your child's school problems with the assurance that I will not discuss what you have told me with anyone else without your consent. 

The thing that makes it possible to be a therapist in a small town is regular supervision with a skilled and experienced therapist/supervisor who lives and practices in a different place. If a client has shared something, in confidence, about a person, and this disclosure leads to an emotional reaction of some kind - there is a name for this - "countertransference" - I can take this to supervision to get the support I need to process my emotional reaction and continue to practice safely and professionally.

I hope you find this article helpful and informative. Please also know that I am available for a free 15-minute consultation by phone if you have any concerns or questions about engaging in psychotherapy.