survive his next hospitalization. He had done independent research and talked with his physicians, and he was certain that, if pneumonia developed again, it would be fatal due to numerous complications and that it would likely be a long and painful death. George said that when that time came, he wanted to die in the off-campus apartment he had lived in since he came to college—not in the hospital. He would, when he felt himself getting sicker, take some illicitly obtained drugs that would ease him into death. Dr. Hightower tried to dissuade him from this plan, but George refused to discuss it and said that if Dr. Hightower continued to bring up the subject, he would quit therapy. Convinced that George would quit therapy rather than discuss his plan, Dr. Hightower decided that the best course of action was to offer caring and support—rather than confrontation and argument—to a patient who seemed to have only a few months to live.
Four months later, Dr. Hightower was notified that George had taken his life. Within the next month, Dr. Hightower became the defendant in two civil suits. One suit, filed by George’s family, alleged that Dr. Hightower, aware that George was intending to take his own life, did not take reasonable and adequate steps to prevent the suicide, that she had not notified any third parties of the suicide plan, had not required George to get rid of the illicit drugs, and had not used hospitalization to prevent the suicide. The other suit was filed by a college student who had been George’s partner. The student alleged that Dr. Hightower, knowing that George had a partner and that he had a fatal sexually transmitted disease, had a duty to protect George’s partner. The partner alleged ignorance that George had been suffering from AIDS.
LIFE IN CHAOS
Mr. Alvarez, a 45 year-old professor of physics, has never before sought psychotherapy. He shows up for his first appointment with Dr. Brinks. He shares with Dr. Brinks that his life is in chaos. Dr. Brinks was granted full professor status about a year ago and about one month after that, his wife suddenly left him to live with another man. He became very depressed. About four months ago, he began to become anxious and to have trouble concentrating. He feels he needs someone to talk to so that he can figure out what happened. Mr. Alvarez and Dr. Brinks agree to meet twice every week for outpatient psychotherapy.
During the first few sessions, Mr. Alvarez says that he feels relieved that he can talk about his problems, but he remains very anxious. During the next few months, he begins talking about some traumatic experiences in his early childhood. He reports that he is having even more trouble concentrating. Dr. Brinks assures him that this is not surprising, that problems concentrating often become temporarily worse when a patient starts becoming aware of painful memories that had been repressed. She suggests that they begin meeting three times a week, and Mr. Alvarez agrees.
One month later, Mr. Alvarez collapses, is rushed to the hospital, but is dead upon arrival. An autopsy reveals that a small but growing tumor had been pressing against a blood vessel in his brain. When the vessel burst, he died.
Months after Mr. Alvarez’s death, Dr. Brinks is served notice that the licensing board is opening a formal case against her based upon a complaint filed by Mr. Alvarez’s relatives. Furthermore, she is being sued for malpractice. The licensing complaint and the malpractice suit allege that she was negligent in diagnosing Mr. Alvarez in that she had failed to take any step to rule out organic causes for Mr. Alvarez’s concentration difficulties, had not applied any of the principles and procedures of the profession of psychology to identify organic impairment, and had not referred Mr. Alvarez for evaluation by a neuropsychologist or to a physician for a cognitive and medical examination.
LANGUAGE: THE INTERPRETER
Angelica, who was born in Bolivia and migrated to the US two years ago, is a 55 year-old mother of three. Following the advice of her physician and sister, she decides to seek psychotherapy to deal with insomnia, lack of appetite, and uncontrollable crying spells. Angelica only speaks Spanish and there are no bilingual therapists available at the clinic; however, Dr. Jones agrees to work with Angelica. Wanting to help Angelica, Dr. Jones agreed to do therapy with an interpreter, although this is the first time she is providing therapy services with an interpreter. She is sure that all interpreters know what to do. Dr. Jones proceeds to schedule Angelic’s intake. During the clinical interview Angelica seemed to be worried and went back and forth with the interpreter. Dr. Jones, not speaking Spanish, is unable to follow what’s happening and when she inquires, the interpreter only says that Angelica feels ashamed of speaking about her family’s business. Dr. Jones, via the interpreter, tells Angelica not to worry and goes on to discuss informed consent and confidentiality. Angelica does not return to her second session and several months later, Dr. Jones receives a letter indicating that a civil law suit had been filed against her. According to the letter, Dr. Jones assured Angelica that all of the information that was shared in therapy would remain confidential, but somehow her husband, who has a long history of domestic violence, found out all of the details that Angelica disclosed to Dr. Jones during the intake interview. He became so violent toward Angelica that she spent several days in the intensive care unite (ICU) recuperating from the physical abuse.
COMPUTER COINCIDENCES
What happened to these therapists was so traumatic that, even though they are fictional characters and never existed, they have fled into other lines of work, do not want to be recognized, and demand anonymity in this hypothetical scenario. The catastrophes seemed to start when one of them hit the “send” button on his computer.
For many years they had maintained a small and very successful group practice. Then they modernized, bringing in state-of-the-art computers, elegantly networked and equipped with wonderful software that made the therapists’ work so much easier.
Until one day the first therapist hit the send button. He had carefully collected all the electronic records of one of his patients, who was involved in litigation, to e-mail to the patient’s attorney. There were the billing records, results of psychological testing, records of therapy sessions, as well as the background records (employment, disability, etc.) that the therapist had on file. The therapist gave one last look and then hit the send button.
It was only after watching his computer send off the records that the therapist realized he had used the wrong address on the e-mail. The patient records were on their way, not to the patient’s attorney, but to a large internet discussion list that the therapist belonged to. This unfortunate series of events led to a formal complaint against the therapist.
By a far-fetched coincidence typical of hypothetical scenarios, the second therapist walked into the first therapist’s office just when the first therapist was hitting the send button. Here’s what the second therapist said: “Can you believe it!? I’m being sued, and it’s all because of my computer! When my patient temporarily moved to the east coast for a sabbatical, we thought it best to continue treatment, but because of the time difference and our heavy schedules, we couldn’t find a time when we could both talk, so we decided to communicate by e-mail. But then she got mad at me about something and filed complaints against me in the other state! So now they’re saying I was providing psychological services in that state without being licensed in that state, and that I failed to follow that states rules and regulations about…well you’d have to read the complaints her attorney has filed with the licensing board, the courts, and the ethics committee. It’s terrible!”
As if sensing that another wild coincidence was needed to keep the story moving, the third therapist rushed into the first therapist’s office at that moment and said: “You won’t believe what just happened! I just got a formal notice that I’m being sued! I just found out what happened: Somehow a virus or Trojan or Worm or one of those things got into my computer and took my files—you know, all my confidential case files—and sent them to everyone listed in my address book and to all the other addresses in my computer’s memory. What do I do now?”
On cue,
