Q: Dear APW,
I’ve been married for two and a half years (but we’ve been together a decade) and recently my husband and I have been going through some tough times. We’re in the process of trying to find a couples therapist and after a particularly bad fight my husband decided he should start seeing one individually. This is actually where my question comes in because we have a pretty open relationship and now it feels like my husband is talking to someone else about things he might not be talking to me about. Also, might he be talking about me? We’ve been together for a while and my husband never seemed to have a lot of issues, but now I’m wondering if things that seemed small may actually be huge but he doesn’t want me to know about them (a few strange phobias, a somewhat repressed sexual identity he said wasn’t an issue, divorced parents).
So, my question: how much of what he talks about in therapy do I get to know? I really want to ask for a play-by-play (or a tape-recording?) of the session, but I understand that this is probably off limits. Can I ask about general topics? Can I ask about things (his sexuality) that might affect me? Should I be worried that my issue-free man apparently has lots of issues? I’m not against people seeing a therapist, and have considered it myself, but I am concerned about the specifics of his visits. Thanks.
A: Dear APW Reader,
The core of your question is about trust. You have been in a relationship with your partner for many years, and you have strengths as a couple. But recently, you’ve been going through a difficult time. And now, you’re wondering whether you can trust your partner, and whether he trusts you. Understandably, this is anxiety-provoking, and whatever feelings you’re having are totally valid. But just as you deserve validation of your feelings, your husband deserves validation of his. So far, his therapy has likely provided that.
Even when couples have been together for a long time, there can still be topics that are tough to talk about, or new topics that have come up over the years. And no one is issue-free. That fact may be upsetting, but it’s realistic, and being aware of one’s issues is much healthier than not being aware of them. In other words, it’s a good thing that your husband is exploring his concerns in therapy.
It’s normal to worry about partners and relationships, and it’s also normal for anyone who has a partner to talk about that person in therapy. But your husband also needs to understand that you’re feeling concerned, excluded, and worried about him and your relationship. You should talk to him directly, and compassionately, about these concerns. Your idea to begin couples therapy is also great. With your husband’s permission, you can also talk to his therapist, with him or without him. But his therapist also has to set boundaries to ensure that his sessions feel safe to him. I’ll talk more about options for how to talk about this, including in couples and individual therapy. First, I want to address the important issue of a patient’s privacy and confidentiality in therapy, which therapists take very seriously.
Patient Privacy and Confidentiality
To give a short answer to your question, it’s up to your husband how much you can know. In therapists’ practices, patients’ confidentiality is critically important. You have probably heard of HIPAA (the Health Insurance Portability and Accountability Act of 1996), the federal law that sets rules about how private health information can be shared in health and health-related contexts. HIPAA ensures that patients have rights over their health information and how it’s shared. This includes sharing information with anyone—with other providers, family, partners, or close friends. HIPAA states that if private health information is to be shared, patients must give explicit permission, usually written, to indicate what information can be shared, and with whom.
Otherwise, the default is that therapists keep information private. It’s become harder than ever to find true privacy, and therapy can serve as a unique and sacred space to talk about important things. There are, of course, circumstances in which providers can make exceptions to these rules without patients’ permission. In the practice of psychology, according to the Ethical Principles of Psychologists and Code of Conduct, these limits to confidentiality include when a patient is considered a danger to self or others (e.g., if someone is suicidal or homicidal), if a patient is believed to be engaged in child or elder abuse, or is a victim of abuse or neglect, or if there are legal requests, such as a subpoena, involving the patient.
How Therapists Can Talk To Partners
Many therapists do talk to patients’ partners with patients’ permission. Some therapists talk with a patient’s partner over the phone, or invite them to a session to collaboratively discuss general issues. Often, this is to facilitate a broader conversation that can continue with a couples therapist. Some therapists may alternate seeing a patient individually as well as with a partner, but most therapists and patients find it most helpful to have a separate couples therapist who can work more objectively (and, therefore, more effectively) with interpersonal dynamics, and whom each partner can equally trust.
Because a trusting therapeutic relationship and a patient’s privacy are so important, it is not common for an individual therapist to give a patient’s partner a play-by-play report of a session. Most therapists, unless they’re in training or are engaged in certain styles of therapy, do not even record sessions or write them down verbatim. If they do, the tapes or transcripts are typically used for the therapist’s private review, or for review with a clinical supervisor, so that the therapist can reflect on and understand how to best help the patient. Your wish to know exactly what’s going on in the sessions is understandable, but it is unlikely that your husband and his therapist would agree to this.
Trust… And Boundaries
In a healthy relationship, partners need to be able to talk openly about a variety of topics. This is what’s bothering you the most: so far, your husband has felt unable to openly discuss important issues with you. It’s normal to feel worried, hurt, or angry about this situation. It may be a sign that something is wrong. But it’s also healthy for partners not to talk about every concern or issue they have. Boundaries are necessary, to a certain extent, to ensure that people do not get hurt. Some things should be kept private, or can be kept relatively private, while they’re being worked through. But you can also do your own work as a couple to process your feelings about this, and to work on communicating more effectively, which should facilitate more open communication and deeper trust in the future.
It’s really important for couples to have people with whom they can safely explore concerns about their relationship, as well as their own issues, which may be affecting the relationship. So, while your idea to start couples therapy is wise, I’d also encourage you to see your own therapist. There may be parts of your own history or psychology that are making these circumstances harder to deal with, and an individual therapist can provide support around those issues. It’s been a tough time for you, and you should make sure that you’re taking care of yourself and getting support. In addition to working on your marriage, this means finding ways to reduce your anxiety, spending time with supportive people, and making sure that you have private space for yourself and what’s important to you, too.
The information provided in Ask a Psychologist is intended by Dr. Brofman and APW to serve as general advice and guidance for all readers. The advice herein does not constitute a clinical recommendation or relationship, and Dr. Brofman and quoted mental health professionals do not take clinical responsibility for this information. Ask a Psychologist does not take the place of a confidential clinical consultation with a trained mental health professional.