So, What Can Therapists Write About?

A response to Gary Greenberg’s op-ed, Should Therapists Write About Patients?

In an op-ed for the New York Times, psychotherapist and author Gary Greenberg recounts a recent mishap in writing about his patients. After obtaining consent and/or taking elaborate attorney-approved steps to render his patients’ stories unrecognizable even to themselves, Greenberg published about some of his work with patients. Despite his meticulous efforts, one patient identified himself in the book — not in any obvious characteristics but in the story’s essence. The patient felt violated, and the therapeutic relationship never recovered.

In addition to honoring patient confidentiality, therapists have an ethical aspiration to do no harm. Although Greenberg did his due diligence, he learned that — at least for this patient — he should have done more. I suppose he made (as we all do) a mistake. Perhaps if he’d asked this patient’s permission, the patient would have declined and Greenberg could have avoided the fiasco. Or perhaps — and I say this with great trepidation, not knowing what or how Greenberg wrote about his patient — the patient was being a bit over-sensitive. Whatever the case, Greenberg then concludes that not only is it unsafe to write about patients after thoroughly disguising them, but because of the power dynamic inherent in therapy, therapists should never write about patients— even with their informed consent. He suggests that to publish about patients at all is to alter and potentially damage the therapeutic relationship.

Like Greenberg, I am a psychotherapist, and I am a writer who loves reading about and reflecting on the therapeutic endeavor. Psychotherapy — often more art than science — is about being human, from which no amount of professional experience exempts me. I have also been a client plenty (I prefer the word “client” to “patient”), and today in addition to full-time psychotherapy practice, I teach and supervise counselors-in-training. My students have complained that their training is too technical and impersonal — that it doesn’t connect to the actual practice of therapy — and I agree. When I went through school, most of my professors hadn’t worked with clients in decades, and they’d lost touch with what it was really like. Thus, books about actual therapy relationships by real therapists remain among the most instructive teachers.