Hi LG,

I'm a former provider planning on entering therapy soon. While I've had some interactions with psychiatrists/psychologists before, I haven't had a lot of contact with them- it was pretty much "here's your meds, have a good day" sort of deal. As a result I've never been close enough to be honest to any of them about my (now former) profession as an escort. This therapy thing will be new for me, and I'd like to start it off on the right foot by being honest about my past.

But a couple of things concern me. The first is my children- I don't want my past coming back to haunt me, especially as I was escorting as a mom. The second thing is the fact that the therapy program I am looking into (which has totally pioneered therapy in this area of mental health) happens to be at the school that I hope to attend within a few years- in the very department, in fact (psychology).

So is honesty the best policy, or should I keep some things to myself?

Thanks,
J.D.

Dear msjanedoe,

I am confused as to the role of your children in your therapy - are you entering FAMILY therapy or INDIVIDUAL therapy?

For the sake of argument, I am assuming you are entering individual therapy. If so, then you have nothing to worry about, since psychotherapists/psychologists/psychiatrists have to maintain 100% confidentiality, with a few exceptions. These exceptions are:

1. If you tell your therapist you want to kill yourself, your therapist can disclose this to authorities for your protection.

2. If you tell your therapist you want to kill someone else, your therapist can disclose this to authorities for the protection of the victim.

3. If you tell your therapist that you are abusing your children physically/sexually, the therapist is MANDATED to contact Child Protective Services in your state.

4. If you tell your therapist that you are abusing anyone in your family over 62 years of age, the therapist is MANDATED to contact Adult Protective Services in your state.

If you tell your therapist that you used to be a prostitute, there isn't a thing s/he can do to harm you, disclose to any authorities or otherwise reveal ANYTHING you say in session.

Your therapist may take notes during/after the session; these notes cannot be revealed to anyone unless subpoenaed in court - and that means THE JUDGE ORDERS the therapist to serve up the notes. Under normal circumstances, the therapist fights like crazy NOT to reveal his/her notes [yup, I've done that myself, thank you], since his/her allegiance is to the client and the client has  the privilege to consent to disclosing what is in those notes. Of course, if YOU decide you want to make the content of these notes public, the therapist has to obey you. On the other hand, the therapist has the right to provide a case summary rather than the entire notes to opposing counsel. The only time notes are released is either by order of a judge, or by order of the client himself/herself.

So, with all that, you needn't worry. If the therapy is to become effective, you will need to establish a trusting relationship between you and your therapist - hence, holding back impedes the full benefits to occur within the therapeutic process. As to the therapeutic program, the school etc., all those things are immaterial, since the therapeutic relationship is between you and the therapist and not the school or program in itself.

Having said all that, I sincerely hope that you get a non-judgmental therapist who can be empathic to you and your life situation, regardless of your profession. In all honesty, I would be much more worried about that, since the subtle elevation of a mere eyebrow can contaminate the trust in the therapy room and make for some spectacular empathic failure. Therapists are just like other people, and can be extremely judgmental. In addition, don't forget that therapists are schooled in a certain model of "normalcy," which does not include paid sex. So choose carefully; if after disclosing, you notice that something is amiss, bring it up and ask the therapist point blank if this disturbs him/her. If it does, change therapists as soon as possible. No sense in YOU being there for him/her to learn to deal with his/her own judgments.

Good luck,
the Love Goddess

Thank you for the quick and informative reply. Yes, I am speaking of individual therapy. One more thing- I've recently applied for disability, so I've had to sign over medical records to the Social Security office. If my escorting showed up in those records that Social Security had, could that negatively affect me and my children even if there were no court order?

Thank you so much for pointing out that last paragraph. I will definitely keep that in mind.

the therapist doesn't release his/her personal case notes to Social Security. In general, they have forms that the therapist needs to fill out, in which a diagnostic code is requested, with additional details. And, unless you were raped during a session or something so untoward happened to you during escorting that it affected you to the point of creating a diagnosis such as PTSD or the like, I don't believe the therapist would be so dense as to put that in there.

In any event, it is my understanding that it would not affect you. BUT: PLEASE ASK ABOUT THE REPORTING REQUIREMENTS with the therapist when you first meet him/her. If there is something that needs to be stricken from the record, that's the time to discuss it.

Hope it works,
the Love Goddess

Ok, I will. Thank you so much!

Thank you for the reply. "If you are not honest you may undermine the entire process."- That's exactly what I'm afraid of. I've already considered that it's possible there will be a class I will want or need to take that will only be offered by my therapist. Luckily, the school is big, so maybe that can be avoided if needed. I'll put a lot of thought into what you said- thank you.

Dear David8,

Your advice is good and very sound, however, a therapist with any sense of ethics would never choose to provide therapy to a student who would be dependent on his/her academic evaluation. This constitutes a dual relationship which certainly is an ethics violation. Having said that, many schools of psychology provide therapist interns at reduced rates. These interns receive supervision from licensed therapists and that is where 100% anonymity may be compromised, particularly if there are records of names being maintained. As a former student at a school where there was a counseling center, I can emphatically say that it would be unthinkable for a therapist to take on a student - it just doesn't happen. Supervision of interns either happens in group or individually. If in group, no names or identifying details are ever mentioned. If individually, there is no guarantee, although needless to say, the supervisor maintains complete confidentiality - or else his/her license is in peril.

As to therapists consulting on cases with one another, I would say that a very small minority of therapists blab unnecessarily. However, anyone who's provided therapy for hours on end knows that the last thing you want to do is discuss your clients any more than you have to, unless you run into difficulty and desire peer supervision/case consultation. And during those conversations, therapists take pains to conceal any indentifying information. But as to gossiping...well, it can happen..because, as you say, therapists are human.

Hope that adds to the info,
the Love Goddess

You've already received allot of good advice, and issues to consider. I would just highlight the issue of safety. I believe the greater degree of safety one feels the greater degree of benefit from one receives from their treatment. The situation you describe sounds all very convenient, but I'm not certain how truly safe you will feel given all that you have to lose if your information gets out. Ideally you and your information should be safe, but as LG and others have pointed out, that's not always the case. I would recommend that you focus on finding the most therapeutic context for yourself, then see what happens regarding where you might do your training.

sorry , this is the only time I have even peeked at this board, usually over at legal,,, anyway..
I know the answer to this one...not exactly private,, even with HIPPA, here is why
1) HIPPA is a farce, it gives false sense of security.in reality does not work
2) if you file A HIPPA complaint you will 99.99% get denied
3)IF you ever have a legal case WC.PI, does not matter if Plantiff or Def etc.. they can legally force you to sign releases to look into ALL old medical records even if it is completly
unrelated to case....
so much for privacy laws

again , i know this one, I am going through a nasty PI case, & they can get "all forms" even your application. the lawyers looked through my forms to find old in case of emergency contacts, to search for old aqquantances to find "dirt"
also they found were i told a nurse practionor something personal & off the record & not medical related & there it was in detail in my reocrds...scary....

1)not use legal name
2)do not give SS#  
3)pay cash
this what folks do at STD & abortion clinics

Hi msjanedoe. All I can say, being familiar with the field, is that if I was going to enter therapy I would do so with a private therapist and would discuss record keeping on first session. You can be open about the desire not to have compromising information on any record and they should be sensitive about it. You also gave the right to ask not to have sensitive information documented. A well trained therapist knows that there is no need to display detail in records, especially if it can be countreproductive. A good therapist will store the sensitive stuff in memory and write more neutral data. Same goes for other sensitive issues (illegal in country,...). So long that holding info does not put pt or third parties at risk.  

Some therapists keep a separate set of scratch notes on particular so if records are subpoenad those "scratch" notes may still be confidential. However wouldn't be the first time "scratch"ones have been requested in court.

All that being said, the most important thing is finding somebody you trust or connect with. Its true that in the end they are also humans and subject to judgment, etc. Good training actually teaches to put all that aside (but some may have "not attended class that day"). That's how even a sociopath can get much needed treatment. But even so, you need to feel comfortable because ultimately he/she will need ultimately to know the very personal stuff (not necessarily right from start).
Good luck with your therapy and career goals (actually having been in therapy will be very helpful to you as a therapist)