Is It Okay to Write About My Patients? *

 Loose lips sink ships. ― World War II poster

Before you pick up that pencil, read these tips.

Occasionally one of my therapist colleagues will approach me because they want to write a book -– maybe an academic book about their specialty, or a how-to, or a memoir, novel, or even a children’s book. They may have been sitting on a book idea for years and want to get it off their bucket list; or they want that instant credibility that comes from being “the author of. . .” a book on their specialty; or they may just want to have a carton of books in the trunk of their car to to sell at seminars, workshops or conferences, or give away to colleagues, clients, friends and family as gifts.

No matter what the book’s topic or genre or what the therapist’s reason is for wanting to get published, the first question I usually get asked is: “Is it okay to write about my patients? What if my patient reads it? How do I not get sued?”

Let me reassure you that licensed mental health professionals definitely can write about patients. Thousands do it. But there are some Do’s and Don’ts involved. That’s what we’ll look at here.

Confidentiality

All writers, not just therapist writers, should concern themselves with the possible consequences of what they say in print, just as we should all think before we speak. Blabbing off can get anybody in trouble. However, unlike “regular” writers, licensed mental health professionals have to be particularly vigilant when it comes to writing about clients because we have some extra legal and ethical restrictions. Our main concern is always the issue of confidentiality.

“Protecting patient confidentiality is the bedrock of psychotherapy,” says Gerry Grossman of Gerry Grossman Seminars, a company that provides California mental health professionals with exam preparation and continuing education courses. “Breaking this trust . . .puts the therapist at risk for losing his or her license.”

Yikes! Agreed! Nobody wants to get sued! That’s definitely not a perk of getting published. So let’s go over a few guidelines before you hop on the computer. If you just follow these hints and tips you should be just fine.

The Art of Disguise

This is standard. When you write about patients, always disguise their identities. This doesn’t mean just changing their names! Changing a name is never enough, especially if the other details or situations in the piece could help readers identify them. For example, stating that a wealthy female patient is “married to the Chicago-based CEO of XYZ company” doesn’t work for obvious reasons. It wouldn’t take a rocket scientist to do an Internet search to find out the name of that CEO and know immediately the identity of Mrs. CEO. So also change the name of the company. Change the location. Change the nature of the company’s business. Change their adult son to twin teen daughters. And if any of these things are really just fluff and not crucial to the story, leave them out.

Rule of Thumb

Danielle Ofri, M.D., physician and author of the books Incidental Findings: Lessons from My Patients in the Art of Medicine,  and Medicine in Translation: Journeys with my Patients, commented in an article (“Harnessing the Winds of Change”) that as writers we of course have to change names and identities of patients, but that’s not all: “My rule of thumb is that the description must be different enough so that it will be tough for anyone, other than the person being described or close associates, to recognize them.”

Psychoanalyst Judy Kantrowitz, M.D. interviewed 141 fellow analysts on the subject of writing about patients and found there wasn’t consensus on exactly how to disguise patients, only to do it. Kantrowitz came up with a similar conclusion to Ofri’s above, only she went a step further: “Disguise a patient so when they read it they don’t even recognize themselves.”

Self-Disclosure

What about a licensed therapist who wants to write about themselves, not their clients? A memoir perhaps, or a novel that’s obviously based on them? While it’s not illegal or unethical to do this, not all therapists think it’s a good idea. It often depends on the therapist’s training. A psychoanalytically trained therapist who believes in the “blank screen” approach is probably never going to write a memoir or disclose anything personal in a book. On the other hand, a therapist with a personal recovery story (addiction, e.g.) that’s related to their specialty may feel quite comfortable writing about it, seeing it as an appropriate self-disclosure which can be an asset to the therapeutic process, even inspiring some clients: “If my therapist can beat the problem, then I can beat it, too.”  The yes or no choice is up to the writer.

Informed Consent

An alternative to mastering the art of disguise in writing about patients is to get signed releases from them (“informed consent”) prior to making their identities known for some specific purpose or event, such as a case presentation at a conference, a teaching video in a classroom, or the publication of an article or book in which the patient might be identifiable.

A psychologist friend of mine who has published four books and is fairly well-known in her specialty area of weight management, has been a guest on many of the big daytime TV talk shows where she has talked about her private practice cases. Sometimes she will even have a client join her on camera. Advance discussions with the patient and signed releases are what make this possible.

Be Kind

The play Tea and Sympathy by Robert Anderson was a hit on Broadway in the 1950s and later became a movie. It’s about a shy young man in a boarding school who has an affair with the wife of the headmaster. At the end of the play the wife tells the young man, who is about to leave school, “Years from now when you talk about this, and you will, be kind.”

When writing about patients (ditto friends, family and neighbors), do the same thing ― be kind. You can rarely get into trouble for saying something nice about somebody. Leave the mean digs alone. In your description of your pudgy client, say “slightly overweight” not “fat” if weight is relevant. If it’s not relevant, skip it. Just don’t throw anyone under the bus. Remember, “First, do no harm” as it says in the Hippocratic Oath. And in the Twelve Step recovery groups, such as Alcoholics Anonymous, members are encouraged to be forthcoming (if they wish) about their own shortcomings (referred to as “taking your own inventory”), but it’s frowned upon to “take the inventories” of others. No loose lips!

Fearless Writing

Don’t let these legal and ethical restrictions on writing about clients scare you, just be aware of them. Basically, it’s just common sense. Put yourself in your client’s place: How would you feel if this or that were said about you? Abide by the guidelines of our profession. And then write on and prosper!

* (c) Sylvia Cary, LMFT. This article is from Sylvia Cary’s book, The Therapist Writer, which is currently being updated since things in the publishing industry change at lightning speed. Please email sylviacary@gmail.com if you are interested in being informed when the updated version of The Therapist Writer launches. Website: sylviacary.com.

 

 

 

 

 

10 Things Therapist Writers Worry About

Publishing a book can be scary. But don’t let your fear keep you out of the game. Forewarned is forearmed. Here are ten things therapist writers worry about and what to do about them.                    — photo by Morguefile

Loose lips sink ships.  — World War II poster

All writers, not just therapist writers, should pay attention to the legal side of publishing, and concern themselves with the possible consequences of what they say in print. Blabbing off and not heeding the rules can get anybody in trouble. No writer benefits from getting sued. That’s definitely not a perk.

Writers who also happen to be licensed mental health professionals and write about their work with clients have to be particularly vigilant because they are bound by a number of legal and ethical restrictions (such as maintaining patient confidentiality) which can inhibit and impact what they say.

Now, I don’t know if it’s just that therapist writers are worry warts, but when it comes to writing a book, here are 10 things therapists seem to worry about, have the most questions about , and need the most help solving:

Help is on the way.  Photo credit: Morguefile

1. Should I copyright my book idea?  It’s mostly new writers who worry that somebody is going to steal their book idea. News flash! You can’t copyright an idea, even a good one. You can only copyright the execution of an idea, i.e., how that idea is expressed in writing. The minute you put it down, you are protected. You don’t even have to officially register a copyright, but it’s still wise to do so just in case you get involved in a legal case. Then, you’ll have an official copyright date on file. Go to www.copywrite.gov, read the instructions, and email a digital book file and $35 to get your “placeholder” copyright (while you are finishing the book). When your book is published and available for sale, go to www.copywrite.gov again, follow the instructions, fill out two copies of a form, and then mail the two copies of the form, a check ($65.00 as of this writing), and two copies of your book to the Library of Congress, Copyright Office, Document Recordation Section, 101 Independence Ave SE, Washington, D.C. 20559-6000. (Always double-check the website for any new information and instructions). One copy of the book goes to the Library of Congress. (Yes, you can go there and check out your own book!); the other copy gets stored somewhere.

Don’t worry if there are other books on your topic. Tweak your book idea into something new and fresh.        Photo credit: Morguefile

2. What if my book idea is already taken? So what? Unless your topic is unique, there are probably hundreds of books on your subject already in print. Search Amazon. You’ll be astounded at how many authors have beat you to the punch. But that doesn’t matter. Your challenge will be to tweak your idea so it’s “better and different” than the rest. If you want to write “about alcoholism,” and you note that thousands of others have already done so, then tweak it. Write about “high IQ alcoholics” instead. That will be your niche. That will make most of the competition go away and make your book stand out. Next, look only at the books in your niche that were published in the last five years. Read the customer book reviews. Read the “Look Inside” feature. How do competing books handle the topic? What’s missing? Note the Tables of Contents. You’ll learn what to focus on, what to add, what to leave out, and you’ll get ideas about how to market your book – the hardest part.

3. What if my book title is already taken?  Same answer as #1 above. You can’t copyright a title. For example, there are many books called “The Gift.” Some are differentiated by their subtitles. There’s was also a movie called “The Gift” and a TV show called “The Gift.” You can still call your book “The Gift” if you want to, but why would you? Don’t you want it to stand out? The only titles and words you can’t use are trademarked — like Hell’s Angels, Hello Kitty or Harry Potter.

4. Can I write about my patients? Yes, you can write about your patients, but you know the drill. As mental health professionals, we are legally bound to protect their identities. This means you have to learn the “art of disguise” to the point where friends, family and even the patient themselves won’t be able to tell who you are writing about. This actually shouldn’t cramp your style too much because the details of a patient’s life are rarely critical to the story you are trying to tell, or the message you are trying to convey. Of course, you can side-step this by getting signed releases from the patient and perhaps recognizable others in the story, but that’s not always foolproof. The other way is to change everything — dates, ages, places, details about looks, jobs, family members, even therapy issues (if uncommon enough to be recognized). It’s the core of what you are writing that’s important. Focus on that.

When you’re writing about friends and family, be kind. Photo credit: Morguefile

5. Can I write about friends and family? Authors rarely get sued for saying something nice about somebody. It’s when you get critical or expose gossip and hurt someone’s reputation in the world that makes people cranky – or litigious. In my first book I said that my sister, during her high school years, looked “scruffy.” I didn’t think that was such a big deal, but she was hurt. And I learned something. It wasn’t necessary for the sake of my story to use a critical term. Did you ever see the movie “Tea & Sympathy?” It’s about a male student at a boarding school who has an affair with the head master’s wife. When the boy leaves the school, the wife tells him, “When you talk about this – and you will – be kind.”  So unless you are a journalist and writing a killer exposé about, say, the mistreatment of the elderly in a nursing home (and your facts better be right!), then, as a general rule, “be kind.”

Saying unkind things in your writing not only hurts         people but makes them cranky.                                          Photo credit: Morguefile

6. Can I quote from other experts in my field? Being able to quote from thought leaders in our area of expertise is critical. How could we progress without referring to those who have gone before us? The tradition of “Fair Use” allows authors to quote other people – up to a point. The law here is “fuzzy “and vague. It all depends on what’s being quoted. You may have heard that you can “quote up to 50 words,” but that’s a myth. Perhaps you can quote 50 words from a scientific document, but you probably can’t quote even five words from a song or poem. According to Jonathan Kirsch, a Los Angeles based attorney specializing in intellectual property and publishing law, when it comes to substantial quotes you need to get “permission” (see below). “If you rely on ‘Fair Use,’” Kirsch added during a talk for writers I attended (I’m not an attorney myself so I go hear them speak), “you are taking a risk.” Being published traditionally doesn’t protect you either. “The publisher wants the author on the hook, as in, ‘Author shall indemnify, and hold harmless, the publisher.’” In other words, guess who is considered the “deep pocket” in this scenario? YOU are! One workaround is paraphrasing and giving credit to the original source, but you have to be careful that you don’t get accused of misrepresenting what the original author said. Another “quoting” issue I run into as an editor is over-quoting. Mental health professionals, especially when they are new to book writing, are insecure and tend to fall back on quoting others instead of putting their own opinions out front. I have to scold them: “Don’t keep quoting other people. You are the expert here because this is your book, so quote yourself!”

7. Can I write about myself?  Some mental health professionals are skittish when it comes to writing about themselves. It makes them feel exposed and vulnerable. “What will my patients think?” I know traditionally-trained “blank screen” therapists who wouldn’t dream of disclosing personal information to patients, including the fact that they write. Sadly, it keeps many from writing at all. On the other hand, I know therapists who blog, share opinions, and have Facebook pages filled with family photos and events. Often these therapists who are at ease with self-disclosure are in recovery from the same conditions they are treating their patients for — addiction, over-eating, bi-polar disorder, divorce. They experience sharing and writing as helpful to their clients and vice-versa.

8. Can I use a painting or photograph for my book cover?  If you painted it or snapped it yourself, or hired a graphic artist for the job, yes, if you think it would make a good book cover. But if it’s something from the Internet, probably not, unless you’ve bought it and have the rights. Or it’s from a free photo site, such as http://www.morguefile.com. Paintings and photos, like books, poems, and song lyrics, are often under copyright protection — unless they have fallen into the public domain (meaning the copyright has expired). Written works fall into the public domain 70 years after the death of the author. This means thousands of books are up for grabs every year. That’s why anybody can make a movie of Hamlet or reprint Sense and Sensibility through their indie publishing company. You don’t need to get permission from Shakespeare or Jane Austen.

As they say, “It’s easier to ask for forgiveness than to ask for permission.”                           –Photo credit: Morguefile

9. How do I get permission to use quotes in my book?  You’ve probably heard this cute little line: “It’s easier to ask for forgiveness than to ask for permission.” Unfortunately, when quotes don’t fall under the “Fair Use” umbrella, or are not in the public domain, or are not properly paraphrased with credit to the original author, then you’ll have to get permission. How do you do this? You ask. The hard part is finding out who to ask. Check www.copyright.gov to see who has the copyright. (By the way, this information is sometimes dated or wrong.) Track down the author if he or she is still alive. Write a letter to the author via The Writer’s Guild because they’ll sometimes forward a letter on to authors. Contract the publisher who may do the same. Check Facebook even if the author is dead. When you do find somebody who can say yes — they may say no. I wanted to use a poem in one of my books, but the poet told me she still gets paid speaking gigs based on that poem, so she wasn’t going to let me have her cash cow! In most cases, once you manage to track down the author, they are happy to be quoted if you quote them correctly, give them credit, and are “kind.” (Warning: Sometimes there’s a fee involved.) In your book, either on the page where you use the quote or in a special section, you say “reprinted by permission.”  Getting those “permissions” is an achievement!

10. What if my book is a best-seller?  That’s a problem!? Well, I guess it could be since it’s usually just famous authors who make money who get sued. Unknown self-published authors who sell 100 copies or less rarely get sued. But don’t count on things going either one way or the other. Don’t blow off the legal side of publishing. The best advice I got was to hire an attorney read a book I wrote to make sure there was nothing libelous or slanderous in it. He had me get a release letter from one person, which I did – just in case. With another book, I deleted one of the twenty-one interviews in which a man said something “not kind” about somebody else. That “somebody else” threatened to sue if the book was published, so I replaced the interview and avoided a potential problem. Rule of thumb: Prevention trumps litigation! Now you can go ahead ad tell your tales without fear.

May all your writing puzzles be solved.                     Photo credit: Morguefile

(c) The Therapist Writer: Helping Mental Health Professionals Get Published by Sylvia Cary, LMFT, available on Amazon and Kindle