Navigating Complicated Relationships in Primary Care

1. Session # B2a October 28, 20111:30 PM Navigating Complicated Relationships in Primary Care Jeffrey T. Reiter, PhD, ABPP Co-Director, Primary Care Behavioral Health Service, HealthPoint Community Health Centers Seattle, WA Collaborative Family Healthcare Association 13th Annual Conference October 27-29, 2011 Philadelphia, Pennsylvania U.S.A.

2. Handling Complicated Relationships • Complicated relationships are common • Prior contact w/ one patient may provide BHC with knowledge about another (e.g., a family member or neighbor) • The patients might (not) know about the multiple r/s • Longitudinal care can pose challenges • Patient history obtained at one point in time might be information a patient wants to protect later (e.g., a patient is seen in a conjoint visit then a year later seen in a conjoint visit with a different partner)

3. Handling Complicated Relationships • RelevantAPA Ethics Standards: • 4.01 (Confidentiality) • 10.02 (Therapy Involving Couples or Families) • When psychologists agree to provide services to several persons who have a relationship, they take reasonable steps to clarify at the outset (1) which of the individuals are clients/patients and (2) the relationship the psychologist will have with each person. • What If related pts present independently for care?

4. Handling Complicated Relationships • Real-World Scenario for Complicated Relationships: • A 26 y/o man was being seen by the BHC, chronically depressed/suicidal, often complained of parental intrusion • Patient’s mother called the BHC (even scheduled appt in son’s name) on two occasions, asking to discuss son’s case • Rebuffed on the calls, the mother established as a patient at the clinic and was referred to BHC by her PCP for depression • During the visit, the mother repeatedly asked about her son • Dilemmas: Now both mother and son are patients • Should the son be informed of the mother’s actions? • Should the BHC continue to see both mother and son?

5. Handling Complicated Relationships • Real-World Scenario for Longitudinal care challenge: • A 40 y/o man and 42 y/o woman are both known to me from independent visits • Both have mood, alcohol and drug problems, and attend AA • Both have marital problems (recently divorced, divorce in progress) • The woman returns after long absence, has just met a man in AA she “feels in love with.” It is the man known to me. • The man returns after long absence, has now met a woman, she brought him to clinic. It is the woman known to me. • Dilemmas: • Confidentiality concerns w/ both pts and prior partners

6. Summary Thoughts • Primary care poses some unique and different challenges involving confidentiality and patient relationships • Smaller clinics (esp CHCs, where other care options are limited) can in particular pose challenges • Despite this, thoughtful attention to ethics can prevent harm • “What is in the best interest of the patient?”