One thing you notice in a small town, is that everyone pretty much knows everyone else. Most people are related to one another, either by blood or marriage.
And everyone always wants to know what's going on.
Especially when someone new comes to town.
Shortly after my arrival here, one of my neighbors strolled up my driveway (under the premise of walking her dog) then stood on tip-toe in an attempt to peer into my dining room windows. Unbeknownst to her I was home, watching from one corner of my kitchen, simultaneously intrigued and unnerved to be so blatantly spied upon.
It's a strange dynamic. On the one hand in places like these people can be very isolated, which only increases their chances of becoming mentally ill and possibly suicidal. On the other, everyone is into everyone's business.
This raises unique challenges with regard to maintaining confidentiality. We are bound not only by HIPAA, but our ethics. Trust in confidentiality is one of the reasons counseling can work.
Everywhere I go I see a client. Grocery shopping, getting gas, eating out, taking in a movie. Even this past summer when I'd head to the mountains for a hike, I was sure to see a familiar face along the trail. Worse, when taking bids for lawn care services last spring, one of my clients showed up at my front door. And every time I've had to put my poker face on and pretend I didn't know who they were.
Potential ethical dilemmas abound.
Casual contact isn't the only challenge. In getting to know your community, and getting yourself grounded and connected, you quickly learn that anyone you meet is likely to be tied in some way to one of your clients.
Challenging, yes. But I've chosen to turn this into a positive.
I generally don't talk about my work away from the office, anyway. Think, “Every appointment ran over 10 minutes today,” or, “Lots of people in crisis this week,” or, “We're getting a new psychiatrist at the clinic.”
But when your new social contacts may know someone who comes to the clinic, you don't want any of those broad generalizations out there, however benign they may seem. The reputation of a small community mental health center may lay in the hands of any idle chatter.
So when I came here I learned not to talk about work outside of work, hardly ever.
And that's a good thing.
This means at closing time on Friday, I leave it behind. And that means my time away from the profession I'm passionate about is truly healthful. I seek supervision on clients or troubleshoot office politics in the only place that is appropriate: the agency.
And that frees my mind to rest and re-charge, so I'm ready to hit the ground running again on Monday morning.
I'd love to hear from others working in small towns and rural communities about some of the challenges you've faced with regard to maintaining client confidentiality (or your own privacy!).
Stormy Filson is an independently licensed counselor living and working in Wyoming, with special interests in treating trauma, community building, and empowering women. She is also passionate about writing, photography and film.