It's All About the Relationship
Again research shows its all about the relationship: Nondisclosure of imminent threats by patients: Assessment of the reasons. Levy AG et al. JAMA Network Open. 2019; Aug 2;2(8):e199277. doi: 10.1001/jamanetworkopen.2019.9277 This is an extremely thoughtful and important study. Here are the facts: 1) The patient’s comfort level with their clinician is key. If the patient feels they can open up, they may be more willing to not withhold important personal information. 2) This underscores the importance of building a solid therapeutic alliance with the patient, part of which includes trust from day one. 3) Being upfront with your patients could alleviate some distrust some patients may feel. If a patient is embarrassed, potentially reassuring them regarding the confidential nature of the relationship would be helpful. 4) If the patient is concerned about being judged, then the clinician should work on incorporating an emotional portfolio, to deal with the patient at his/her emotional level, e.g. a younger individual may feel as though they are being talked down to. 5) If a patient is concerned about a rigorous or difficult follow-up, then potentially working and negotiating with the patient on the future plan can achieve a collaborative approach. In Summary: It is important to build trust to ensure a good therapeutic alliance. In my opinion, in mental health, it is important to get collateral information from other sources after getting the patients’ consent. We may not get all the information in one attempt, and hence, several visits may be needed to get a good understanding of the entire issue.