Seasonally Depressed & Concerned for Privacy

 I am a 45 year old solo practitioner suffering from what I think is seasonal winter depression. My mood gets better in sunnier, warmer weather. With each passing winter though, the depression gets worse. I try and stay in the light, but it does no good. It is becoming harder to get motivated. Some days are alright, but some times it is a struggle to get through the day. Because of my life experiences, especially in the law, it is hard to believe that anyone would genuinely want to help. I have received very little help from people over the years. It is usually me doing the helping. Seeking help is frightening and a risk. Plus, it is embarrassing not being able to overcome this problem on my own. I would love to feel better if it is possible, but it does not seem possible. I am very familiar with the law regarding privilege and confidentiality, 51A’s, etc. yet have witnessed the lengths some individuals will go to get information on others. I have seen lawyers convince courts to release or make available sensitive medical/ psychiatric/ psychological information. I have represented good intentioned people that have sought help from social service agencies and have witnessed their dilemmas worsen. Although I may benefit from help, I am afraid that if I seek help, despite the privilege and confidentiality rules, my case will not remain confidential and my situation will become even worse. Is it possible to get help using only a first name? How can confidentiality be maintained if medication is indicated? Health insurance companies routinely share medical information and are allowed to do so. Thank you.

· If do you have seasonal depression (also known as Seasonal Affective Disorder), you may benefit from self-treatment with a Light Box. A typical light box is made of metal, about 2 feet long and 1 foot high, and priced from $300 to $500. ;The light is produced by white florescent bulbs and passes through a UV filter as a plastic screen that spreads the light evenly. The user faces the box for 20 to 90 minutes a day during the depressive season, typically while reading, making phone calls, etc. Among the sources of light boxes are www.sunbox.com, www.apollolight.com, and www.biobrite.com. If this type of treatment is going to help, the effects will be noticed within 2 weeks.

· Your disappointing experiences in asking for help may be related both to realistic matters, such as the adversarial culture of lawyers, but probably also reflect your own personality features and expectations. Someone who starts out with a fragile sense of trust, for example, often finds experiences that seem to confirm that others cannot be trusted. This itself might be a fruitful area to explore in therapy, including by taking that interpersonal risk with the therapist and working through any reactions.

· We have heard from some lawyers who handle such matters that they feel no medical records are truly private. Of course, we are all aware that confidentiality becomes secondary in cases of likely harm to others, child or elder neglect, etc. For what it’s worth, however, none of our three clinicians have ever been forced to disclose clinical information without the client’s consent other than rare mandated reports involving child abuse/neglect.

At LCL, we do agree to see people who withhold their last names, and we would guess that some psychotherapists in private practice would do the same. But, as you suggest, this approach would not work when it comes to prescriptions, or to using health insurance. Concern for privacy is probably the main reason that many people do not use their health insurance for mental health services. (Most use their real names, but the information does not routinely go anywhere other than the therapist’s own files.)

Feel free to arrange an evaluative appointment with us, anonymously if you like, to discuss these dilemmas further.

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