HW 10

The case of Jane Doe, LMHC

Three years ago, Jane was practicing in an outpatient community center when she started working with a patient “John”. John had been a 58-year-old cis-gendered Caucasian male self-referred to counseling for panic attacks, after thinking he was having a heart attack and was cleared medically. For the first six months of treatment, John discussed various stressors, including a new job, balancing finances with a child in college and a history of somewhat anxious behaviors that never met criteria for a disorder until recently. He is married mostly happily to his wife of 21 years. Many years ago, John had become addicted to alcohol after being injured in an auto accident, partially due to self-medication and depressed symptoms when out of work. He additionally disclosed some alcohol and illicit drug use in his 20s, though he states that this was a short time in his life when he lived in a different state (NY) after high school and ran with “the wrong crowd”. At the time of treatment, John had not had anything to drink, nor did he use any drugs recreationally for over a decade.

Around the six-month mark, Jane reflected that John had initially made progress in treatment and implemented CBT strategies and had a good therapeutic relationship with Jane in the first few months. However, ongoing monitoring of symptoms were indicating that he had started regressing, even experiencing almost as many panic attacks as when he first started. She brought it up in session, wondering if maybe the treatment plan was not supporting John and if there was need for a change. John abruptly broke down sobbing and disclosed an enormous secret: he had murdered someone many years ago.

Jane was quite alarmed as John had absolutely no known legal history or a history of violent thoughts or behaviors (self-reported). Apparently, according to John, when he was running with a “bad crowd” and under the influence of what was unhealthy drug/alcohol combination, he and his friends would occasionally rob people that they found walking alone on the streets. On one such occasion, to scare an individual John had been ‘roughing up’ someone in an alley at the behest of his companions. Tragically and unintentionally, this led to the victim hitting their head and they became unconscious. The group became alarmed and left the victim, who was not found until quite a while later and did not receive proper care in time to prevent their death. John reports that it was shortly after that he decided to move away to MA and start over, though he has been tortured by this ever since. He has gone as far as to seek out the victim’s family members on social media and follow the news reports of his former town as well as twice in the last few decades he has driven out to visit the gravesite of the victim and left flowers. Jane asked what happened to his friends, and John said “Craig and Joe and those guys? I have no idea. I changed my number when I moved, I haven’t heard from them since. They weren’t good people…that was so long ago now.”

When he was done discussing this, Jane asked why he chose now to disclose this information. John admitted that oddly, while it was a cold case previously after years of no leads, someone had been arrested for this crime recently who had not even been present. John told Jane the name of the person, stating in disbelief-that this was a relative of the victim and that he had “no idea how this could have happened’. John stated that he would have to live with this for the rest of his life, but he couldn’t speak up and ruin his family. Then, realizing what he had disclosed, he fearfully asked Jane if she would tell anyone. Jane admitted that this was a unique circumstance, and while she was not permitted to disclose information regarding crimes that had been committed in the past unless directly asked or an indication that someone was in imminent danger, this situation was unique as there was an innocent person on trial. John left abruptly, tearfully, and clearly anxious. Jane attempted to call him several times in the next few days, even reaching out to his emergency contact (his wife) who explained to her that while John appeared anxious, he was not threatening unsafe behavior and simply stated that he never wanted to see the counselor again.

Jane was very distressed regarding this case and felt as though she may have handled the session better. In supervision, she reported the incident and the supervisor told her that since the crime had occurred in the past, she had to respect confidentiality. Jane noted this in the client file, but disagreed with her supervisor, stating that another person was unjustly suffering. Her supervisor pointed out that the person who was on trial was not yet convicted and that there was no “threat of imminent harm”.

Frustrated, Jane closed out the case. However, she could not let it go. So, attempting to be anonymous, she looked up the town in NY that the client was from and called the police station there, reporting Johns’ name and what he had told her. She left it out of the file and closed the case. In her discharge paperwork she noted John left a session and was unresponsive to outreach attempts.

About a year afterwards, Jane was served with a lawsuit from John’s lawyer. John was investigated because of her anonymous tip and since he hadn’t told anyone else, he assumed (correctly) she had reported him. He is suing her for breach of confidentiality and additionally, he claims he was improperly transferred to care once he left her office and is claiming client abandonment.