One of our most basic sacred contracts with our clients is confidentiality. It seems simple and straightforward enough: We keep confidences by not speaking about our clients to anyone outside of the treatment room.We don't tell their stories. We don't mention names. We don't even say, "Oh, so-and-so is my client," or even "Oh, I know so-and-so, too! They come to my office (or spa, etc.)." In this way, we protect and respect our clients' autonomy, privacy and the sacred trust they give us.
Indeed, it is trust in this one basic tenet of the client/practitioner relationship that allows our clients to lower their defenses, take off their street clothes, as it were, and become vulnerable and open on the deeper levels at which healing and change occur. As long as we just keep our mouths shut, we're OK, right?
Well, maybe not. We must then ask: When is the omission of silence a breach of that trust? I'm going to bring in another few thoughts here and then return to this question.
This silence is not just a training of restraint. It ties in, I think, to a core piece of what transforms us from people (with a lot of training) who care into practitioners. For me, an important piece of this transformation has been learning (and continuing and continuing and continuing to learn) how to leave myself outside of the treatment room.
The first time I became conscious of this quality was when, as an acupuncture student, I had the fortune of having a treatment/diagnosis consult with J.R. Worsley, the founder of Classical Five-Element Acupuncture as it is taught in England and the U.S. Of the many things with which he is credited and the controversy engendered around him, he was undisputedly a master healer and diagnostician in the treatment room. It was a profound experience. When he entered the treatment room, I felt and knew I was the only person in the world at that moment; nothing else mattered or existed, not even J.R. His total presence was such that I felt completely held, seen and appreciated without judgment. Just as clearly, I felt and knew that as soon as he turned and left the treatment room, I ceased to exist for him. It didn't feel like a loss or abandonment; he just didn't carry me with him. There were no strings of attachment.
This teaching from J.R. has been a guiding post for me. I have learned, for the most part, to leave myself and all else outside the treatment room doors and be totally present for and with my clients. I knew I had achieved this a few years ago when a dear friend of mine came to me in crisis and asked for help. I heard her story in the treatment room; a story I had largely heard before as her friend on the living-room couch. But this time I heard and saw her completely differently. As is my training, I saw and helped her understand the health, virtue and struggle of her core energetics (in the language of the Five-Element tradition, her core element and its officials). From that perspective, I watched as the struggle of self-acceptance dissolved and she came to a place of peace and self-trust. I felt joy at the healing of this place of conflict within her.
What makes this interesting enough to retell is that this issue had a direct effect on me as her friend. On the living-room couch, we had had many arguments over this. I wanted something from her; something I believed was natural to expect of a close friendship. Yet the natural consequence of the self-acceptance she found was not to judge herself by other people's standards or feel obliged to fit herself into others' expectations. While the practitioner me in the treatment room celebrated with her, it meant the friend me outside of the treatment room was not going to get what I wanted! The greatest gift this medicine has offered me over the years of study and practice has been a personal expansion of understanding, compassion and acceptance of others and myself.
But things don't always fit so neatly into "inside" and "outside" the treatment room. In this case, because it was just between the two of us, back on the couch as friends, I was able to speak from my new understanding and our issues were healed. J.R. easily maintained an enigmatic oracular presence because (in part) he did not live in, or was part of, the communities in which he often came to consult.
However, living and working within our communities, distinctions in relationships overlap and get blurred. Many books and writings on professional ethics warn that all blended or dual relationships must be prohibited. As such, going out to share a cup of tea or attending a party at a mutual friend's house would be considered a breach and puts you on "the slippery slope" of unethical behavior. Yet in Issues and Ethics in the Helping Professions, Corey, et al., maintain dual relationships are inherent in all helping professions. Despite clinical, ethical and legal risks, some blending of roles is unavoidable and not necessarily unethical or unprofessional. In fact, sometimes there is clear benefit to both the client and the practitioner. And there are those instances in which we find kindred spirits in our clients and a true friendship develops.
As we establish ourselves in our communities, word of mouth spreads. Our neighbor in the office park comes to see us; our dentist becomes our client and then refers other patients; a client sends her brother. Your work helps to transform people's lives from suffering to vitality. Others see the change, hear about you, people you don't know start referring to you, and now your client's ex-wife or a politician whose political stance differs from yours shows up at your door. Hmmm - now what do you do? Can you see and receive this person new and unbiased? Should you even accept them into your practice? If no, where do you draw the line? If yes, where do you draw the line?
Something of this nature recently happened in my practice. I decided to accept the challenge and see in the first appointment if I could indeed see this person without bias, completely independent of any association. And as I did with my friend, I congratulated myself on being successful. The other people just did not exist within the treatment room. Since I hold a very strict vow of never talking about people outside the treatment room, I thought I was fulfilling my commitment of inscrutable trust.
Since "Bob" was not the person who gave the direct referral for "Alice" to come see me, I couldn't say to Bob, "Are you OK with me treating Alice?" because that would be a breach of Alice's confidentiality. And I couldn't ask Alice if it was OK to talk to Bob, because that would be a breach of his confidence to bring up his name. As they shared a child, I knew they would find out they both came for treatment, but it wasn't my place to let that information out. I could only hope my silence would be interpreted as something that protected each of them. But something kept nagging at me and my self-congratulations faded. When is the omission of silence a breach of that trust?
There is something about silence that speaks of things that must be hidden, of shame, of guilt. In the treatment room and the classrooms, we speak of the value of bringing up to the surface things that have been submerged and even hidden from our conscious awareness, because we understand these holdings often are what locks the disease process into the cells of our consciousness and the cells of our body. We believe in openness and we practice its suppression, thinking and hoping we are doing what is best for our clients.
This dualistic nature of valuing openness and maintaining silence is a direct contradiction in nature. At best, it is a biao-li, an inside/outside, a practicing in the propriety of the yin/yang of things. At best, it can be uncomfortable and difficult to reconcile within ourselves as practitioners and as humans. At best, we keep asking: Where are we (or are we) embodying our truth? How do we truly honor another being? What really makes us trustworthy?
Dava Michelson is a Classical Five-Element acupuncture physician licensed in the state of Florida. She holds masterís degrees in both acupuncture and medical qigong. She has private practices in Miami Beach and North Miami, and also is a clinical supervisor and clinic director of the Academy for Five Element Acupuncture.