Navigating complicated relationships in primary care
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Session # B2a October 28, 2011 1:30 PM. Navigating Complicated Relationships in Primary Care. Jeffrey T. Reiter, PhD, ABPP Co-Director, Primary Care Behavioral Health Service, HealthPoint Community Health Centers Seattle, WA.

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Navigating Complicated Relationships in Primary Care

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Navigating complicated relationships in primary care

Session # B2a

October 28, 20111:30 PM

Navigating Complicated Relationships in Primary Care

Jeffrey T. Reiter, PhD, ABPP

Co-Director, Primary Care Behavioral Health Service,

HealthPoint Community Health Centers

Seattle, WA

Collaborative Family Healthcare Association 13th Annual Conference

October 27-29, 2011 Philadelphia, Pennsylvania U.S.A.


Handling complicated relationships

Handling Complicated Relationships

  • Complicated relationships are common

    • Prior contact w/ one patient may provide BHC with knowledge about another (e.g., a family member or neighbor)

      • The patients might (not) know about the multiple r/s

  • Longitudinal care can pose challenges

    • Patient history obtained at one point in time might be information a patient wants to protect later (e.g., a patient is seen in a conjoint visit then a year later seen in a conjoint visit with a different partner)


Handling complicated relationships1

Handling Complicated Relationships

  • RelevantAPA Ethics Standards:

  • 4.01 (Confidentiality)

  • 10.02 (Therapy Involving Couples or Families)

    • When psychologists agree to provide services to several persons who have a relationship, they take reasonable steps to clarify at the outset (1) which of the individuals are clients/patients and (2) the relationship the psychologist will have with each person.

      • What If related pts present independently for care?


Handling complicated relationships2

Handling Complicated Relationships

  • Real-World Scenario for Complicated Relationships:

    • A 26 y/o man was being seen by the BHC, chronically depressed/suicidal, often complained of parental intrusion

    • Patient’s mother called the BHC (even scheduled appt in son’s name) on two occasions, asking to discuss son’s case

    • Rebuffed on the calls, the mother established as a patient at the clinic and was referred to BHC by her PCP for depression

      • During the visit, the mother repeatedly asked about her son

  • Dilemmas: Now both mother and son are patients

    • Should the son be informed of the mother’s actions?

    • Should the BHC continue to see both mother and son?


Handling complicated relationships3

Handling Complicated Relationships

  • Real-World Scenario for Longitudinal care challenge:

    • A 40 y/o man and 42 y/o woman are both known to me from independent visits

      • Both have mood, alcohol and drug problems, and attend AA

      • Both have marital problems (recently divorced, divorce in progress)

    • The woman returns after long absence, has just met a man in AA she “feels in love with.” It is the man known to me.

    • The man returns after long absence, has now met a woman, she brought him to clinic. It is the woman known to me.

  • Dilemmas:

    • Confidentiality concerns w/ both pts and prior partners


Summary thoughts

Summary Thoughts

  • Primary care poses some unique and different challenges involving confidentiality and patient relationships

    • Smaller clinics (esp CHCs, where other care options are limited) can in particular pose challenges

  • Despite this, thoughtful attention to ethics can prevent harm

    • “What is in the best interest of the patient?”


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