I just found out my BFF has been my employee’s therapist for years

by Alison Green on November 25, 2024

A reader writes:

I have been the direct supervisor of Bob since 2022, but I was also previously his supervisor in another position, I have worked with him in some capacity for almost 10 years. In many ways, he has been my closest friend at work: we work together on many projects and I often talk to him about things going on outside of work and in other relationships.

Recently, my best friend, Lori, a psychiatrist, decided to unload a list of grievances on me and in a heated moment said, “Bob told me that you weren’t supportive of me!” The thing is, as far as I knew, Lori and Bob had never met. I was shocked and asked how she knew him. Turns out she was his psychiatrist for years, including after he decided to come work with me in 2022. Apparently she encouraged him to find a new doctor at that time but he didn’t want to, so she kept him on. I feel that was a conflict of interest.

I feel so betrayed in this situation. There are so many instances where I have said something to either of them about the other, and neither of them ever told me. I feel like they were voyeurs in each other’s lives through me. Also, Lori telling me is a clear HIPAA violation, so now I’m stuck keeping her secret because as angry as I am (I’m considering ending the friendship), I don’t want to destroy her career.

I’m stuck working with Bob. He is realizing that I’m pulling back, but I haven’t said why. My plan is that if it comes up, I’ll say that I’ve “decided to have very strong boundaries at work,” but the whole thing feels horrible, weird, and isolating.

Should I tell my boss or HR? I’m worried that this will spill out somewhere in the future, not through me but maybe through Bob or Lori (neither has demonstrated great decision-making skills), and it will come back to haunt me. Any advice you can give is helpful. I feel stuck and alone in this secret.

Whoa, Lori really messed up here. Bob too to some degree, but Lori had both a professional obligation and a personal one to tell Bob she couldn’t treat him anymore and refer him to someone else.

Bob erred too, but far, far less so. When Lori first told him it would be a conflict of interest to continue to treat him, he should have respected that and realized that talking candidly about his boss (a completely normal thing to want to do in therapy) wouldn’t be appropriate to do with said boss’s best friend and that — as Lori said — he needed to seek a new therapist.

But Lori! Lori violated the very clear ethics of her profession, and the very clear boundaries of best-friendship. Bob doesn’t have nearly the same obligations toward you as his manager as Lori has toward you as her close friend and toward Bob as his therapist. 90% of this, maybe more, is on Lori.

As for what to do … even aside from this situation, it’s a good idea to have better boundaries with Bob. Someone who works for you can’t be a close friend, because the power dynamics in the relationship prevent the relationship from being an equal one (among other reasons, all described here). So yes to establishing more distant boundaries (still friendly, just not friends) — but that’s not because of who Bob’s therapist is, it’s because of who Bob’s boss is.

You should probably let your own boss or HR know about the situation. It’s not an absolute imperative unless you’re concerned that you can’t manage Bob fairly or objectively anymore (in which case you would have a duty to disclose that and ask for a change in the reporting set-up) but if there’s any risk that it will be perceived that way at some point, it’s in everyone’s interest for you to disclose the situation and get ahead of it.

I’m sorry this happened. It’s a major betrayal by a friend and, on her side, of a patient.

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      1. Clisby*

        I don’t think HR or LW’s boss should know about Bob being in therapy, but Bob has kind of brought that on himself. I mean, what was he thinking? In his place, I’d have been worried that my therapist might let slip something to my supervisor. As she did.
        \

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        1. NerdyKris*

          Which is why Lori shouldn’t have given him a choice. She had a professional obligation to refuse to have him as a client anymore. I’m not going to blame Bob for not making the right decision any more than I’d blame a patient for getting into a sexual relationship with their doctor. They aren’t the ones with the professional obligation.

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          1. Na$ty Larry*

            Completely agree. Lori’s first and possibly biggest ethics violation here was not firing Bob as a patient when the conflict arose. It can be a huge burden in many different ways for a patient to seek a new psychiatrist and I completely understand why Bob would’ve chosen to stay with Lori. He shouldn’t have had the option.

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            1. constant_craving*

              I will note that Alison called Lori Bob’s therapist, but the LW did not. The LW said Lori is a psychiatrist, which is really different and doesn’t have the same concerns for multiple relationships as is present when seeing a therapist.

              Psychiatrists follow the same ethics codes as other medical doctors, with some additional considerations (https://www.psychiatry.org/getmedia/98ee85de-07c6-4b59-8ccf-3082c4f2449c/APA-Commentary-on-Ethics-in-Practice.pdf). We wouldn’t normally think it a problems for a cardiologist to have a patient if the patient works with the cardiologist’s friend, and this is much more comparable to that than to being a therapist.

              The HIPAA violation is still egregious.

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        2. Mad Harry Crewe*

          Mmm, no. Bob should have listened when Lori raised the concern, but she had a set-in-stone obligation to NOT BLAB about her patients (I believe exceptions are carved out for very, very specific and constrained medical situations, but that’s IT).

          This is not on Bob. He did a minor dumb thing, presumably to stay with a therapist he likes working with. She did a major violation of professional ethics.

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          2. Visually Impaired Guy*

            Medical folks shouldn’t even acknowledge their patients outside of their workplace. My optometrist happened to see me at a social event and pretended she didn’t know me until I acknowledged her first. Initially I thought she was being weird until she explained that she wasn’t avoiding me, rather it was professional obligation. I think the only exceptions are danger to the patient or others. Lori is absolutely at fault and I think LW will find it difficult to continue a friendship given what happened – I know that I’d have trouble being friends with someone who did this.

            Also strongly agreed with Alison’s comment about employees and managers: Always friendly, never friends. It’s possible that LW really meant that they are long-term friendly, not close friends, because I often talk about my life outside of work with coworkers and my boss. Still, LW should think about this dynamic and whether it’s a problem.

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            1. Kyrielle*

              Yup. My primary care provider and I once ran into each other (almost, but not quite, literally) at the local Japanese Garden and had I not greeted her happily she would have continued to react as you would to any stranger in that circumstance; as she should. She was happy to say hi once I did, though. :)

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            2. Testing*

              I thoroughly agree with you, but would like to add that it’s perfectly possible to talk about your life outside work and even about your friends without identifying them!

              My colleagues know various funny stories about my friends, but rarely know that the librarian is the one with the young son and the CEO is the same person who went on holiday to blah blah blah. So there will never be a “aaah, YOU’re that person”, even if they ever meet in real life.

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            3. Arrietty*

              My therapist and I had a conversation about this, which was handy as we did happen to see each other at a public event one evening. We just waved and said hello across the room, as we’d agreed would be fine.

              I work in a field that means I’m privy to a lot of personal information and I have to be very careful not to let anyone realise how or even that I know someone. It’s a delicate balance between being polite and being professional. Lori was neither.

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            4. Polar Bear Hug*

              My dental hygienist had liked a work-related Facebook page of mine (after asking my permission) and when I mentioned there that I had had a root canal, she didn’t like that post because, as she explained to me, that might have made someone figure out which dental office I went to.

              I was not concerned whether someone could find that, but that was the degree to which not acknowledging me went.

              Lori here is way out of line.

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          3. BlueCanoe*

            Agreed. Bob is an adult, but Lori is the one that should know the ethics of her own profession and when and how to end a client-therapist relationship.

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        3. MigraineMonth*

          Strong disagree. Lori breached professional ethics and *broke federal law* just by saying that Bob was a client, much less passing along things he said in therapy. With the waiting list for mental health professionals in my area, and how long it takes to establish the trust it takes for therapy to be useful, I don’t blame him for not wanting to find another therapist (particularly if she was also his medication prescriber). It was on Lori as the professional to end the counseling when there was a conflict of interest.

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        4. Esmae*

          Bob should have been able to be completely confident that his therapist would never mention anything said in his therapy sessions to her friends. That’s part of his therapist’s professional obligation. Yes, she should have been firmer about him finding a new therapist and he should have listened, but it absolutely should not matter if his boss and his therapist know each other.

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      1. Umiel12*

        This! I completely agree. As licensed mental health professional myself, I believe Lori should be reported. I understand that the LW is reluctant to help damage their friend’s career, but Lori has done a good enough job destroying her own career with her grossly unethical behavior. I would be surprised if this is the only instance of her unethical behavior, and she needs to be investigated and disciplined by her licensing board.

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  2. Account*

    She suggested to him that it’s a problem to continue seeing him; he disagreed; and she overruled her own judgment and continued seeing him?? Wow. I work in the field as well and that’s seriously problematic, but Alison already said that.

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    1. bamcheeks*

      Yes, I’m not clear that Bob’s done anything wrong in this situation! “I can’t continue to provide care to you because of a conflict of interest” isn’t supposed to be a suggestion for the patient to take or leave. As a patient or a client, if someone continues to provide care/services to you, it’s completely reasonable to assume they’ve decided the ethics are actually OK. You’re not the person with expertise in this situation!

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      1. JB (not in Houston)*

        I mostly agree that Bob hasn’t done anything wrong, with one exception. OP’s statement about what Lori said that Bob had said makes it sound like Bob is talking to Lori about things that the OP has said about Lori, and that’s not ok. I can’t think of any good reason why Bob would need to be discussing Lori’s and the OP’s relationship.

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        1. bamcheeks*

          I still think that’s the professional’s boundary to enforce, not the patient’s. A patient shouldn’t be in a position of having to set boundaries around what they tell their psychiatrist or therapist (I am not entirely sure which Lori is, or whether they are two different professions in the US): that’s the professional’s job.

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          1. metadata minion*

            “I am not entirely sure which Lori is, or whether they are two different professions in the US”

            FYI, those can be two separate professions in the US, but aren’t necessarily. A psychiatrist is a medical doctor specializing in psychiatry. Many of them just do medication management, but some do talk therapy as well, often primarily for more complex conditions.

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        2. Amy*

          It’s therapy. He’s supposed to talk about anything that he wants to talk about. I can think of several ways it would come up like “my boss keeps ranting about her friend and I’m getting stressed secondhand” or “I worry my boss is talking crap about me behind my back based on what she says about other people to me” or “I feel uncomfortable hearing my boss say unsupportive stuff about the people in her life, but I struggle to speak up and push back, so I’d like to work on that.” It’s not on Bob to moderate what he discusses in therapy. It was on Lori to not allow a situation where anyone would think they need to moderate what they discuss to avoid interpersonal drama.

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          1. MsM*

            Or it could even be Lori using the session to dump her own grievances with OP and Bob just noncommitally going, “Yeah, that sounds bad. So, about why I’m here today…”

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        3. Dark Macadamia*

          Honestly, I think that’s the one part of this that’s on the LW. He shouldn’t know gossip about his boss’s best friend to be able to pass it along! He’s stuck between two people who lack professional boundaries. For all we know, this was ONE comment he made that was reasonable in context – “Yeah, I was upset LW didn’t back me up on (work thing), it’s like how they didn’t support you with (gossip thing).”

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          1. Starbuck*

            Yeah that stood out to me – LW, why does Bob need to know anything about how your friendship with Lori is going? That is too much! I am plenty chatty with my coworkers but even ones I’ve known for 10 years don’t know things like this about my outside relationships. In a professional/office setting this is just not a good idea.

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        4. NerdyKris*

          I don’t see how that’s Bob’s fault. What good is a therapist if you can’t be honest with them? Which brings us back around to why Lori should have ended it regardless of Bob’s willingness to continue.

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        5. Specks*

          Hard disagree. A therapist is not your friend. You’re not “gossiping” with them by telling them all about your life. If someone is withholding their grievances, no matter how silly or trivial or morally wrong, that says bad things about the therapy relationship. Lori is 100% to blame here as a professional for turning this into a gossip session.

          Shrinking might be fun to watch, but let’s face it, Jimmy should lose his license or step back for some years and get some close supervision and retraining. So does Lori.

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      2. Antilles*

        I don’t think Bob did anything wrong per se, but it feels wild to me that he wasn’t uncomfortable with the overlap and just went along with it. Even if I 100% trusted my therapist’s professionalism and discretion, the idea of my therapist being BFFs with my boss would feel way too much crossing the streams and I’d absolutely be asking for a referral to one of OP’s colleagues.

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          1. bamcheeks*

            Did Bob know? For all we know, the conversation is,

            “You should find another doctor, because, uh, Reasons.”
            “No, I’m good!”
            “Oh, OK then.”

            “..And my boss is constantly offloading on me about his co-dependent relationship with his former roommate, who genuinely sounds like nightmare, but why is he telling me?”
            “Wait, what did he say about the roommate? I mean, yes, that sounds very difficult for you.”

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            1. Silver Robin*

              I guess it depends on how incompetent we think Lori is; there is a lot of second hand reporting happening, but I am assuming that Lori said something like “hey, both of us are friends with OP, probably a good idea to see a different therapist” and Bob says it is fine, and then Lori makes the incorrect call to keep Bob as a client.

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              1. Anon21*

                It’s a little hard to puzzle out. Often a therapist would have no reason to know the name of the client’s boss even if the boss is a frequent topic of sessions. But this was clearly not a typical therapeutic relationship…

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                1. Lexi*

                  A therapist would know the name of a client’s boss because they probably refer to their boss by name in sessions instead of saying “my boss” every time. The therapist would also know where their client works so it’s not difficult to figure out that their friend who is a boss at that same company is probably the client’s boss. Plus it’s not unheard of for people to talk about coworkers to friends so it probably wasn’t difficult for Lori to figure out who everyone was and how they were all connected.

                2. Lydia*

                  Yeah, my therapist knows the names of my coworkers and boss, etc. Otherwise, when I’m talking about things happening at work, it would be very tiresome and confusing to only refer to Coworker 1, Coworker 2, wait, didn’t I call Jojo Coworker 1 last time? Anyway, boss says Coworker 3…

                3. MigraineMonth*

                  @Lydia – Instead of Coworker 1 and 2, I refer to my coworkers by the pseudonyms Juaquin and Wakeen. For some reason my therapist is never able to follow my stories.

                4. metadata minion*

                  It could also be as simple as knowing that Bob is a junior widget designer in at the Grackletown branch of Widgets R Us and that the LW is the manager of widget designers there.

                5. Cmdrshprd*

                  Idk I don’t think mentioning the name of the boss is out of the realm of normal, as is the name of the place you work in therapy.
                  Bob says I work as a teapot maker, at Teapots LLC. Lori might think what a coincidence my BFF works at Teapots LLC, but not think anything of it at first.

                  Then bob says my supervisor Jane is really getting on my nerves and Lori pieces it together, my friend Jane is a supervisor at Teapots LLC. Then lori asks Bob is your supervisor Jane Smith? I am good friends with Jane Smith fyi we should not continue our therapist/client relationship.

                1. Kyrielle*

                  I’m not sure it’s not the first time – but if it’s the first time, it probably won’t be the last, unless something hauls her up short.

          2. Specks*

            1) Bob didn’t want the awkward conversation of dropping the therapist
            2) Bob is really struggling and finding another therapist seemed an insurmountable obstacle. Or maybe being on a waitlist for months really was an insurmountable obstacle for whatever her was going through
            3) Bob is not a professional and doesn’t understand that a therapist being your buddy isn’t appropriate or good for him in the long term. He found someone he gels with and didn’t want to lose them, even if the therapy isn’t working.

            Etc. This is on Lori.

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            1. Wayward Sun*

              Or 4) this is a small town and there are no other therapists. It happens a lot.

              I once had the same therapist as my fiancée for similar reasons. Fortunately the things I wanted to see a therapist for had nothing to do with her, so the therapist and I just agreed that if that ever changed I would have to find someone else.

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        2. anne of mean gables*

          Yeah I live in a small enough town, and am professionally enmeshed enough with the mental health profession, that this situation is entirely plausible to me and it’s a hard (HARD) no for me as a patient. Non-overlap with my professional network is an absolute must when I’ve sought mental health care.

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          1. Koala*

            I’m a mental health professional in a mid sized city and I had to break up with one therapist after a couple sessions when we figured out that my new boss was her husband (they had different last names)(running into her at his retirement party was awkward), and later, when my psychistrist left the practice I was going to (in a neighboring town, which I deliberately chose to prevent this issue) they scheduled me with her replacement, and I walked in the door to discover my new psychiatrist was my previous office mate! My kid goes to the clinic I used to work at (but with a doctor I never worked with) because of the difficulty of finding a child psychiatrist.

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              1. Koala*

                Right? There’s at least 250 K people in the city but apparently I know the vast majority of the mental health providers.

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            2. Frieda*

              My parents are longtime friends with a couple who are both mental health care providers (psychiatrist and therapist, respectively) and they went to see the wife, who is a therapist, after my mom had a very serious mental health event* while staying at my house for a visit.

              The therapist later called me, evidently with my parents’ permission since how else was she getting my number, to explain that my mother had spent most of the first session complaining about how messy my bedroom was when I was a child (!) and suggesting some things I could do to make my mother less angry when I needed to set boundaries around her behavior towards my children.

              Was I this family’s nanny for a summer as a young adult? Yes, yes I was. At the time of the phone call I was in my early 40s, though.

              What was anyone in this scenario thinking? God only knows.

              * This event involved very specific threats of self-harm as a means of revenge against me for being rude to her while we were at a Target store.

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              1. Andie*

                That is totally bonkerballs and I worry that your mom is relying on a therapist with extremely bad judgement and therapeutic boundaries to handle such a serious mental health disturbance.

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          2. Scintillating Water*

            Yeah, this is why I do telehealth for my therapy and psychiatric meds, even though I prefer to be in person for it. My town is too small, it’s just impossible to find someone who is more than one degree of separation. (I also have to look for therapists outside my minority religion because it’s too tight-knit of a community in this part of my state.)

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        3. JustaTech*

          If Lori was clear with Bob about her relationship with the LW (see other comments about that) then the only reason I can see that Bob would stick with Lori is the availability of another therapist (ie, someone in-network with hours that work for him).

          But even in that case I would think Lori would be at least somewhat obligated to find Bob an alternate therapist!

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      3. MK*

        It doesn’t sound as of she said anythjng that direct to him, she apparently “encouraged him to find another doctor”. If it was more along the lines of “would you prefer to find someone who isn’t your boss’ BFF?”, he likely didn’t register the importance. Many people don’t realize how code of ethics of other professions work.

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        1. Clisby*

          It shouldn’t have been put on him. Lori was responsible for severing the therapist/client relationship (and giving him some referrals.) He should have had the basic common sense to see why that was a good idea, but like they say … common sense isn’t always that common.

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        2. NerdyKris*

          Yeah, a lot of people aren’t going to think the situation through. It’s not a problem now, so why would it be a problem in the future? They don’t realize that the problem is when the situation changes. Like dating a boss. Sure, it might not have a conflict now, but what about when one does come up? It’s the professional’s job to handle this, not the patient’s.

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      4. Irish Teacher.*

        I’m also not sure how reliable a narrator Lori is here. It sounds like the LW only has her word for it that she suggested Bob switch therapists and given that she broke a client’s trust by talking about his therapy and has generally behaved unprofessionally, I wouldn’t be inclined to take her word that things went down exactly as she said.

        They MAY have, but it’s also possible there is more to this that she isn’t telling. Like that it was more a “I can refer you to somebody else if you’re not comfortable talking to your boss’s friend” or even that she didn’t say anything at all and is just trying to deflect some of the blame.

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      5. JelloStapler*

        Bob is not as in the wrong but he is not free and clear here.

        Lori should have said “I am referring you out” not “Maybe you should see someone else”.

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    2. mango chiffon*

      Not only that, but Lori seems to be talking about her own relationship with OP with Bob? How is that appropriate for her to be doing?

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      1. dogmom*

        I’m wondering exactly how much gossiping about Lori LW is doing with Bob. I know LW said they talk about their non-work relationships and events, but is LW just saying general chit-chat like “my friend Lori and I are seeing Wicked this weekend” or is it like “my friend Lori’s boyfriend Mike is such an asshole, he lies and cheats all the time and she keeps taking him back, it’s really hard to listen to her keep complaining about him”? Like, if it’s more like the second scenario, idk why LW would be gossiping about people their coworkers don’t even know, so this whole situation is just really bizarre to me.

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        1. Zoe Karvounopsina*

          Like, if it’s more like the second scenario, idk why LW would be gossiping about people their coworkers don’t even know, so this whole situation is just really bizarre to me.
          I talk to my coworkers about people they don’t know all the time! Especially when those co-workers are also my friends! It could come up like so “How was your weekend, OP?” “Great except for that really draining talk with Lori.” “It’s the worst when that happens–what was it?” “Ugh, MIKE!”

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          1. Koala*

            I LOVE hearing about my coworker’s group of friends. She’s a little younger than me and childfree and I vicariously live through their adventures.

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            1. Nah*

              Drama you have zero stake in but get to hear about first hand is always delicious, but also there’s a reason I’m not a licensed therapist or the person recounting its manager.

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            2. Na$ty Larry*

              Oh same here. I could spend hours listening to my boss talk about her family drama. I cannot blame Bob for that part of it LOL

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        2. carrot cake*

          >idk why LW would be gossiping about people their coworkers don’t even know

          Huh? At some point, everyone talk to a co-worker about someone outside the workplace. That’s work life. Not sure why it seems strange.

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          1. Hastily Blessed Fritos*

            I think there’s a difference between “Oh I hung out with friends” talk about your own life and “My friend did this and that” gossip about someone else’s. Talking about your own life, which obviously involves mentioning other people, is normal. Talking just about people your coworkers don’t actually know seems weird, but I’m less social at work than a lot of people, so maybe some people do that a lot?

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            1. Wayward Sun*

              I had a coworker for a while who used us to vent about his wife. After months of complaining about her to us, he brought her to the office Christmas party. Awkward.

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        3. Rusty Shackelford*

          If Lori said the LW “wasn’t supportive,” it has to be more like your second scenario. And I can think of ways that would come up… if Bob is complaining about something, and the LW says “oh ha ha that’s like my friend Lori, she does stuff like that,” it’s not so bizarre.

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          1. Rusty Shackelford*

            But I want to add that, while it’s not bizarre for LW to gripe about a friend with a coworker, it’s very weird and inappropriate for Bob to bring that back to Lori, and of course beyond weird (and wildly inappropriate) for Lori to report it to LW.

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        4. JustaTech*

          “Like, if it’s more like the second scenario, idk why LW would be gossiping about people their coworkers don’t even know, so this whole situation is just really bizarre to me.”

          Good gravy, I used to have a coworker who *loved* to gossip about people I didn’t know and had never met (and would never want to meet). The drama in her apartment building would have filled three seasons of a soap opera.
          As far as I can tell it was one of her hobbies (and one of the reasons I was glad I never had anything “juicy” to share about myself).

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      2. Silver Robin*

        I would not assume that; Bob can bring up comments about how OP is generally annoying about something and then add in “ya know OP has been dismissive of you too! OP said….” And now Lori has to just know that.

        I also cannot imagine continuing with a therapist who I know is good friends with my boss, about whom I complain in therapy. How could Bob be sure Lori is responding appropriately to those complaints? How does Bob not feel gross talking about OP behind their back at therapy while OP has no idea? Sure, Lori has a larger share of responsibility, but even if Bob assumed Lori had the professional ethics down, what about personal ones? It is gross all around.

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      4. Person from the Resume*

        Yes. If Bob is in therapy for issues that come up with work, he could be talking about his boss to his therapist, but how does it come out to “LW is not supportive of Lori.” That’s not something Bob needs to be discussing in therapy.

        Lori is the problem here. And LW should probably distance herself from both. With Bob a more strictly professional relationship with no talking about things going on outside of work and especially in LW’s other relationships. Possibly just cut Lori off entirely. Was she fishing for info from Bob about how the LW feels about her?!? It sounds like there’s other issues in the friendship anyway.

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      5. Csethiro Ceredin*

        Yes that is a very strange element. Lori’s boundaries seem very shaky – not a good thing for a therapist.

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    4. Rage*

      I work in a healthcare field, and am completing a Masters in Clinical Mental Health Counseling. The thing about multiple relationships (which is what this type of conflict of interest is called) is that the care of the client is of utmost importance. It is possible to successfully manage a dual/multiple relationship, and may even be impossible to avoid. Ethically, the provider has to determine which is the least harmful course of action to take.

      A big factor in psychiatry (and clinical psychology) is that, in many areas, wait lists for services are very long. Psychiatrists don’t often perform “therapy” – they are doctors, not counselors, and their specialty is psychotropic medications. Not to say that they don’t do a bit of it while reviewing a client’s medications and progress – but their services are different from a counselor or mental health therapist.

      So…when Lori learned of the multiple relationship and she suggested Bob find another doctor….it’s possible that he could NOT (not merely didn’t want to). At least not without a wait that could jeopardize his overall healthcare (if he’s taking a medication that requires monthly or quarterly check-ins to maintain his Rx, stopping all services would be considered detrimental). It’s entirely possible that Lori DID go through everything at the time and come to the decision that the lack of care was more detrimental to Bob than the potential for multiple-relationship conflicts.

      Of course, Lori’s blown that all out of the water by breaching HIPAA. I know OP doesn’t want to harm Lori’s career, but the real victim here is Bob. Lori violated Bob’s expectation of confidentiality, and he’s the one who should get to make that call.

      As tough as it will be, I would suggest alerting Bob. I’d alert your HR before you do that, though, because you don’t want him coming back on you for this, when it was really none of your doing. And you might have to sit down with Bob and lay out the groundwork for future boundaries and interactions, because now that he knows this, he might be pretty wary around you.

      I’m sorry. You’re in a situation with no winners.

      Reply ↓
      1. Guacamole Bob*

        It seems like less of a giant red flag to continue on as Bob’s psychiatrist if it was mainly for medication management… but those visits are usually perfunctory enough or at least focused enough on the medical side of things that I really don’t see how the topic of LW’s support or lack thereof for Lori would even come up? I don’t think most people would talk to their psychiatrists about their boss much at all, unless the psychiatrist is providing therapy (which some do).

        Reply ↓
        1. Joana*

          Yeah, I went to one for a while (my meds didn’t need to be adjusted anymore for now so my doctor is able to just resubmit them for me) and the only thing we talked about was how I felt they were helping me (an antidepressant and a stimulant), any side effects, if I thought they should be adjusted or wanted to try an alternative. There was obviously talk of mental health, but I can’t remember ever having more than a small talk conversation with her about my day-to-day life.

          Reply ↓
        2. Turquoisecow*

          Yeah my therapy sessions are frequent and long (an hour every other week) but when I saw a psychiatrist it was maybe a half hour to discuss medication and whether we thought it was working/any side effects or whatever, and more like every few months.

          Reply ↓
          1. Wayward Sun*

            I think this varies a lot. My psychiatry sessions are often ten minutes or less, because I’ve been stable on my meds for a long time. My wife’s involve a lot more conversation about how she’s feeling and how things are going, because that’s her psychiatrist’s style and she hasn’t been on her current meds as long.

            Reply ↓
      2. cosmicgorilla*

        Rage, your call outs make the situation so much worse to me. We’ve been speculating over whether Bob was complaining about LW during therapy, or whether Lori was dumping on Bob, and Bob said something like ,”wow, LW is not supportive of you!”

        But if Bob and Lori are supposed to have a relationship based on medication management, where is this conversation around how supportive LW is or is not coming from? That makes me think there is some additional friendly chit chat and venting going on. Some friendly chit chat, ok, but going to the level of venting about the psychiatrist’s friend just seems like it crosses many lines, especially given that this shouldn’t be a talk therapy situation, based on the role of a psychiatrist.

        Reply ↓
      3. MigraineMonth*

        Yeah, I do think that Bob has the right to know. I’m sorry, LW, but Lori broke all professional requirements and federal law when she told you that she was treating Bob, and I’m not sure it’s a secret you can ethically keep from the injured party.

        Please try to remember that Bob is the injured party here. He wasn’t gossiping about you with your friend behind your back; he was talking about his boss in therapy as part of a treatment plan. Work and relationships with managers are major stressors in most people’s lives; it’s not personal against you at all. (Though as Alison points out, you shouldn’t really be friends with your reports.)

        Reply ↓
      4. Manic Sunday*

        The question of what kind of care someone might get from their psychiatrist is so interesting to me. As someone not in the field, my understanding has always been that things usually go the way you describe, with a psychiatrist or other MD providing medication management while another non-MD mental health professional provides therapy, if both are needed. But at one time I did have a psychiatrist who did both for me. My partner once had both a psychiatrist and a therapist, and the psychiatrist provided him with just as much therapy as the therapist did! For both of us, this happened when we lived in major cities. And both psychiatrists were in their sixties or seventies. Not sure whether either of those factors are relevant, but it’s interesting.

        Reply ↓
    5. Pizza Rat*

      Nice to hear confirmation from someone in the field.

      I really don’t get why Bob’s disagreement was even considered. This wasn’t a discussion about whether pineapple goes on pizza.

      I’m a bit creeped out that Lori would let it continue. What on earth was her motivation for doing so?

      Reply ↓
    6. Csethiro Ceredin*

      Yes, her professional organization would probably have a pretty serious response to that.

      Although of course reporting her to them would likely be a friendship-ending move, but ugh, i am peripherally in the field too and this is really beyond the pale.

      Reply ↓
  3. Ess Ess*

    OP should also let Bob know that his therapist has violated his confidentiality. That was HIS information that she disclosed so he needs to decide what to do about the data breach, not OP.

    Reply ↓
    1. FashionablyEvil*

      I can’t imagine having that conversation with an employee and don’t think that should be the OP’s responsibility.

      Reply ↓
      1. Liz the Snackbrarian*

        If Lori works at a larger practice I think the key is to let them know and have them relay the information to Bob. I feel for OP, they may not feel great about doing that to someone they considered a friend, even if it is the right thing.

        Reply ↓
      2. Not on board*

        I don’t think OP needs to tell Bob what Lori said specifically, but OP could say, “It accidentally came out that Lori is your therapist.” And then, “It’s made me realize that I need more professional boundaries and this is not your fault nor have you done anything wrong – I think, as your boss, it makes sense to pull back a bit”.

        Bob should know that Lori has terrible discretion and decision-making before he continues his therapy with her.

        Reply ↓
        1. Elsewise*

          That’s a really good way of putting it. If OP reveals exactly what Lori says, it runs the risk of making Bob feel like he has to justify or explain to his boss what he was talking about in therapy and why he said it. If she puts it the way you suggested, Bob still gets the information he needs (Lori broke confidentiality; OP is pulling back to a more professional relationship for reasons that don’t have anything to do with him) without putting him in that situation.

          Reply ↓
        2. MsM*

          I don’t know that I’d give Lori enough benefit of the doubt to say “accidentally,” but this seems like a generally good way to handle it to me.

          Reply ↓
          1. Observer*

            The issue is not to protect Lori, but to have enough cover that if Lori decides to go after the LW can protect themself a bit more easily.

            Basically when asked about this, the LW can point to the *fact* of what Lori did and point our that they did not say anything about her reasons, character, general behavior.

            Reply ↓
        3. Naomi*

          Honestly, I think that’s underselling the situation. “It accidentally came out that Lori is your therapist” does not convey the degree of seriousness of “Lori not only revealed you were her patient but told me something you said about me in therapy.”

          Reply ↓
          1. FashionablyEvil*

            Dude, the LW has to keep working with Bob. Saying “Lori disclosed information from one of your therapy sessions” is going to blow that working relationship up in spectacular fashion. LW should keep their mouth shut.

            Reply ↓
            1. Naomi*

              My point is, while the above poster’s wording works to explain OP’s change in attitude to Bob, the poster suggested it as a way to let Bob know about Lori’s breach of ethics, and I don’t think it communicates that.

              Whether OP should be the one to tell Bob at all… I’m on the fence there. I take your point that Bob is unlikely to take it well, but on the other hand, Lori disclosing the information already happened, so the working relationship is already damaged on OP’s side. And Bob does need to know. Others have suggested things like reporting Lori to her professional board, which could get her removed as Bob’s therapist without OP being the one to tell Bob directly.

              Reply ↓
              1. Testing*

                I don’t think the LW’s and Bob’s relationship is blown here. LW should be a bit more selective about what she talks about at work, Bob should find a new therapist, and they should just get on with it. Lori is the one who screwed up majorly here.

                Reply ↓
      4. duinath*

        I think Lori needs to be reported. Not to Bob, but to whoever handles medical ethical violations.

        Like, I’m sorry, I know she’s OP’s friend, but the chances this is her first (or last) serious lapse of ethical judgment are so very low, and even if it was the unicorn time where it only happened once, she has essentially sabotaged her patient’s work.

        That is so bad. It’s not a small mistake, and it should not be brushed off. Which I am afraid, given Bob’s lack of respect for boundaries, he is likely to do.

        Lori’s career has serious rules for serious reasons, and protecting her from the consequences of her actions is not fair or ethical.

        Sorry, OP, I know that’s not what you want to hear.

        Reply ↓
        2. Rajacat*

          Agree. What same to mind was a perhaps similarity to sexual harassment. Probably isn’t the first time Lori has shown poor judgement. And OP isn’t doing this *to* Lori. Lori did it to herself.

          Reply ↓
          1. Alexander Graham Yell*

            Yeah, I understand that the OP has been friends with this person for a long time and that can include loyalty like not telling their other friends when your BFF vented about them bc she needed to get something off her chest. The “don’t rat out your friend” training runs DEEP.
            And when you’re really mad about a fight, reporting something like this can feel vindictive and we have collectively decided vindictiveness is not a quality we want to embody.
            All that to say – there is a LOT of stuff probably going on in your mind, OP, and all of it points to not telling anybody about this lapse in judgement.
            But this was a spectacular lapse in professionalism on Lori’s part on multiple levels. Imagine you’re in Bob’s shoes – you have a therapist you shouldn’t trust, who doesn’t hold good professional boundaries, and now it might have major consequences at work. She got mad and put his job in the middle of your fight.
            You NEVER should have known she was his therapist. Ever. And it’s doing all of her clients a favour to report her to whatever governing body has authority here so that she gets the wake up call on professional boundaries she desperately needs.

            Reply ↓
    2. Lynn*

      That conversation with Bob would be so very uncomfortable. But I do think it needs to happen as he is the one whose privacy was violated. I would hate doing it-and I would probably give Lori a chance to disclose in hopes that I could avoid the whole thing. But how to handle her lapse should be his decision. One way or another, he should be told, IMO.

      Reply ↓
      1. toolegittoresign*

        I was also thinking it would be due best to tell Lori she has to tell Bob — but I wonder if Lori would be honest or if she’d try to put it on LW. Lori clearly has ethics issues and I don’t think she can be trusted.

        Reply ↓
        1. Troutwaxer*

          “Lori clearly has ethics issues and I don’t think she can be trusted.”

          Yup. This. (Speaking for myself alone this would be a friendship-ender.)

          Reply ↓
    3. Specks*

      That’s not on OP to disclose to Bob. OP should absolutely disclose to Lori’s governing body or practice, if she’s not solo. I know that’s tough to do to your best friend, but she is violating all sorts of boundaries and professional ethics here and needs a wake up call. Hopefully someone from the field can weigh in here, but I imagine she wouldn’t necessarily lose her license for something like this, but getting censure and additional oversight might actually help her in the long run.

      At a minimum — if you’re just 100% opposed to reporting – OP, you need to tell Lori that she needs to terminate her professional relationship with Bob immediately. If she’s going to ask you to participate in covering up her very problematic behavior in the past, she needs to at least stop actively doing it.

      Reply ↓
    4. Margaret Cavendish*

      The better thing to do would be to report the breach to Lori’s regulatory body – they have procedures for how to handle it, including notifying Bob and whatever conversation needs to happen with Lori.

      OP has enough on her plate already, just knowing that Lori and Bob are connected in this way. She should focus on managing her own feelings, and her relationship with each of them, and let the professionals handle everything else.

      Also, ooof, OP, this sounds awful. I’m so sorry it happened to you.

      Reply ↓
      1. Kyrielle*

        Also, OP may need some therapy to deal with all of this too. Not with anyone in any way associated with or working with Lori, however – you want as much distance from that as you can get.

        Reply ↓
    5. RagingADHD*

      If Bob were a stranger, I don’t think OP would be obligated to seek him out. But since Bob is a work-friend as well as a direct report, and OP says they have spoken to Bob about Lori as a friend, I think it is only right to inform Bob that Lori has broken his trust.

      What else is Lori going to blab next?

      Reply ↓
    6. Turquoisecow*

      I think Lori needs to do that but if she’s going to be unethical about it then OP needs to do something, whether that’s reporting her for a violation or telling Bob himself. This is a big enough deal that OP cannot just walk away. Yes, the relationship with Lori will suffer and maybe end, but if she’s violated professional ethics this much with Bob, it’s not out of the question that she’s done so with other patients.

      Reply ↓
  4. mango chiffon*

    Honestly, even Lori’s comment is so strange and alarming to me. She is talking about Bob like he is her friend rather than a patient. Saying that “Bob told me you weren’t supportive of me” is about Lori’s relationship with OP and not Bob’s. Lori is crossing so many boundaries in her position and I question her judgment as a therapist.

    Reply ↓
    1. Michigander*

      Yes, that does not sound like the kind of thing she should even know! Why is Bob talking about how supportive his boss is of her best friend? That’s such an odd thing to come up in therapy, unless they’ve formed a friendship that involves talking about the person they have in common (LW), which is inappropriate.

      Reply ↓
    2. toolegittoresign*

      Not to mention the whole “decided to air a list of grievances” thing. If I told my therapist I was going to do that to a friend, even if that friend had wronged me, my therapist would definitely have something to say about it. Ambushing a close friend with a LIST of long held resentments is never going to be productive or make anyone feel better. Lori has terrible judgement.

      Reply ↓
    3. pomme de terre*

      It’s so weird! The only way it makes sense (aside from Lori talking about herself in sessions) is if the OP said something offhand at work that was dismissive of talk therapy in general and not Lori in particular?

      Or OP said, “Apropos of nothing, my best friend, Lori LastName, is terrible at her job as a psychiatrist,” which is, from what we know, true.

      Reply ↓
    4. carrot cake*

      “Lori is crossing so many boundaries in her position and I question her judgment as a therapist.”

      —–

      I immediately heard the “L&O:SVU” theme music when I read that sentence.

      Reply ↓
    5. Observer*

      Lori is crossing so many boundaries in her position and I question her judgment as a therapist.

      Yes.

      Also, as a person. But frankly, while I understand why you don’t want to destroy her career, I do think that this is a big enough issue that she *needs* to get a real consequence here. Either this is really the first time she’s been so over the top, in which case her career probably won’t be over, but the sanctions would be enough to scare her straight. If they don’t then she needs to get pushed out of practice. Same if it turns out that this is a pattern.

      It’s like the discussion on this morning’s letter about the yelling boss. Someone mentioned that people who yell at staff should not be a manager and someone else said that it was “too harsh” and people need to be given chances. Others pointed out that those chances cannot be given on the backs of other people. Same thing here.

      Reply ↓
    6. linger*

      I did wonder for a moment if it was a simple typo for “Bob told me you weren’t supportive of him” (which would be a really easy mistake from mixing direct/indirect quotes). Except that doesn’t seem to fit as well into Lori complaining about OP’s perceived shortcomings in the context of their own relationship. So let’s assume it really is “me”=Lori.
      That means OP had previously complained about Lori, by name, to Bob … and Bob, knowing who this Lori was, still did nothing to mention he knew her or to stop OP complaining, and then … mentioned it to Lori.
      So what have we learned?
      1. Bob routinely complains about OP to Lori.
      2. OP routinely complains about Lori to Bob, and about Bob to Lori (and incidentally, about both to us).
      3. None of Lori, Bob, or OP are good at identifying and respecting boundaries, which is most egregious for Lori’s profession, not great in OP’s role, and still questionable even for Bob.
      4. I think it’s complicated enough already, and maybe we need to stay out of it and let all three go to counseling, if they can find a practitioner who doesn’t already know one of them.

      Reply ↓
    7. I went to school with only 1 Jennifer*

      I’m wondering whether Lori is actually a psychiatrist (a type of MD), which is the word LW used, or if Lori is some kind of therapist/counselor. People can use them interchangeably even though there are specific definitions for each.

      Reply ↓
  5. Liz the Snackbrarian*

    What a cluster. What a terrible position for Lori to put you in. And Bob! You should have listened to Lori in the first place! And she should have held firm!

    OP, I hope that you can salvage things with Lori. Her judgement as a professional and a person feel off base here and stepping back for a time might be the play.

    Reply ↓
    1. Liz the Snackbrarian*

      As in Bob should have listened to Lori in the first place, not OP. OP has done nothing wrong here that I can see.

      Reply ↓
      1. Not Tom, Just Petty*

        Agree. Some people are saying Bob should not be telling Lori what OP says about her. In a perfect world, no. But the ultimate goal of Bob’s therapy is for Bob to work through Bob’s life. OP is part of Bob’s life.
        If OP and Lori were not friends and Bob told his therapist about boss who doesn’t seem to support his/her own best friend, that could open up, “will my boss think suggestions outside the box are not worth supporting?”
        And a therapist could help Bob decide if and how to make suggestions.
        But Lori instead tells Bob she can still be his therapist, but don’t say anything to OP. So Lori is completely wrong in this situation.

        Reply ↓
    2. Observer*

      OP, I hope that you can salvage things with Lori

      Why? I don’t think that the LW should even try. This is not someone who I could see myself trusting. Why and how would you maintain this kind of close relationship with someone who is untrustworthy?

      Reply ↓
      1. Liz the Snackbrarian*

        Hoping that they can is probably the wrong phrasing–but if LW does decide to part ways, they might still feel fraught about it. I see what you’re saying on an intellectual level but for the person in it when there are real emotions attached it can be tough. I was more trying to express empathy for that side of things and did so poorly.

        Or maybe they feel decisive about no longer having Lori in their lives. Who knows!

        Reply ↓
  6. Harper the Other One*

    Yikes on bikes did Lori EVER mess up – and not in an “oh I didn’t know this was an issue” kind of way because there’s no way these kinds of conflicts of interest aren’t explicitly covered, PLUS then she outright stated something Bob had said about you from a session.

    OP, I’m very sorry this happened. I agree with Allison that you should notify HR, and also establish stronger boundaries with Bob.

    As for Lori, I would end the friendship personally, and honestly I would report this to her professional body. Someone who works with vulnerable people CANNOT use confidential info against someone else because of an argument. Please don’t think of it as ruining her career; think of it as protecting people who might be hurt by Lori’s failure to follow professional ethics.

    Reply ↓
    1. Lilia Calderu*

      “don’t think of it as ruining her career; think of it as protecting people who might be hurt by Lori’s failure to follow professional ethics.”

      100% this

      Reply ↓
      2. ferrina*

        Absolutely. And OP is already in a terrible place because of Lori’s ethical breach. It’s impacted OP’s relationship with Bob, and if Bob complains, OP feels like they can’t tell anyone the reason why. OP is being set up to take the damage for this- not okay.

        OP, this isn’t you being vindicative or “ruining” Lori’s career. This is you giving highly relevant information to the licensing board. If this really is a one-time slip, it’s unlikely to destroy Lori’s career. It might ruin your friendship with Lori, but I would argue that Lori already did that by continuing to see Bob as a patient (and by complaining to Bob about you, as per her “Bob said you weren’t supportive of me!” just…what the what is up with that?!)

        Reply ↓
    2. Observer*

      Please don’t think of it as ruining her career; think of it as protecting people who might be hurt by Lori’s failure to follow professional ethics.

      Yes. Very, very much this.

      I suspect that there are going to be a lot of “Yes” responses here. Because this is soooo important.

      Reply ↓
  7. Blovigar*

    You need to tell Bob that his therapist violated his HIPPA protected privacy and let him decide if he wants to pursue a complaint or not. Like, obviously what she did to you was messed up but but what she did to Bob was fully illegal. If she cannot be trusted with patient information then unfortunately she really shouldn’t be a therapist.

    But also, you said she’s a psychiatrist? Psychiatrists are doctors, they don’t generally provide therapy, so it’s weird that they were talking about you at all to be honest.

    Reply ↓
    1. Elsewise*

      I’ve known a few people who get therapy from their psychiatrist. It’s more common to talk to someone with a counseling degree and then get your meds from a psych (or a gp) without counseling, but both do definitely happen. (It’s also very common for people who aren’t in the field to confuse therapist/counselor/psychologist/psychiatrist so I wouldn’t read too much into it.)

      Reply ↓
      1. Csethiro Ceredin*

        My ex saw a psychiatrist for therapy as well as medication. (It didn’t seem to me that the psychiatrist was very skilled as a therapist, though, but then my ex was an unreliable narrator, so who knows).

        Reply ↓
    2. The Rafters*

      It’s more normal to see a psychiatrist to regulate medications and see a counselor in between, but psychiatrists absolutely can and do provide therapy.

      Reply ↓
    3. Hlao-roo*

      I don’t know how common it is for psychiatrists to provide talk therapy for their patients, but at least some psychiatrists do, and Lori is probably one of them.

      Reply ↓
    4. North American Couch Wizard Society Member*

      It’s not clear here that Lori was doing psychotherapy with Bob although most psychiatrists do get some training in therapy. That may be why she thought it was OK to continue seeing his as his doctor. However, she does clearly have a therapeutic relationship with him and even if the relationship came up during routine chitchat around an appointment primarily focused on medications it would be inappropriate to continue it given alllll the power differentials here.

      I feel very bad for Bob, who has appropriately kept his medical issues out of the workplace, seems to have been reassured by Lori that there were no ethical problems with continuing care, and now has to deal with OP making rapid adjustments to their working relationship without the context to understand why.

      Reply ↓
    5. Wayward Sun*

      In some states, therapists can prescribe medications, so the distinction between the two can be blurry. e.g., when I lived in Washington state my therapist also handled my meds. She was a nurse practitioner and could prescribe under the supervision of a doctor.

      Reply ↓
  8. Snarkus Aurelius*

    You’re not going to ruin Lori’s career by reporting her for a HIPAA violation. The bar for therapists to lose their license is really, really high because they’re given a very wide berth. Automatic career-ending actions are having sex with clients and overcharging them or some other financial exploitation.

    I tried to report my childhood therapist for having a dual relationship with my mother, failing to report sexual assault (at school) of a minor, believing my mother’s version of events over mine, and allowing my mother to dictate what was and wasn’t relevant in my sessions. The licensing board told me bad therapy isn’t enough to take away someone’s license, and what I reported wasn’t enough to start an investigation.

    Go ahead and report Lori and consider your friendship over. (Seriously, why would you want to be friends with her at this point?) She’ll get a ding on her license, and the Office of Civil Rights at Health and Human Services will find out, but that’s it.

    Sad but true.

    Reply ↓
    2. Specks*

      Ugh, I’m so sorry to hear this and that your mother and therapists both abused you this way as a child.

      Very depressing, but tracks… losing a license and your career is just not that easy. Getting justice as a victim of HIPAA violations or other issues is not that easy. OP, I really hope you report and that this will serve as a wake up call for Lori. Because she really needs one.

      Reply ↓
    4. Bibliothecarial*

      My former employer would absolutely have fired your therapist. I’m sorry yours did all that with no consequences. Gross.

      I’m not sure Lori would have been outright fired but she would have been on thin ice and watched like a hawk.

      Reply ↓
      1. Bunch Harmon*

        Agreed. Even if there are few consequences for this particular case, reporting it will help establish a pattern if it happens again. And someone can keep a much closer eye any other violations.

        Reply ↓
    5. Grumpy Elder Millennial*

      LW, even if the likely consequences were much harsher, YOU would not be destroying Lori’s career. SHE would have. She’s the one who violated HIPAA. You didn’t make her. You are not responsible for any of the fallout that may come from that information becoming known. She screwed up and it’s not on you to protect her from the consequences of her actions. (Yes, it’s easy for me to say, as someone with no involvement, and much harder when it’s people you care about).

      If I was Bob, I’d probably want to know that my doctor had broken confidentiality. He cannot make the best decisions about his own care without this information. Is he still comfortable receiving care from her after this? If yes, is there anything he would change about his therapeutic relationship with her?

      It totally sucks that you’re stuck in the middle of all this mess. But if Lori won’t disclose to him, I think you should strongly consider doing so.

      Reply ↓
      1. Snarkus Aurelius*

        Correct. For two reasons: 1) 25 years had passed from my time with him so the board was concerned about timeliness and 2) they needed more people to come forward.

        Reply ↓
  10. Ex-Prof*

    I have a friend who works at a psychiatric hospital. I remarked to her conversationally that I’d read Extremely Famous Artist had once been a patient there.

    She immediately got a very professional look on her face and clammed up, neither confirming nor denying that Extremely Famous Artist, WHO DIED FIFTY YEARS AGO, had been a patient.

    That’s the level of confidentiality that’s expected in the mental health field. Lori not only told you that Bob was a patient, but what he said in confidence and what he said about you.

    Lori should lose her license.

    Reply ↓
      1. bamcheeks*

        In the UK, this would almost certainly go to the GMC (not just the breach of confidentiality, but all the decisions that led up to that.) What the outcome would be would depend on the level of insight and remorse that the doctor showed. People who say, “yes, I fucked up, and I am going to do XYZ to make sure I don’t do it again” are much more likely to keep their licence than people who go, “What? It’s not MY fault!”

        Reply ↓
      3. atalanta0jess*

        No way in heck. Everyone makes a breach at some point. This was a real bad one, to be fair, but it’s easy to breach by accident – mail the wrong paper to the wrong person, etc. I’d be surprised to meet a therapist who has never accidentally breached.

        Reply ↓
    2. The Rafters*

      Just chiming in to say, 50 years is the exact amount of time that needs to pass following the patient’s death for someone in the field to be allowed to release or discuss patient information. If the famous artist died 49-3/4 years ago, that would be a breach.

      Reply ↓
    3. Insert Clever Name Here*

      Yeah, I realize that OP doesn’t want to “destroy Lori’s career” but…Lori committed such a huge violation! Lori should feel the professional consequences of that! I could understand OP feeling conflicted because it could come across as vindictive but LORI DISCLOSED THAT SOMEONE WAS HER PATIENT AND WHAT THEY TALK ABOUT. Flabbergasted.

      Reply ↓
      1. Isben Takes Tea*

        And not just disclosed it to a random person, but a person the PATIENT KNOWS AND IS DEPENDENT ON PROFESSIONALLY?! Gobsmacked.

        Reply ↓
        1. Strive to Excel*

          That’s THE WHOLE REASON WHY HIPAA exists. Celebrities aside, the vast majority of the world would not care what a given person discloses in therapy, nor would it be likely to affect them. If some random person in the middle of Argentina goes to therapy and then their info gets splayed all over the internet, it’s not all the people in the EU and Africa and Oceania they need to worry about; it’s their family, friends, and coworkers.

          Reply ↓
        2. Grumpy Elder Millennial*

          Isn’t it also super weird that apparently BOB said that the LW isn’t supportive of LORI? Like, why should Lori be saying that stuff to Bob? I can maybe understand it if it came up in the context of Bob saying the LW wasn’t supportive and Lori saying she had had similar experiences. It’s still not great. But it would make sense. Otherwise, it sounds like Lori *may* be using her sessions with Bob in ways that are not focused on helping Bob (i.e., complaining about the LW).

          Reply ↓
      2. Irish Teacher.*

        Yes and to their BOSS. It’s not beyond the bounds of possibility that somebody’s boss finding out they were in therapy could harm their career if the boss had prejudices around mental health. Or in this case, because Lori has basically said “Bob was complaining about you.” This could easily damage Bob’s career and in fact, it DOES seem to have caused the LW to question his professionalism.

        Reply ↓
      3. Margaret Cavendish*

        It’s so hard because of all the crossed lines between personal, professional, and therapeutic boundaries here. I wonder if OP thinks that reporting would be overkill because she’s experiencing it as a personal issue rather than an ethical one.

        In which case, OP, please don’t worry about that part! At the very least, the regulatory body needs to know about the breach so they can notify Bob. And whatever happens to Lori is not your fault – she’s the one who committed the breach of ethics, and she’s the one who can deal with the consequences.

        Reply ↓
      4. Marie*

        Lori is the one who destroyed her “career.” She is a sub par MH professional doing more harm than good and an extremely sub par fake friend. I absolutely imagine her encouraging Bob to spill all the dirt on OP. Report her. She is an untrustworthy “professional “; she also is an untrustworthy person and not at all a true friend. OP, you deserve better. Begin and maintain professional and courteous boundaries with Bob.

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  11. bamcheeks*

    I am not sure that I would be too concerned about damaging Lori’s career by reporting the HIPAA violation! I mean, it’s not just that, it’s that she’s apparently unable to separate what she’s hearing from a patient from her own feelings and relationships, to the extent that she’s included it in a rant at a friend. That’s a level of unprofessionalism that I think should be reported, so she can be better supervised or take a break from practice or whatever she needs to do to not harm another patient.

    Reply ↓
    1. John*

      Agree completely. While it’s likely rare that a situation such as this would present itself, her ethical breach was significantly severe to suggest that patients may be at risk.

      Reply ↓
    2. Silver Robin*

      I think the unprofessionalism is that she did not immediately stop seeing Bob as a patient. Having chosen to continue seeing my him, I am not at all surprised that she struggles not to take information she hears about OP (and OP’s opinions on her!) into the rest of her life. Humans cannot just un-know things contextually. In the heat of an argument with high emotions, she let it slip.

      That difficulty is *exactly* why her profession’s standards require her to have excused herself from being Bob’s therapist. I do not think the unprofessionalism is in allowing what her clients say stick with her, it is the egregious lack of judgement in continuing to be their therapist when the social situation is so fraught.

      Reply ↓
      1. bamcheeks*

        Quite possibly! I don’t know whether this kind of relationship would be explicitly covered by Lori’s code of ethics, or whether it would be up to her professional judgment to decide when it interfered with her ability to provide care to Bob. But if it was the latter, the point where she’s hearing a client TALK ABOUT HERSELF should have been a giant wake-up call.

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      2. MigraineMonth*

        I am not ready to excuse Lori’s breach of professional ethics as a “slip of the tongue” in a heated emotional moment. For one thing, it sounds like she *engineered* the heated emotional moment by deciding to confront LW with a long list of grievances (which is a terrible way to work through a conflict to begin with).

        For another, while it’s impossible to un-know things, it is possible to keep them secret when you decide it’s important to do so. I am bad at keeping secrets and generally lean towards TMI, but I don’t share secret information from my job. If a friend tells me something in confidence I don’t share it. If the information really bothers me I will tell my therapist, who has an ironclad professional obligation not to share it with anyone but their therapist.

        Reply ↓
  12. Benihana scene stealer*

    I don’t know all the regulations, but wondering which part of this Lori messed up – was it treating Bob in the first place once she knew of the connection, or was it revealing to LW that Bob was a patient, or both?

    Also, you mention this is your best friend – can’t you work it out rather than ending the frienship?

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    1. Lab Boss*

      I don’t know the therapy side of things to say whether the conflict of interest should have been an absolute red line not to cross, or just required treading carefully. I know enough people in health care to say that unless Bob gave specific permission for Lori to tell OP he was a patient, that’s a very likely violation of HIPAA.

      Even in a completely neutral situation like “I bumped into your friend in the waiting room, he says hi,” the health care pros I know will tell the patient “I won’t tell Lab Boss hi unless you specifically tell me it’s OK for me to tell him that I saw you here as a patient.” I don’t know if that level of caution is strictly mandatory but that’s an indicator of how thoughtful professionals handle patient confidentiality.

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    2. Alex*

      It was definitely both. HIPAA is very serious and prohibits any medical provider from disclosing the identity of their patients. To anyone, but to THAT PERSON’S BOSS?? An incredible violation. And Lori had a professional obligation to discontinue treatment with Bob when it was realized that Bob’s boss was Lori’s best friend.

      If this gets back to the licensing board, I would assume Lori would lose her medical license.

      Reply ↓
      1. dulcinea47*

        you might be surprised what it takes for people to actually lose a medical license. It ain’t one hipaa violation, it’s a lot more than that. She’d prob get a fine and a slap on the wrist.

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        1. Alex*

          Perhaps, if this is the only thing on her record. But this behavior is so egregious that I doubt it is the only time. If it is the first time, then the next time won’t be the first report.

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    3. bamcheeks*

      Lori’s job as a professional is to decide whether there is a conflict of interest which makes her an unsuitable service provider for this individual. There are some places where that’s quite clearcut — you shouldn’t usually be a formal medical provider for your husband or wife, for example, and certainly not for psychiatric care — and others where it’s more a grey area, and it’s on the provider to decide whether they can responsibility provide care to this individual. On paper, “client is managed by a friend of mine” is probably a grey area– there are plenty of situations where there’d be no conflict there at all, and a responsible service provider could absolutely continue to provide care. At the point where the client is talking about their manager’s relationship with teh service provider, it’s getting darker grey, and it’s on Lori to decide when it becomes impossible for her to separate her care of Bob from her feelings about what he tells her in therapy sessions.

      Generally speaking, if you’re providing any kind of therapy, you should have a supervisor to discuss this with– specifically someone who supervises your practice, separate from a manager.

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    4. LizardOfOz*

      Both, really. The revealing part is the worst violation of the two, I believe, but once she’d realised it was a conflict of interest she should have stopped being Bob’s therapist.

      That would have also made less likely that Lori would reveal anything about her patients to the OP, funnily enough.

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    5. Not that kind of psychologist*

      Rule may differ if she’s a psychiatrist instead of a psychologist, but APA code of ethics would classify this as a case of “multiple relationships” and states that, basically, psychologists should avoid entering into these, try to resolve/eliminate it in a way that is maximally beneficial to the patient, and if it can’t be resolved [e.g., in a case like court-mandated assessment/therapy where the psychologist has to report back to the court], clearly discloses it to the patient. Assuming that there’s no mitigating factor like “we live on a small island without telemedicine such that Lori is the only psychologist who could provide care to Bob”, this would pretty clearly require Lori to transfer Bob’s care to someone else, maybe agreeing to continue to see him for a month or two if there would otherwise be a gap.

      Revealing that Bob is a patient at all, let alone anything he said, is definitely a HIPAA violation.

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      1. JelloStapler*

        If she is a counselor with a social work license:
        (a) Social workers should be alert to and avoid conflicts of interest that interfere with the exercise of professional discretion and impartial judgment. Social workers should inform clients when a real or potential conflict of interest arises and take reasonable steps to resolve the issue in a manner that makes the clients’ interests primary and protects clients’ interests to the greatest extent possible. In some cases, protecting clients’ interests may require termination of the professional relationship with proper referral of the client.

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    6. I'm just here for the cats!!*

      1. Being that OP and Lori are long time best friends it is on the ethical gray side to be therapist for someone who works directly with a close friend or family member. And based on what Lori said it sounds like the two have been talking about the OP in therapy, and that Lori has brought up their relationship. A therapist should NOT be talking about their own situations in that context.
      2. It is a HUGE violation to disclose that Bob was a patient. I work in a college counseling center as an admin assistant and we are not to disclose anything about clients. So much so that counselors will wait to exit the office to use the restroom until their client has left, so they are not walking down the hall together.
      3. I don’t know if OP should work it out with the friend. Its obvious that she has been talking about the OP behind their back. And then blew up at them.

      Reply ↓
      1. Margaret Cavendish*

        This is my question as well. In addition to the grey-ish area about Lori being Bob’s therapist, and the absolutely black-and-white area of Lori disclosing it to OP – why on earth were they talking about *Lori’s* relationship with OP, in Bob’s therapy?

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    7. Overit*

      OP neess to dump Lori as a friend pdq. Lori has demonstrated clearly that shs is not worth one second of continued trust.

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      2. ferrina*

        This. OP, I’m sorry. I fully believe that Lori was once a wonderful friend and had previously earned the title of Best Friend. But she doesn’t deserve it now. She betrayed professional ethics, talked behind your back under the guise of being professional (doing both you and Bob a grave disservice), put you in an awful situation at work by committing a HIPAA violation, put you in a position where you feel like you can’t tell anyone what happened when you were the one who was wronged.

        I’m very sorry. But I think you need to mourn this friendship as a loss and put it in the past.

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    8. Irish Teacher.*

      Revealing to Bob’s boss not only that he is in therapy but that he has spoken critically of the boss there is appalling. It could easily damage his career and gives away some of his private medical information.

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    9. Observer*

      was it treating Bob in the first place once she knew of the connection, or was it revealing to LW that Bob was a patient, or both?

      Both. But the second AND that she revealed WHAT he said are flatly illegal. Not just unethical, although that’s also true.

      Medical providers are absolutely forbidden from releasing any of this information outside of extremely narrow conditions, none of what apply here.

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    10. Jackalope*

      To the last question: I know that I personally have a really high bar for what counts as relationship-ending with my closest friends. I too would want to consider if things could be salvaged. So I get where you’re coming from. That being said, this is such an enormous breach of trust that it would be really tough to get over. How do you move beyond knowing that your best friend was badmouthing you to the client she was providing therapy to? That’s a whole lot of untrustworthiness there. And I believe that the OP has an ethical mandate to report this to whatever board supervises Lori because this is so egregious. What will THAT do to their friendship? Whether she reports it or not, she still knows what happened.

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      1. Starbuck*

        Also, is Lori putting any effort into salvaging things? She is the one who “unloaded a list of grievances” on LW – maybe she considers the friendship ended already! Who knows.

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    11. Nightengale*

      both although I think the second is worse

      Sometimes conflict of interests are inevitable in smaller communities or with very specialized care. I professionally care for the children of several people I also have a professional (all in the mental health fields) and social relationship belonging to the same disability community. The parents and I discussed this pretty transparently before scheduling their kids to see me and we set some guidelines about what would and wouldn’t be discussed in certain situations and channels. For example I wouldn’t pretend not to recognize them at community events, but we also would not discuss the child’s care in those settings. I’m pretty much the only person in the city who provides the kind of care they were seeking and we decided to go forward.

      But there is no excuse for a professional to disclose that someone is a patient to a friend who also knows that patient.

      signed – physician in a psych adjacent field

      Reply ↓
  13. Honoria Lucasta*

    I think I agree. Bob needs to know that his therapist violated his confidentiality. “Bob, I’m very sorry I’ve been more withdrawn lately. Lori recently disclosed some of your conversations to me; I didn’t ask her to, and I wish she hadn’t, but I can’t unhear what she said. It has caused me to reflect on my boundaries at work, and I’ve realized that as a manager I can’t have such close relationships with my team members.”

    I would tell him at or near the end of the day so he can go home early and doesn’t have to process at work.

    And then probably a brief note to your HR so that they also know you notified him right away.

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    1. FashionablyEvil*

      This is going to escalate this problem to an alarming degree–this wording would freak Bob out and sabotage the OP’s working relationship with Bob.

      Reply ↓
    2. Willow*

      I wouldn’t phrase it this way, it will lead to him freaking out over what was told. I would either just say that it came out that he is Lori’s patient, or specify that it was a single comment about OP and Lori’s friendship. This is going to be upsetting enough for him without making him think that lots of his personal stuff was shared.

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    3. Manic Sunday*

      For Bob’s sake, if I were OP I’d keep the focus off what Lori told them. The less OP says about their relationship with / feelings about Lori, the better. Instead I’d make the conversation about OP’s professional relationship to Bob and how OP is going to approach their role as a manager going forward. I’d say something like, “I recently learned you’re a patient of my friend Lori, and although I didn’t seek out this information, it has made me reflect on my own professional boundaries. Since I’m your manager, it’s not appropriate for us to be as close personally as we were in the past, and that’s why you might have noticed me being withdrawn lately.”

      I don’t think OP should apologize for withdrawing; it’s the right thing to do! Honestly, if they’d used better boundaries with Bob all along, they probably wouldn’t be having so many uncomfortable feelings right now because Bob would have had less to say about them in his therapy sessions.

      I also think it’s not OP’s job to explain how they got the info that Bob is Lori’s patient, and in fact they should say as little as possible from now on about their interactions with Lori. As other commenters have pointed out, Lori’s professional review board can be responsible for informing Bob of his therapist’s transgression. He needs to know about it, but he doesn’t need to be burdened with his boss’s feelings about it.

      Reply ↓
  14. Lab Boss*

    Look, I understand the impulse not to torpedo your friend’s career, even after she hurt you. But also… if you report her to the relevant authorities for this professional violation, YOU aren’t damaging her career, SHE damaged it with a series of outrageously wrong choices, and I would argue it’s a service to her other (and potential future) clients to report her.

    You are aware of one case where she has a connection to someone in a patient’s life, and you know that she violated patient confidentiality in that case in order to fill a personal need to confront you. How long before she finds out something from another patient that causes her to do the same thing? She deserves the professional damage she has coming to her. Not because she’s a bad friend or because you want revenge, but because she needs to face consequences that ensure this NEVER happens to another patient.

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    1. MsM*

      It’s arguably even a service to her, if she takes this opportunity to reflect on why what she did was so bad and does the work to make sure it doesn’t happen again. (And if she doesn’t, that’s all the more reason she needs to consider a career change.)

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      1. Troutwaxer*

        It’s certainly a service to the rest of her patients! (Note that I have no idea what her practice is like – it could be anything from lots of counseling to lots of meds and maybe work in 1-5 hospitals depending on how Lori has built her career, but counseling patients without good HIPAA protections are not being well-served.)

        Reply ↓
    2. MigraineMonth*

      Yeah, I’m horrified that Lori breached all the ethics of her profession and broke federal law in service of… scoring just one point in an argument in her personal life. WTF, Lori?!?

      Reply ↓
  15. Mantic Re*

    Was Lori talking about her relationship with the OP with Bob during a session? Because that also feels super inappropriate. It’s bad enough she kept seeing him as a patient—but “Bob told me you weren’t supportive of me!” suggests that they talked about Lori and OP’s relationship and that feels especially inappropriate.

    Reply ↓
    1. Michigander*

      Right? Your boss’ relationship with her friends is not something you would normally bring up in therapy because it has nothing to do with you, so it suggests that Bob and Lori have been having conversations about the LW and their connection to her.

      Reply ↓
    2. Tuesday Tacos*

      Exactly. Obviously Bob somehow knows their relationship is that of best friends and Lori and Bob were talking about OP not in a manner of how Bob was relating to his boss at work, but of how OP and Lori were relating to each other. This shouldn’t even come up in a therapist/client relationship. Its bizarre.

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    3. CheesePlease*

      I assumed it happened something along the lines of

      Bob to OP “my therapist told me to use these tools when I struggle at work”
      OP – “that therapist sounds dumb! I used those tools and they never helped me. I would seek a different therapist”
      Bob to Lori “my boss said the tools you gave me were dumb and I feel like she doesn’t support you as my therapist”

      NOT Bob telling Lori “OP hates your new haircut” or whatever

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    4. Csethiro Ceredin*

      That stood out to me too. Mind you, I’ve done non-clinical supervision for therapists and counsellors and some of them have shown errors in judgment or ethics that completely shocked me.

      Most are great, and they do get training in this stuff, but a small percentage still treat their clients like a dating pool or admiring audience or support system.

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  16. Kitano*

    Can we also talk about how WEIRD it was for Lori to pull out a complaint that Bob made in therapy during a fight with OP?? What was she trying to accomplish with that?? Some weird “Look, even the people i treat in therapy think you suck!” sort of power play??

    Lori’s judgment sucks, and imo she has proven herself to be unfit for her job. OP should report her for this egregious HIPAA violation.

    OP’s sympathy for Lori as a friend doesn’t change the fact that she seriously screwed Bob over in a way that could have cost him a job had OP decided to be vindictive and nasty to him over Lori’s words. She shouldn’t be allowed to escape from that unscathed.

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  17. Three Cats in a Trenchcoat*

    I’m not impressed with Lori here. I am a psychiatrist, and I have been in a situation where a patient and I found out that we had a mutual friend. Awkwardly, we found out at a destination wedding for the friend. When we both got back, we had a discussion about how it was not ideal to continue as patient/doctor given the connection (we occasionally get invited to the same parties, etc), and I transferred them to another psychiatrist in the office. There was not going to be an option where the patient said “oh no, I’m cool” and then we continue treatment.

    I told my husband the generalities (a patient was also at the wedding! how awkward!) but only after we returned, so that he wouldn’t be able to tell from my reactions who it was. NONE of our mutual friends know, unless the patient decided to disclose. This is NOT mine to share!

    Reply ↓
    1. Lab Boss*

      The wedding- oh dear! We found out that our therapist friend Kate had seen another friend, Emma, as a patient for a while. That had ended before anyone realized the connection, so no harm no foul until we got married and both were invited to the wedding. Emma was very exited and said “ooh, sit me with Kate, I’d love to catch up!” and we had to very gently remind her that her former therapist might not want to sit with an old patient. Everything worked out well enough, but it was an awkward moment avoided.

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    2. I'm just here for the cats!!*

      Good for you! You are the opposite of Lori!

      From my experience (not a therapist but work as admin support for counseling center) the only time it would be ok was if there was SI risk and you did a few sessions until the new provider had an opening. We’ve had to do that once as there was no other choice.

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      1. Margaret Cavendish*

        Yep. Pretty much the only thing that supersedes privacy regulations is a serious and immediate threat to a person’s safety. Having an argument with your friend and wanting to use a patient’s information to hurt them is…not that.

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    3. Rusty Shackelford*

      What do you do at the wedding in those circumstances – pretend you don’t know each other? Pretend you’re just acquaintances?

      Reply ↓
      1. JelloStapler*

        The professional acts like they don’t know the client. If the client brings up the relationship, the professional can acknowledge it but then probably remain cordially polite at best. Then you talk about it in the therapy setting as to next steps. This is the same as if you see them at a grocery store. In that case obviously you don’t have to end the professional relationship, but it’s good to acknowledge the situation.

        Reply ↓
        1. Three Cats in a Trenchcoat*

          Exactly! There’s an awkward “you have to acknowledge me first so that I can take your lead” dance, where I do my absolute best to pretend I have never seen you before in my life while I wait to see how/if you acknowledge me. If we pretend this is the first time we’ve met, sure, I can do that. You want to act like vague acquaintances, I can do that too. You want to tell everyone “hey, this is Doc Cats!”, I’ll be very surprised, but I’ll follow your lead.

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      2. Hastily Blessed Fritos*

        For less close interactions than a wedding (think running into each other at a concert or the swimming pool or something similar) the direction I’ve had is that the client can say a quick hello but nothing in depth, and the therapist will not initiate any contact.

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    4. Paint N Drip*

      Thanks for chiming in as a pro. Regardless of the blow-up with OP, Lori choosing to stay Bob’s therapist really stuck out to me as profoundly unprofessional – Bob NEVER should have been able to say nah I’ll just stick with you as my therapist

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  18. Retired Medical Professional*

    I would not want to keep a friend who would disclose someone’s personal medical information to me in violation of all kinds of medical ethics. And Bob should know this happened.

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  19. Alex*

    I know you don’t want to destroy Lori’s career, but Lori clearly cannot handle the responsibilities of being a psychiatrist! Lori has violated her patient and her profession in the EXTREME. If you do report it, it isn’t YOU destroying Lori’s career, Lori has done that all by herself. I would not want someone who behaved this way to be my psychiatrist. Reporting it is up to you, but if you do report, you can view it as protecting future patients rather than an act of revenge.

    Reply ↓
  20. Anna Green*

    Lorie violated HIPAA, so she is the one who is ruining her career, not you! It’s unfortunate that the burden of reporting is on you (or Bob), but she deliberately made career-ruining decisions over a long period of time hoping to get away with it.

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  21. Never the Twain*

    I don’t really know how these things work, but is Lori’s behaviour in keeping on Bob a professional disciplinary matter? I can’t imagine how she could maintain the boundaries, but she seems to have done it for two years up to now (though admittedly no one can know whether Bob’s therapy has been compromised).
    Obviously, revealing the name of any client is a huge no-no, but if it came to licence-revoking, would the triangular relationship of itself be an issue?
    (Like I say, I don’t know how these things work; whenever I think of therapy I can’t see past an image of Lorraine Bracco and James Gandolfini, where such boundary-crossmg had its own rules for conflict resolution)

    Reply ↓
    1. Observer*

      I can’t imagine how she could maintain the boundaries, but she seems to have done it for two years up to now

      As you note, no one knows whether Bob’s therapy has been compromised. Which means that there is no basis for saying that she has “apparently” been managing the boundary. And the way she put her complaint to the LW indicates that it’s quite possible that she has *not* been managing the boundary.

      But, I doubt that just keeping Bob on as a patient would get her into much trouble. But in addition to the HUGE overstep of what she revealed? I suspect that it would have a much higher impact.

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    2. Bibliovore*

      I wondered that, too. While I’m not in the field and absolutely no expert on the matter, I think that Lori committed at least two or three violations here: keeping Bob as a patient after becoming aware of the conflict of interest, breeching HIPAA not only by disclosing that he was a patient of hers _and_ what he said in treatment but doing so to his boss (!), and also potentially in whatever had been going on in those therapy appointments that Bob would be telling Lori that OP didn’t support her (could be a non-issue if, as someone suggested earlier, it was something generic like Bob saying his boss didn’t support the idea of psychiatrists, or could be a very big deal indeed if Lori was using Bob as an informant of sorts or other inappropriate provider-patient stuff).

      There could, of course, be additional issues not touched on either in this letter or in what Lori said to OP.

      Reply ↓
  24. Overthinking It*

    Well, wonder. She said “Bob told me aren’t very supportive of ME” Not “Bob told me you aren’t supportive of him.” So, isn’t this likely something related outside the therapeutic relationship? Like, just chit- chat, on the way out the door, or something? Now, it’s possible that Bob is actively trying to cause drama, but more likely Bob said something about “Boss was pretty put out when you canceled your plans with him.” Or “Boss says you have it easy as a therapist and wouldn’t last a day at our company.” And neither of these would be ” I (Bob) am having a problem with Boss.” I’d just reassure her you are supportive (of her) but tell her you’re disturbed that she continued the therapeutic relationship behind your back, and not quibble about HIPPA. Don’t pursue it – it’ll blow up spectacularly. She shouldn’t have said anything, but it doesn’t seem like a clear cut violation, because it wasn’t about Bob’s relationship with you, nor his with therapist.

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    1. Observer*

      not quibble about HIPPA.

      This is not a *quibble*. HIPPA violations are a major thing. And *anything* a patient says in the context of therapy *is* protected information. So is the *mere fact* of someone being a patient.

      To repeat: It is *absolutely* illegal to share that someone is a patient without explicit consent from the patient, which is clearly not the case here, or other very narrow circumstances. It is *also* completely illegal to share *anything* a patient tells you, regardless of whether it’s “chitchat” or not.

      None of the rest of it matters. And please don’t try to minimize what Lori did. She was totally out of line in a major way.

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    2. Frosty*

      OP should not reassure Lori that she did nothing wrong because Lori violated multiple codes of ethics in her behaviour. Lori should have discontinued her relationship with the patient as soon as a conflict was discovered. She absolutely should not have disclosed anything that was said in any of these sessions.

      The subject matter and the way she disclosed it (during an argument) is so beyond the pale that I’d be deeply concerned about the rest of Lori’s patients and even if Lori is using substances or engaging in other behaviours that are damaging her ability to function professionally.

      Reply ↓
      1. Margaret Cavendish*

        Agreed. This isn’t a “quibble” about HIPPA – Lori committed multiple breaches of her professional licensing requirements. Keeping Bob as a patient, talking to Bob about her relationship with OP, and disclosing the info to OP – those are all very clear violations of the law.

        OP can decide to handle it however she wants, of course. Her personal relationship with Lori, her professional relationship with Bob, and even reporting Lori to her licensing body – those are all up to her. But she shouldn’t feel any guilt about over-reacting or blowing anything up if she does decide to report – this is a pretty big deal, and it’s 100% on Lori.

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    3. Esmae*

      It’s a violation of Lori’s professional ethics to even mention that she knows Bob unless he gives her permission. It doesn’t matter what she said about him, or whether she’s repeating information that was shared in a session or outside of one. Their entire relationship is protected.

      Reply ↓
  25. Lisa*

    I know the LW doesn’t want to report Lori, but if Lori would make this massive of a breach of ethics, it makes me wonder if Lori’s doing other things that are not appropriate with other clients. It sounds to me like this has been going on for longer than since the ’22 change. As soon as Lori realized that the LW that was her best friend and the LW Bob was talking about were the same person, she should have dropped him as client. Maybe that didn’t happen until ’22, but that just seems so unlikely.

    So, uh, yeah, I would recommend reporting her, LW. If she’s done something like this, it’s not you that caused her to lose her job, it’s her. A one-time infraction may not be egregious enough for her to lose her license, but if she’s been this unprofessional with other clients as well, she would deserve to lose her license. (And depending on where you live, license rules and enforcement can be so lax she might be fine even if she were friends with all her clients’ bosses.)

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  26. cactus lady*

    This warrants reporting to the state medical board, since psychiatrists are MDs. They might not do anything about one complaint, but there may have been others that you don’t know about. They should have a mechanism to protect you if you do report it. Lori is misusing her position as a physician. (If I misread and she is not a psychiatrist, but a psychologist, you should report her to the board that licenses psychologists in your area.)

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  27. Carolamy*

    We know that Lori knows Bob’s connection to LW, but do we know if Bob knows Lori’s connection to LW? Did Lori just reference a “conflict of interest” or was she specific with Bob?

    Reply ↓
    1. Percysowner*

      Well, we know that Lori has told Bob about HER relationship with the LW, since she claims Bob said the LW wasn’t supportive of Lori. That indicates that he does know there is a relationship between Lori and the LW, not just a conflict of interest.

      Many years ago, in college, I had a counselor who used her patients to work out her own problems by talking about her past relationships and stating how that applied to the client’s situation. I probably shouldn’t have ever found out that her father was abusive, her mother as an alcoholic and her ex-husband was a liar and a cheat. She also shouldn’t have told me the details of other client’s sessions. I didn’t report her because I was a college kid who didn’t know better and she was good at manipulating me and others into thinking this was what therapy should be. Reporting Lori is good because, since she is willing to breach HIPAA, she may well be breaching other ethical boundaries.

      Reply ↓
      1. Elsewise*

        My first therapist, when I was in high school, told me all about another patient she had. She told me that she was treating another student at my school, who was a refugee from a specific country, and struggling to adapt to life in the US and failing a few of her classes. It was presented as “some people have it worse” and also “you could feel better if you interact with this other student, why don’t you seek her out and tutor her.” I didn’t know the other girl (big school), but there was enough information that I could have found out who it was very easily.

        Point being, like you said, that wasn’t the only issue! She also tried a therapeutic exercise with me that, in retrospect, could have been extremely damaging if I’d had certain mental health conditions she didn’t assess for. Fortunately, I only saw her for one session, so she didn’t do any long-term damage. Like you, I was too young and inexperienced to do anything about it, but luckily for me, I had been referred to her by another practitioner, who happened to be my mother. She got the full story, and I believe followed up accordingly.

        Reply ↓
    2. Fíriel*

      This is the key question I think, though not one I think LW can actually pursue answering in any meaningful way. I’m not persuaded from what we know in this letter that Bob was necessarily ‘in on it’ at all. Not least because otherwise his choice to keep seeing her seems very weird (though there are plausibly mitigating factors relating to insurance coverage or medication prescriptions – you wouldn’t want to change providers if you thought it might effect your coverage or access to medications, even if you were wigged out about a connection to your boss).

      Reply ↓
    3. DVM*

      I am very curious about this as well. She could and SHOULD have just said to him “we have a conflict of interest.” Disclosing more details than that is a boundary issue itself. And if Bob had that info, he has a (very small) hand in this as well.

      Reply ↓
  28. AnnOminous*

    Lori deserves to have her career destroyed, and it will have been her own fault by giving you a (valid and extremely serious!) reason to report her. She has shown that she is wildly unethical, and I wonder if she’s behaving unethically with other patients as well. It might help to reframe reporting her as “protecting patients” vs “destroying her career”

    Reply ↓
    1. Benihana scene stealer*

      “Lori deserves to have her career destroyed”

      No – that’s a ridiculous thing to say for one violation. I wonder if one instance of this would even bring more than a warning

      Reply ↓
      1. cactus lady*

        It’s unlikely to get her license taken away or anything like that. Most often the complaints are that the medical board doesn’t do anything. However, this is an instance that OP knows about that should be reported. What we DONT know is if/how many other complaints there are gain at her. Maybe there are none and nothing will happen. But maybe she is doing other stuff that the board knows about and should/will address if there are further complaints. I have worked in a medical licensing adjacent field for only four years and in that time have seen two physicians lose their licenses for behaving inappropriately. But it wasn’t about one complaint in either case – it was a litany of complaints and egregious offenses. If someone complains about her and she is notified, it might be the kick in the pants she needs to improve her professionalism.

        Reply ↓
    2. JelloStapler*

      No, she (and her clients) deserves to be checked on her behavior so she does not do it again. If she does- then she destroyed her own career.

      Reply ↓
  29. The Rafters*

    I think OP does have a duty to let Bob know that his therapist spoke about him to OP. Since they work together and OP is his supervisor, this will very likely eventually blow up in her face. It might be a good idea to speak with a company attorney or EAP to discuss the best way to go about this. I have a feeling that this is going to be above HR’s head. I wouldn’t feel too badly for the friend, either. OP may well lose the friendship but therapist doesn’t sound like a very good friend, and she definitely deserves to lose her license.

    Reply ↓
    1. Troutwaxer*

      If I were Bob in this situation I’d be angry to know that my therapist hadn’t disclosed the other relationship, but I’d also want to know about it. If I learned later that my boss had know Lori for years and also hadn’t told me about the relationship, I’d be super-incredibly angry! And the thing about secrets is that they tend to come out, usually at the worst possible times and under the worst possible circumstances. So I definitely agree that LW should tell HR and the company attorney, and Bob should be told as soon as possible.

      Reply ↓
  31. Blue Mina*

    Everyone has discussed Lori’s culpability in this situation, but I don’t think enough focus has been given to OP’s relationship with Bob. Alison touched on it, but I think the fact that the OP was sharing enough personal information with someone she manages about her friend (who as far as she knew had never met Bob) that Bob would have material to share in his sessions with Lori suggests some fairly egregious crossing of boundaries on OP’s part. It doesn’t justify Lori’s actions, but it certainly suggests that OP needs to really take a long hard look at herself and how she’s been managing her employees.

    Reply ↓
    1. Paint N Drip*

      I tend to agree. I am EXTREMELY interested in what OP could have possibly said that was work-reasonable to Bob but also infuriating to Lori, and how it possibly came up in therapy (but I’m nosy like that)

      Reply ↓
      1. Frosty*

        Bob knows that OP is friends with Lori (but OP doesn’t have the same info that Bob and Lori d0). It’s possible that Bob goes fishing for information by asking leading questions because he enjoys the fact that he has this over OP.

        There are so many reasons why therapeutic relationships need to be completely outside of all social and familial relationships and this is such a good example of how much damage can be caused even by “small” transgressions of that boundary.

        Reply ↓
      2. Observer*

        I am EXTREMELY interested in what OP could have possibly said that was work-reasonable to Bob but also infuriating to Lori,

        I’m curious too. But it’s worth keeping in mind that Lori is not really reasonable or this whole situation would not have come up. So, it’s hard to conclude that LW said anything really odd or out of place.

        Reply ↓
    2. Frosty*

      I can think of many ways that OP could mention her friend that would not be an issue. Bob knows that OP is friends with Lori (because Lori told him he should get a new doctor). OP doesn’t know that Bob sees Lori, so she could have made a rather off-hand remark. We don’t know what “you aren’t supportive of me” really means.

      It could be that OP said “my friend is a doctor and wants to move her office into that neighbourhood you were in yesterday for that meeting. It seems like there aren’t that many other businesses around there, I wonder if she’ll be able to make a go of it”.

      Bob tells Lori “OP said she’s worried you won’t be able to pay your rent in the new office that you’re moving to”.

      We don’t know what OP said to Bob but it could be a range of things, especially if they have worked together for over a decade. I don’t think we can assume that OP has an enmeshed relationship with Bob or that they are crossing boundaries themselves.

      Reply ↓
    3. Margaret Cavendish*

      I disagree! OP hasn’t done anything wrong here, other than having a friendly relationship with someone she has worked with for ten years. There’s nothing in the letter to indicate that she has been anything other than professional with Bob. “Things going on outside work and in other relationships” could be nothing more than “my husband and I are taking the kids to Disneyland over the holiday” – these are perfectly normal workplace conversations, that people are encouraged to have all the time.

      She has already planned to step back a bit from Bob. So telling her to “take a long hard look at herself” is unnecessarily harsh – given that she is already aware that there might be an issue, and given the egregious harm committed by Lori. OP is the victim here, not the perpetrator.

      Reply ↓
  32. Sick of Workplace Bullshit (she/her)*

    I would tell Bob what Lori said. He has a right to know his (former?) therapist is violating HIPPA in regards to him and let him decide what to do about that. I would also think seriously about reporting her yourself. I know *you* don’t want to blow up her career, but she’s done that herself. She does not deserve to be in a trustworthy role, as she clearly is not and does not deserve to be holding sensitive information for anyone.

    Reply ↓
  34. Anon Psych*

    Lori really, really, REALLY messed up. She should absolutely not have continued to see Bob. And also…I gotta be honest, keeping confidentiality is not hard. I’ve treated VIPs. I’ve treated my neighbour’s grandson and know her daughter’s whole unfortunate and very violent mental health history; whenever my parents talk about it I go, “Gosh, poor Elena” and otherwise keep my mouth shut. There is no “I told him to find another doctor but he didn’t want to.” You ask a colleague to take your patient; there’s an unspoken expectation that they can then ask you to do the same at some point in the future. Then you tell your patient that X day will be your last appointment. If they refuse to go see the new person, then it’s on them. If you live in The Sticks and you are the only option around, then, well, you’d better be good at boundaries.

    Whether or not to report is up to you; ultimately it’s unlikely that it would tank Lori’s career. I don’t work in the US, but in Canada it’s very hard to defrock a doctor. You pretty much have to be convicted of a felony. In Canada, at least, the most she’d likely get is formally admonished and have to do some modules and coaching.

    Reply ↓
    1. Margaret Cavendish*

      Yep, exactly. Our family lawyer is the father of one of my son’s best friends – he’s quite well-known in the community, to the point that he often knows very private information about the kids who are playing D&D in his livingroom. And he doesn’t even tell his wife about these things – there’s a *very* firm boundary between what he knows as a lawyer and what he knows as Wakeen’s dad.

      Reply ↓
    3. MigraineMonth*

      I’ve noticed that professional bodies–whether for lawyers, judges, doctors, etc–are generally slow to impose serious consequences on their own members. I’m not saying you can’t get disbarred or lose your medical license for a first offense, but probably not for one of this scale.

      Reply ↓
  35. Delta Delta*

    There are a couple things here. 1) If Lori is a part of a larger practice/group, OP could report the issue to their compliance or risk management office. Let the company sort out what should happen from there. This may lead to her job being terminated, and may lead to licensing action, although the latter isn’t necessarily guaranteed. 2) If Lori is a psychiatrist, that means she’s an MD, which means she’s most definitely a licensed professional (if she’s a therapist and not a psychiatrist she is likely also licensed, although probably by a different overseeing board). OP could choose to make a professional complaint to the relevant board. If she loses her license(s), she is very likely going to lose her job, because she can’t work without the license. If she gets suspended or some other sort of mark on her licensure that may or may not cause her to lose her job, but OP can’t know that from where she currently sits. 3) OP can choose to do nothing and let Lori sort out her mess. 4) The least likely – OP doesn’t specifically know that Lori doesn’t have a release to talk to her about Bob.

    I don’t know that OP ought to say anything to Bob. Bob seems to know OP and Lori are friends (did I read that right?). OP can certainly maintain a cool professional distance. OP may also suggest Bob be supervised by someone else, if possible, especially if it appears he will continue to see Lori professionally.

    This does make me wonder, though, how much has Lori divulged about OP over the years?

    Sorry if none of this feels actionable for OP. It’s a hard spot and the more I think about it, the less I’m sure that OP has any obligation to do anything. She didn’t make the mess.

    Reply ↓
    1. Observer*

      4) The least likely – OP doesn’t specifically know that Lori doesn’t have a release to talk to her about Bob.

      Theoretically that’s true. But it’s *wildly* unlikely. Why would she have such a release? It’s not like there was any *therapeutic* reason for it. Keep in mind that the standard releases do *not* include things like “talk to your boss”, “talk to your parents / spouse / children” etc. Doctors have to get specific permission for those things, which is why when (good) advice columnists tell someone to talk to a family member’s doctor, they will often caveat that by also telling them that when they talk to the doctor they should explicitly say that they are not asking for information but are just informing the practice about X, Y or Z relevant information. Because it is *not* typical for this kind of release to exist.

      On top of which, the LW and Bob had a close enough relationship that they talked about other stuff, some of which is quite personal. Yet, Bob never mentioned his therapist. That indicates that he did not want his therapist talking to the LW.

      Sure, it’s *possible* that she had a release. And if she has a signed release, then she won’t be harmed by the LW disclosing. But given the situation here, I cannot believe that she had a release.

      Reply ↓
    2. Troutwaxer*

      I’m not sure we can say for sure that Bob knows anything about Lori and OP being friends. We don’t know enough about the conversation between Lori and Bob to make any valid assumptions.

      Reply ↓
    3. Xanna*

      I don’t know, I think if someone I used to consider my “best work friend,” who I also reported to (huge issues there even without the therapist issue), suddenly went cold, I’d be concerned I did something wrong, or my career was at risk.

      At the very least, I feel Bob deserves a conversation along the lines of, “I’ve done a lot of reflecting, and realise that as your manager, I’ve over shared and blurred a lot of boundaries. I’m so appreciative of our working realationship and think to protect that, I need to dial back on the [daily lunches/amount I share about my personal life/whatever]. It’s not about you, or anything you’ve done wrong.”

      Reply ↓
  36. queueueue*

    I’d go well north of 90% Lori’s fault – it’s her responsibility to put down a firm line of “I can’t be your therapist anymore,” especially since we don’t know how the message was delivered: “I don’t want you to feel like you have to hold back” lands very different than “I cannot offer unbiased treatment”.

    She’s (i) the professional, (ii) the one for whom this is a conflict of interest, and (iii) had the ability to unilaterally end the professional relationship and she just… didn’t. Breaching confidentiality is icing on the cake.

    Reply ↓
  37. Lilo*

    Lori really messed up. My Dad’s a specialist physician and occasionally some of my classmates would say “Oh your Dad is my doctor”. My Dad never, ever, ever say anything about it. You absolutely can’t.

    Reply ↓
  38. Madeleine Matilda*

    OP, I’m so sorry. However, Lori is not your best friend. A true best friend would have never done this or put you in this place. Her ethics are weak at best and she cannot be trusted by you or by her patients.

    Reply ↓
    1. MigraineMonth*

      Also, ambushing your best friend with a list of grievances is a pretty shitty way to work out issues in a relationship, even that list hadn’t contained a major HIPAA and professional ethics breach. I’d hope that a psychiatrist would know better strategies.

      Reply ↓
  39. Jellyfish Catcher*

    I’d lean toward going to your boss or HR now. This is for your and Bob’s sake.

    Wow, wow. In one conversation, Lori disregarded her professional duties, effed up a long term friendship, betrayed a patient, possibly harmed Bob’s mental health and has affected both their job relationships and duties.

    This is a complex situation, with all the possible ramifications, including legal ones, not even showing up yet.
    You and Bob need to give complete disclosure and honesty, beginning right now.
    I’m so sorry.

    Reply ↓
    1. Troutwaxer*

      Maybe speak to HR and/or the company lawyer first, but Bob must definitely be informed, hopefully with a mental health professional standing by, because this will be emotional.

      Reply ↓
  40. Friendly neighborhood therapist*

    Woah. This is a serious, serious violation of Bob’s rights to confidentiality. Like lose your license level violation. I know she’s your friend, but you should think hard about reporting Lori to her licensing board. If she’s this cavalier about patient confidentiality, she may have done this with others. I don’t even talk to my spouse about my clients, this is a big breach.

    Reply ↓
  41. Cat lady*

    I am SO CONFUSED about why OP was complaining about their best friend to one of their employees. I know hindsight is 20/20 but I would legit be so confused if my boss went on a rant about her best friend by name to me.

    Reply ↓
    1. Paint N Drip*

      or if not, if OP had some sort of complaint about her BFF to Bob, and Bob for some reason repeated that in therapy NOT knowing therapist is BFF. The background scenario is so much more intriguing to me lol

      Reply ↓
    2. Margaret Cavendish*

      Eh, it sounds to me like Lori is a bit of a drama llama. OP could have said all kind of innocuous things to Bob – for example, maybe she and Lori were planning a vacation together, and OP wanted to go to San Francisco while Lori wanted to go to Sacramento. OP tells Bob that she hasn’t booked her vacation yet because she and her friend are having a hard time agreeing on where to go. Bob tells Lori that OP *really* wants to go to San Francisco and she can’t believe that Lori is giving her such a hard time about it, and Lori tells OP that Bob said OP isn’t supportive. It’s a huge game of broken telephone.

      And given what we do know about Lori – that she’s willing to use private information to hurt her friend – it’s not a big stretch to assume she’s also exaggerating about the information itself. I don’t think OP has anything to worry about here.

      Reply ↓
      1. Uranus Wars*

        This is kind of where I landed. I have definitely talked to reports about “Ugh, my friends want to go to the beach again even though I’d love to escape the heat” in day to day conversation about annual trips, etc. Nothing bad, not even gossip, and I don’t necessarily
        see anything wrong with that. I think Lori likely blew it up.

        I know OP is unsure of what to do, but I once got burned by someone at work who made something up about me so I decided to cut off ALL out of office talk for a few years. That was actually awful and isolating, I think some casual rapport can be good when it’s appropriate.

        Reply ↓
    3. Pharmgirl*

      It doesn’t have to be a rant. People talk about their lives outside of work to coworkers all the time. It could have been an offhand comment or an anecdote about her own weekend that happened to include Lori and misinterpreted or misremembered by Bob or Lori later.

      Reply ↓
    4. Irish Teacher.*

      Honestly, I think it’s weirder that Bob would repeat it back to the friend.

      I guess I’d be confused if my boss went on a rant about their friend, but something like “damn, my friend, Lori, is calling me for advice again. I wonder what it is this time,” if their phone rang when we were chatting, wouldn’t be a big deal.

      And this has gone through a lot of iterations before it got to us. The LW is telling us that Lori said that Bob said that the LW said something about Lori. It’s quite possible it changed quite a bit in the telling. Especially as Lori might well over-react to hearing something negative about herself.

      And that is even assuming the LW was talking about Lori. Somebody above suggested that it may have been about the therapy. Like Lori said that Bob should avoid doing X/should ask for a certain accommodation/something like that. LW was either unsupportive or felt she was unsupportive and told Lori, “I’m not sure I can ask for that accommodation. My boss seemed kind of irritated when I raised it” and Lori took that as the LW “not supporting her” in her role as therapist.

      Or it could even have been something like Lori mentioned to Bob that she was having her birthday party/engagement party/whatever on a particular day, LW mentions to Bob that they will be working late that day due to an important contract or whatever, Bob casually says to Lori, “is LW not going to your party? She mentioned working late that day” and Lori takes that as “Bob says you don’t care about my party and you’re planning to blow it off because you have no interest in supporting me.”

      The whole thing sounds a little odd, so I wouldn’t be at all surprised if Lori…well, if she was interpreting a little, especially given that this came out in an argument, when it’s easy to get so caught up in pushing your point that you possibly exaggerate a bit, because I find it hard to imagine anybody going into a therapy session and telling their therapist, “I don’t think my boss is supportive of you.”

      Reply ↓
  42. Benihana scene stealer*

    I don’t blame Bob for not ending the relationship once he knew of the COI. First, it’s not his responsibility to know all the therapeutic regulations. Second, if part of what Bob wanted to discuss in therapy is his job, boss, etc he might think that Lori is the right one to work with since she’ll have insight into LW.

    Reply ↓
  43. Anon Again... Naturally*

    I am so torn about whether OP should report this to her boss/HR. Not because I don’t think she should, because she should absolutely disclose this mess before it comes back to bite her, but because how do you disclose this without violating Bob’s privacy further? “I just found out my employee has a professional relationship with my best friend” sounds like a non-event, but ‘I just found out my employee has been getting therapy from my best friend for years” discloses that Bob is getting therapy, which he might not want shared. I feel like at this point OP’s need to set boundaries and protect herself probably outweigh Bob’s desire for privacy, but I personally would feel so guilty.

    For what’s it’s worth, OP, I am so sorry you’re in this mess. You’ve learned some important things about both Bob and Lori that hurt, and I wish you a brighter future with truer friends.

    Reply ↓
    1. Percysowner*

      I guess the best way would be to go to HR and say that they just found out that one of their employees is having a medical relationship with their BFF and the BFF broke confidentiality and disclosed details and they want to give HR a heads up. Medical info comes under ADA discrimination and could affect how LW views Bob. They don’t have to disclose that it was therapy, just let HR know that if you have medical info on Bob that you shouldn’t have and how does HR want to handle it?

      Reply ↓
      1. Anon Again... Naturally*

        Now that you say it it’s so obvious. Please, OP, report this to your boss and/or HR. These people have already shown they have poor judgement, you need to protect yourself.

        Reply ↓
  44. Red5*

    As someone who’s been in tons of therapy, I would be absolutely horrified if any of my therapists had (1) disclosed to someone I know that I am their patient without my permission, and (2) told that someone what I said about them in therapy. On top of all of that, she did that with Bob’s BOSS (!), a person Bob is reliant on to stay employed. OP, it’s not about whether Lori gets in trouble. What she’s done NEEDS to be reported so that any harm mitigation that is possible is done for Bob AND to ensure Lori doesn’t harm another patient in this manner.

    Reply ↓
  45. Rusty Shackelford*

    LW, when you’re considering whether to report Lori, remember that you weren’t the only one injured in this scenario. What she did to Bob is much worse than what she did to you. And Bob’s rights deserve to be considered.

    Reply ↓
  46. XYZ*

    Is Lori a psychiatrist or a therapist?? Psychiatrists don’t do therapy. Either way, Lori is very unprofessional and could lose her license is this were reported.

    Reply ↓
    1. mel*

      That is incorrect; at least in the US, psychiatrists do sometimes do therapy, and can prescribe medication. A therapist who is not also a psychiatrist cannot prescribe medication.

      Reply ↓
      1. ThatGirl*

        As you likely know, psychiatrists are MDs with a specialization, whereas most therapists are MAs with a license. Psychiatrists certainly can conduct therapy, but in most markets the demand for the medical side of things is so great that they leave that to the masters-level clinicians.

        Reply ↓
    2. ThatGirl*

      SOME psychiatrists do therapy; it’s not verboten. But in general most people have separate psychiatrists and therapists. It’s not clear from the letter that Bob was actually doing therapy, either – it’s normal to have regular check-ins with a psych and talk a bit about your life without it truly being therapy.

      Reply ↓
  47. Ann O'Nemity*

    Lori sucks the most, but Bob sucks too. If I were the LW, I wouldn’t trust either one of them! Cut Lori off, loop in HR/manager asap, and rebuild professional boundaries with Bob. There’s also a chance that Bob will be reassigned to another manager.

    Reply ↓
  48. Statler von Waldorf*

    Stories like this are why I don’t trust psychiatrists. A psychiatrist lied in a way that caused a close friend of mine real harm, and multiple people around him refused to do anything to protect her because “they were afraid of ruining his career.”

    In my fifty odd years on this rock, I have seen more evil done in this world by good people doing nothing than anything else, and that didn’t change today.

    Reply ↓
    1. Benihana scene stealer*

      I mean come on, you’re calling the LW evil for not wanting to report a friend? Please reserve terms like that for when they’re appropriate

      Reply ↓
        1. Benihana scene stealer*

          Evil is a pretty strong word regardless of whether you’re talking about a person or an action. I think it’s hyperbole here

          Reply ↓
          1. Irish Teacher.*

            It’s from a quote, from Edmund Burke. Yeah, the word “evil” is pretty strong and I don’t think it is evil for the LW to decide not to report Lori, but the quote is from the 18th century and is generally taken to mean that good people can allow bad things to happen by not speaking up against them.

            And the “evil” here wouldn’t be the LW staying quiet. It would be the harm done to Lori’s future clients, like if one of them was denied a promotion because Lori passed on information like this and it damaged their professional standing in the eyes of their boss or if somebody ended up getting divorced because Lori passed on something their client had said about their partner and it got back to the partner.

            In the context of the quote, it more means “harm” than wickedness.

            Reply ↓
  49. RCB*

    I agree with Alison, you need to talk to your boss or HR and let them know what happened, just so you are ahead of it in case Bob tries to make an issue of something in the future.

    As for Lori, as others have said, and I think it’s important for all of us to know because it’s peace of mind: reporting someone usually doesn’t take away their license unless it’s REALLY bad or a culmination of a lot of little things, so if this is the only complaint Lori has against her it shouldn’t end her career at all, but maybe she does this A LOT and this report is the final nail in the coffin, and that’s the way it should be if she is doing this. I had an issue with an attorney and I was hesitatant to report them because it didn’t quite rise to them losing their law license, and a friend said “they won’t lose their license for this, at most they’ll get a small fine and have to retake some ethics trainings”, so I imagine that psychiatry is probably similar, there are several remedial steps before license revocation.

    Lori’s mistake is a VERY big deal, treat it as such.

    Reply ↓
    1. Benihana scene stealer*

      Does talking with the boss and HR now let even more people know Bob is seeing a therapist though? What if he doesn’t want that?

      Reply ↓
  50. JelloStapler*

    That is.. a license-revoking level mess up on Lori’s part (not ending the professional relationship regardless of Bob’s opinion and then dumping it on you) and not cool on Bob’s if he knew who Lori was to you. I’m so sorry- it sounds like you just got a crash course in seeing their real sides.

    Reply ↓
  51. CubeFarmer*

    Lori screwed up here, big time. Both in continuing to see Bob (like, she should have refused to keep seeing him and not left the decision to up to Bob,) but also in disclosing to you what Bob has discussed in their sessions. Like…yikes.

    Reply ↓
  52. Keymaster of Gozer (she/her)*

    Ooof. Violating the confidentiality standards of your profession is a very serious thing to do. If I heard one of my psychiatrists had talked to her friend about me I’d be absolutely enraged.

    You do NOT do that. My therapists don’t even have the right to contact my husband about my mental state (unless in extreme emergencies) let alone rant to a friend.

    As to what to do. I’d suggest going back to your ‘friend’ and explaining that you are NOT okay with what she said and that there could be serious repercussions if this is how she treats her patients.

    I dunno what to do about Bob though. Part of me wants him to know that his therapist is so incredibly unprofessional. Other part of me doesn’t want that additional stress on his shoulders.

    Reply ↓
  53. NerdyKris*

    LW needs to report this regardless. They won’t be getting Lori fired. Lori did that to herself by allowing this situation to occur and then violating HIPAA.

    Reply ↓
  54. Mark This Confidential And Leave It Laying Around*

    I think OP does have to speak to HR and to Bob. First HR. All she has to disclose is that she discovered that Bob is being treated by a long-time friend you are concerned about the conflict of interest, *for Bob’s sake.* Then go tell Bob the same thing, and that Lori disclosed something he’d said in confidence. If I were Bob, I would be mortified. But I would feel so much worse if I found this out months from now. This is a messy situation involving messy people: it WILL come out.

    Reply ↓
  55. Luna*

    Lori is 1000 percent wrong. I practice medicine. I’ve also had my HIPAA violated and didn’t report it. I didn’t want this person to lose their job.

    Best rule I can advise is keep your work relationships out of your personal relationships. Never discuss your personal friends at work in a negative light.

    Reply ↓
  56. Tobias Funke*

    Also, Bob did nothing wrong here – he is the person who has been violated. This sucks for OP, but it sucks the most for Bob. Expecting Bob to know the minutiae of ethics, laws, and regulations regarding confidentiality, HIPAA, scope of practice, etc is unfair. Lori is the one with the license pinned to the wall. The onus of protecting vulnerable people – and I don’t care if you’re Bill Gates, you’re vulnerable in therapy – is on the person with the license pinned to the wall.

    Reply ↓
    2. Emmy*

      Also, not sure where OP lives, but it’s not always as easy as just getting a new psychiatrist. If Bob had been stable under Lori’s treatment, and she was the only psychiatrist within 30 miles…I mean, it really sucks to change doctors, especially if you have a complex condition. If Lori told him “well, I guess it’s ok, ” I don’t blame him for accepting that at face value.

      Reply ↓
  57. Retired Vulcan Raises 1 Grey Eyebrow*

    The OP must urgently report to HR, to cover her own back.
    She would likely be dinged herself if her employer found – maybe from a disgruntled / confused Bob – that she knew of this obvious conflict of interest and didn’t report.

    She should also say she is reporting Lori to her professional body because of the breach of confidentiality – and do so.
    Lori has committed a gross breach of trust against Bob and may have done so against other patients. She might have her licence suspended, maybe even lose her career, but if so that is a natural consequence of her own actions.

    The OP should accept that the friendship with Lori may not survive – maybe shouldn’t survive – yet another consequence of Lori’s disgraceful actions.

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  58. NobodyHasTimeForThis*

    I have often wondered how the therapist in my very small town kept her license. She used to INSIST that her patients facebook friend her and then she would comment on their activity in session. My friend kept trying to get me to go see her and that was such a red flag.

    I would report Lori, mostly because she knowingly maintained the therapy relationship with Bob. The “slip” of telling you is a HIPAA violation, but the greater picture is that she has demonstrated an extended lack of professional boundaries. Even if Bob protested, the first time you came up in session should have been a major wake up call. This is not a small incident.

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  59. Retired Vulcan Raises 1 Grey Eyebrow*

    HR might advise how best to tell Bob about the breach in confidentiality, if the OP is struggling with this

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    1. Retired Vulcan Raises 1 Grey Eyebrow*

      but he needs to be informed asap, along with HR.
      Don’t put off these conversations because of awkwardness or concern for Lori’s career

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    2. Benihana scene stealer*

      But then aren’t even more people now aware of Bob’s medical history? Bob may not want anyone else to know he’s seeing a therapist

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      1. Retired Vulcan Raises 1 Grey Eyebrow*

        It is a difficult balance of interests: The OP herself may now have a conflict of interest, especially after the confidentiality breach.
        HR might want to check that she is managing Bob fairly.
        If something happens and Bob reports this himself, e.g. he falls out with either the OP or Lori, it could look bad for the OP.

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      2. Retired Vulcan Raises 1 Grey Eyebrow*

        The Op doesn’t have to specify what kind of therapist, maybe just say a medical professional.

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  60. Willow*

    This is such a huge violation. When I was a teenager working retail, my therapist happened to be in the store and came up and said hi to me when I was on my break. It was pretty upsetting (I actually didn’t recognize her at first because she was in a different context) and made me feel like different aspects of my life were colliding in an uncomfortable way. I can’t even imagine if she had talked to my boss about me.

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    2. Blarg*

      Ooof that should never have happened. I have worked as a nurse in several “needing extra caution” settings, including inpatient psych and abortion clinics. I used to live in the most dense neighborhood in my city (also worked for the census in 2010 and learned that info!) and so would see people out and about. I never acknowledged them. In a few instances, people would say “where do I know you from” and I would demure, wanting to say “probably not something you want to address here at this restaurant/in Target/with your kids.” A few times I saw that a patient at the abortion clinic lived on my block and I would literally tell her, “we live in the same area, we are likely going to see each other, I will never act like I know you, don’t worry about it.”

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  61. CorporateDrone*

    If my manager suddenly pulled back for no discernable reason I would be very nervous. It would absolutely affect our working relationship and possibly my work quality and output.

    LW needs to provide some sort of explanation to Bob, and honestly it comes back to having an inappropriate relationship between them given the manager/subordinate realities. Frankly I l think that pure gossip about a third party is rarely healthy at all and should ideally be avoided altogether. If you would be uncomfortable with the person you are talking about seeing a recording of the conversation, usually that’s an indication that you shouldn’t be discussing it at all.

    As for Lori, I don’t see how you can continue the relationship. Certainly not while she is still acting as therapist for your direct report. Personally I think you owe it to her patients to at least point out that it was extremely inappropriate for her to not only reveal to you who her patient was but some of what they shared.

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  62. PropJoe*

    In my final semester of college, I was having some mental health problems. At the suggestion of a friend, I visited our Counseling Services and asked to book with the therapist my friend recommended.

    In the first session, therapist asked me what all brought me in to seek treatment. I disclosed all the symptoms of depression I was feeling, and stated that she came personally recommended by a friend of mine who was another patient of hers.

    “Mr PropJoe, I am not at liberty to confirm or deny that any other particular person is or isn’t a client of mine. I take the privacy of my other clients just as seriously as I take your privacy.”

    Noted.

    Incidentally, I’m glad I went in. I was very depressed and very burned out and getting therapy helped me make it to the finish line, even if it was with a C and four D grades that final term.

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    1. Nightengale*

      yup I get a lot of word of mouth referrals. If a family (I work with kids) mentions another specific family referred them I make some comment about how we get a lot of word of mouth referrals. I don’t specifically confirm I know the person who referred them. I take care of a lot of kids from one homeschool co-op or who attend therapy groups together, and I know they know each other and they know I know all of them but I don’t say anything about it in the office. Also there’s the time I realized that I took care of both children involved in an incident on the school bus. In that case, I don’t know if the families actually know each other or if they know I care for both children. And I will never tell them.

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  63. Annie*

    When I read the title I assumed LW found out in an above-board way, such as Lori signing off on medical paperwork for Bob. I’m interested in what Alison’s response would have been in that case.

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  64. LuLu, MSW*

    This is 100% on Lori. Clients don’t have conflicts of interests, professionals do. Clients don’t have iron-clad privacy rules, professionals do. Lori is a dangerous therapist and it would be a service to her current and future clients to let her licensure board know that she violated HIPPA.

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  65. Blarg*

    Gah, when I was a nursing student I dated a psychiatry resident. (We were both in our 30s). My psychiatrist was a part of the university system, and so I specifically asked her not to use me as a case example with the residents, which she agreed to. Years later, I moved to a new city with a pretty small number of psychiatrists. Lo and behold, guess who also lived there? So I asked my not doc to not talk about me in professional settings and told him why, and he respected that. I no longer live in that city and as far as I know, ex never knew I lived there for five years. That is how it should be!

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  66. Some Internet Rando*

    It reads like Bob is giving Lori advice and talking with Lori about her problems in therapy? In addition to the HIPAA issue it also sounds like Lori has poor boundaries in therapy and is making the sessions be about her?

    Rethink that friendship. This isnt just a slip that revealed some HIPAA information. Red flags are waving….

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  67. Sihaya*

    I suspect Lori will get through this particular incident with her license intact. However, I suspect this isn’t the only incident, and it’s all downhill afterwards. There were enough decisions leading to this moment that it reads like a character trait, not a lapse.

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