Saturday, July 23, 2005

My Letter to the Hospital

I wrote my letter to the hospital today. Like Dr. X. suggested I am going to "sit on it" for a few days before I send it. I am wondering if it's a bit harsh, but in fact I don't think it is harsh enough. In the original draft, at the end I explained that I recognize the facilitators are the messengers and not necessarily the instigators of the message...but they did deliver the messages in a way I was disgusted by, and they are part of the team that made the they are responsible. I always feel this need to "soften" the message when I give feedback...I hate that.'s the letter:


I am writing this letter to explain why I stopped attending the Assertiveness Class. I felt very uncomfortable with the way we were treated during the class. In particular I am referring to our being told we were not to see anyone in the class, outside the class. The reason given was the confidential nature of the classroom discussions. I agree that confidentiality is of utmost importance in all psychiatric treatment programs. I disagree that denying people the right to maintain their existing friendships is the way to achieve that goal.

Being told we, "...would be talked to" if we socialized with other participants outside of class, and we, "...would be talked to if we were caught doing our homework before class", and watching a participant being taken aside after class for collecting homework for another client, was extraordinarily paternalistic. It troubles me that in an assertiveness program, or any psychiatric treatment program, we were being treated as less than responsible adults. If the tables were turned, in similar circumstances, I cannot imagine a nurse or a doctor believing it was acceptable to be told who to see outside the classroom, or that their would be consequences if seen doing their homework.

In the Program there was an emphasis on the development of our learning socialization skills, growing new friendships, and maintaining the friendships we have. We were also encouraged to sign up for various other programs at the hospital. Many of us began seeing each other once we had completed the program. It is very unlikely some of us would not be in other classes together.

The current rule about not seeing participants of a class, outside the class, places an undue strain on many who struggle with managing to maintain the friendships they have gained. There are others who feel as I do. Some have pulled out of classes, or declined to attend particular classes, because they do not want to impact the friendships they have been working on. I do not like to think that people are not getting the treatment they need, because of a rule that I believe is to all encompassing.

I do recognize there are some groups, like Psychodynamic Group Therapy, or the Program Group, where seeing participants outside the group would be detrimental to all participants. In situations where the interpersonal dynamics within the group affect the quality of the therapy I absolutely agree with the rule about not seeing or contacting people in the group. In a classroom type group the situation is different.

The goal of maintaining confidentiality could be achieved in a different way, a way that values a patient's autonomy to develop and maintain friendships with whomever they choose, and in a way that recognizes that, if given the reasons for not discussing group information, they, as participants, have the capacity and the integrity to not discuss anything about the group, outside the group.

I suggest a better way to approach the confidentiality issue in the future would be to explain the importance of maintaining confidentiality. You can then explain that participants are not to discuss anything said, or done, in the classroom with anyone outside the classroom, even with other participants.

If you would like to share my thoughts with the rest of the team please do so, however I would prefer my name be kept confidential.

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