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AIDS: The Therapist's Journey

Disclosing the Therapist's HIV Status?

I injured one of my hands and had to cancel several patients' sessions. One of my partners telephoned these patients and told them that I had an emergency and would phone them later to reschedule. One of the men I was scheduled to see was Lawrence, a 32 year-old referred to me by his AA sponsor. Lawrence's last two therapists had both died of AIDS within two years of each other. Lawrence himself is sero-negative. In addition to wanting to work through his feelings about the deaths of his previous therapists, he wanted to explore his own fears of intimacy that were making it difficult for him to form romantic relationships with other men.

I telephoned Lawrence that evening to reschedule the session the following day. Knowing that his last two therapists had died of AIDS, I assumed he might be anxious about the cancellation. With this in mind, I felt it was important that Lawrence either speak with me in person or hear my voice on his machine rescheduling the appointment. When I saw him the next day, he began the session by telling me he thought I was in the emergency room and he had panicked thinking I too had AIDS and was going to leave him. While he said this, I was thinking that I hoped I didn't get sick any time soon and provide him with one more reason why he shouldn't trust other gay men.

Lawrence went on to say that the phone call from my colleague had reawakened all his feelings about the deaths of his previous therapists as well as several close friends. He told me he realized he didn't even know what my sero-status was, and he felt that perhaps he was holding back from telling me everything out of the fear that I, too might die. He then said that his feelings at this point concerned how he would be affected if I were to become permanently disabled and then asked me how I would react if he asked me about my sero-status.

I told him how glad I was that he was able to share those feelings with me. I then explained that at the present time I wasn't sure how I'd respond to a request from him regarding my HIV status. Before answering -- I'd want us to spend time exploring all his feelings -- what it would mean if I was sero-positive, and what it would mean if I was sero-negative. I also said that before I made any decision about whether to answer this question, I would spend time thinking about where we were in his treatment. I explained that I wanted my response to be in the best interest of his therapy. I then asked him how he felt hearing this answer to his hypothetical question.

After thinking for a few moments, he told me he was very comfortable with my response -- it made him feel well taken care of. He had been afraid I wouldn't tell him my HIV status because of concerns about confidentiality. He then said he wasn't even sure he really wanted to know what my HIV status was anyway.

While I feel that I handled this with sensitivity, it was a difficult session for me because it raised some anxieties and questions I had not spent much time considering. Suppose Lawrence had insisted upon knowing my HIV status. Did he have a right to know this information? What if he refused to continue treatment unless I assured him I was HIV negative? This would not have been paranoia, a simple avoidance of intimacy, or resistance to treatment on his part. I viewed Lawrence's concerns to be well founded and an appropriate attempt to be self-protective. He chose not ask what my HIV status was, and remains in treatment more than two years later.

A Classic Case of Countertransference
Discussing Death
Professional Challenges of Psychotherapy with People Living with HIV/AIDS
Avoiding Burnout
Other Articles by Michael Shernoff

Published in A Perilous Calling: The Hazards of Psychotherapy Practice, M. Sussman, Editor, 1994: John Wiley & Sons by Michael Shernoff, MSW
© 1996 Michael Shernoff

Permission is granted to copy or reproduce this article either in full or in part, without prior written authorization of the author on the sole condition that the author is credited and notified of reproduction.

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This article was provided by John Wiley & Sons. It is a part of the publication A Perilous Calling: The Hazards of Psychotherapy Practice.