Fiction: “Confidentiality” (abridged)

(This is a version of the full story cut to be read while adhering to a ten-minute time limit. I, of course, recommend the original, but given that I told people at the reading that they could find the text on my website, I decided I ought to put up the full version as well.)

I get them a lot, twenty-somethings who can’t keep their hair or clothes or face the same for a month without getting restless.

I ask, “So what made you want to try counseling?”

They say, “I don’t know what to do with myself.” Or, “I don’t feel like I have a purpose anymore.” Or, “I don’t have motivation to do anything.” Or, “I’m not doing what I should be.” Variations on the same themes, familiar and predictable.

Now, Peter Lawrence perched on the edge of the client chair like a sprinter waiting for the pistol while I read over the new client form he’d filled out in the waiting room. He was twenty-four, a graduate student and piano tutor on the side. No medications. No chronic health concerns.

“So, Peter,” I said, looking for a way to calm his tension. “What are you studying?”

“Composition,” he said. “Music.”

“You enjoy music?”

He nodded.

“You play piano, I see.”

“Yeah. And viola. Other things, sometimes, but those are the ones I’m best at.”

“What sort of music do you write?”

“Mostly small stuff. Sonatas, that sort of thing. I’m writing a symphony for my thesis.”

“Impressive. Your first symphony?”

He shook his head. “First in a while, though.”

“So,” I said, because his posture had relaxed slightly, “what made you want to try counseling?”

“I have to,” he said.

This is a reason I don’t work with teenagers, who are often sent by their parents and resentful of it. They’re only there to placate someone. They’re not unreachable, but I do better with the people who start off wanting to be reached.

“Okay,” I said. “Why do you have to?”

“The university …” He scratched his brow. “They think I’m not stable enough for the ‘rigorous academic environment.’ That’s how they put it, at least. So I have to get a therapist to tell them I’m okay.”

Not only was he here out of obligation—he was here with incentive to lie.

“Do you know why they’re concerned about you?” I asked.

“I was talking to my thesis advisor about the symphony I’ve been working on.”

“Okay.”

He nodded, silent, as if his explanation ended there. If a client hasn’t spoken after three mental recitations of the alphabet, I give another nudge. It allows enough silence to begin to get uncomfortable, which often prompts speech, without dragging on. But after the third w-x-y-z, when he hadn’t continued, I said, “What were you talking about?”

He stared past me, eyeing the abstract painting on the wall.

I gave him three more alphabets.

“You seem upset, Peter,” I said. “Can we talk about why?”

“My advisor,” he said, “is worried I’m snapping under the pressure of working on this piece, so I just need you to tell him I’m not crazy.”

“You’re not crazy,” I said. “Everyone gets stressed sometimes. We just need to find ways to handle it. How do you deal with stress now?”

He shook his head, finally looking away from the painting and back at me. “That’s not … I mean, it’s not just that. He does think I’m crazy. I told him something, but he didn’t believe me.”

“What did you tell him?”

“He said part of my piece sounds like the overture from Swan Lake, and I told him that I wrote Swan Lake. That I remember doing it. I remember growing up here, but I remember before that, too. I died once in 1893, in Russia. Now my name is Peter Lawrence, but then, I was Tchaikovsky.”

*

Peter signed a confidentiality waiver for his thesis advisor, Dr. Randolph Jackson, who told me Peter did well in his classes, got along with his peers and professors, didn’t have any academic or behavioral problems on record. His work was consistently good, never brilliant. He was reserved but friendly if approached.

“It’s just,” Dr. Jackson said, “that he seemed so normal. He isn’t even the odd genius type. Just … normal. If I can help, please let me know. Peter is a fine student. I’d hate to lose him.”

“For now,” I said, “just let me know if you see anything concerning. Actually”—the question just occurring to me, although it was obvious in retrospect—”what can you tell me about the real Tchaikovsky?”

“The second movement,” Peter said, “is weird. Most people like it fine when they hear it. Reading it, though, gives a bad impression. Do you know much about music?”

“Not much.” Partly, this was true; partly, I wanted to hear his explanation.

“Well, it’s a waltz. A normal waltz has three beats per measure—one two three one two three, like that. But mine has five beats. It’s harder to feel. Doesn’t seem as natural. Nobody dances to five-four. But if you just listen to it, it sounds right on the surface. It’s wrong on the inside, but all you’d ever see if you didn’t know to look is a normal waltz.”

I had started this conversation by saying, Tell me about your music. Since then, I hadn’t once started to go through the alphabet.

*

I have not stayed in contact with many people from my past. Dr. Madeline Stangler is an exception. After my third session with Peter, we met for coffee when her evening lecture let out.

“And as far as I can tell,” I said to conclude my summary of the situation with all identifying details removed, “he functions fine in his daily life. He just also thinks he’s a dead composer.”

“Do you think he needs psychiatric intervention?”

It’s a point of debate, one that leaves both sides calling into question the ethics of the other: are there times when someone’s disorder is like a piece of shrapnel, embedded and placed in such a way that removing it would be more damaging than leaving it in place—and if so, what’s our obligation? We can’t do X-rays, after all, or consult anatomical models, or run computer simulations. Do we always seek to return a person to a physician-approved mode of being, or do we try to find the best way for them to get by in the world?

I said, “I don’t know. Some sort of counseling, just to give him some guidance on how to manage this. Pushing the Tchaikovsky issue seems more destructive than productive. But what do I tell the school? They want to know if he’s ‘troubled,’ and he probably is, but if I say he’s suffering from a psychotic disorder, I don’t think they’ll hear anything I say about him seeming fine to be in school.”

Madeline tapped a finger on the table, said, “What’s in his best interests?”

“Not getting kicked out of school for being crazy.”

“So what do you do with that?”

Two hours later, Starbucks closed, and in the parking lot, she paused by my car. “When it comes down to it, your client is Tchaikovsky, not the university. Your obligation is to him.”

*

Section 9.04a of the American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct states, “Psychologists may refrain from releasing test data to protect a client/patient or others from substantial harm or misuse or misrepresentation of the data or the test ….”

I made the call with Peter in the office, listening in. Dr. Jackson prodded for details, and I cited confidentiality restrictions while giving Peter my full endorsement. Eventually he said, “I think I speak for the university and myself when I say we’d be more comfortable keeping Peter on if he remained in counseling.”

I glanced at Peter, who was perched in the same anxious position he had been when I’d first met him, and cocked my head. He shrugged, nodded.

“I think Peter would be open to that,” I said.

“You’ll keep us in the loop, I trust,” Dr. Jackson said.

“No, I won’t.”

“You must understand the university’s concern in this situation.”

“There’s no reason Peter is unfit to be a student,” I said for maybe the fifth time. “That should be the extent of the university’s concern.”

This wasn’t the first time I’d had the conversation, or the last. It ended with Dr. Jackson’s irritated surrender and my request that he not take his ethical frustration out on Peter.

After Peter scheduled his next appointment, he said, “It’s okay that you don’t believe me.”

“It is,” I said. “I’ll see you next week, Peter.”

But I didn’t. He left a message at 9:33 two nights before to cancel. I called him three times, hoping to reschedule, but the third time it went to voicemail, I said, “Hi, Peter. This is Rachel Sommers. You have my number, in case you decide you want to come in. Take care.”

I kept his file open. I didn’t expect him to return, but it meant I could, with no discomfort, tell Dr. Jackson that Peter was still a client of mine, and that that was as much as I was able to say.

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