Wow, Dinah brought up a great topic. She said: "So how come it's okay for patients to blog about their psychiatrists, without disguise, without permission, without hesitation?"
I just had to address this because this one-sidedness (if that's a word) is something I see in the correctional world. Here's how it happens:
Inmate X gets released and goes to the media. He/she alleges that the correctional facility, as well as correctional physician or nurses, are horrible incompetent sadistic people who provided terrible care. Inmate X is quoted in the newspaper along with detailed allegations of how he/she was mistreated. Because of healthcare privacy laws, the news media cannot be given factual information from the medical record which directly contradicts the inmate's claims. The article states only that 'the facility/administrator declined to provide information about inmate X citing medical confidentiality'. Thus, it appears that someone is covering up something.
Let me be clear that I have never personally been involved in one of these scenarios, but from my professional colleagues I can tell you that it happens. Patients are allowed to reveal their own information, but we cannot do the same without their permission. Over the course of time I've seen some pretty astounding self-revelations: former patients who have gone on TV talk shows to talk about their crimes and subsequent psychiatric care, patients who have had their offenses turned into made-for-TV movies and television episodes, and patients who have written books about their issues. (I made a cameo appearance in one book but was not mistaken for a nun. The author did not seek my permission.) To my knowledge there is no case law to suggest that this behavior constitutes any kind of de facto waiver of confidentiality.
Now we come to the blogosphere. Here, the landscape may be very different. The blogosphere is a public forum of the nth magnitude. There are numerous cases here in the US in which bloggers, and even their service providers, have been found liable for libel or defamation. I refer you to the Internet Journalist for a very nice little overview of case law surrounding invasion of privacy and defamation on the Internet.
So to get back to Dinah's point, it may really NOT be OK for patients to blog in a negative and undisguised fashion about their mental health providers. The real question is: how do you decide what to do about it? It's a situation similar to the one I discussed in Fully Charged Battery, where I talked about filing criminal charges against patients. If they're still your patient, you will certainly damage what little alliance you may have left by filing a libel suit against them. You could bring it up as a therapeutic issue within session, but then you've created a situation where the patient knows you've read their blog and there are things going on outside the session. Or you could decide that a patient who posts negative information about you is simply someone you don't want to continue treating. Regardless, it's a nasty situation. Patient who blog about their doctors/therapists may do well to consider the same precautions that health care bloggers follow.