I don't worry about those red stars. I just have what fun I can here.

I think there are a couple of problems with the letter, but I think they both revolve around the fact that the LW did not provide enough info. The LW probably is (for very good reason) afraid of being identified. Even to be identified on this topic could breach confidentiality. The other is the improbability that if she/he is a licensed therapist, the LW would not already know both the legal and ethical requirements of the profession.

My conclusion is that the LW is not actually a licensed therapist, but rather in a more tenuous situation. Perhaps the LW's relationship to the co-worker in the past involved a peer-to-peer counseling relationship or perhaps the LW's relationship had some impropriety that makes the whole scenario much more complicated.

I have been both a client of a therapist and, at the same time, because of other work I was doing for some people with mental health problems, I had to consult with this therapist about other clients. It was not comfortable for either of us. I know that she consulted with her psychologist she was "under supervision" with about this matter. Myself, I was not breaching any ethics, because consumers had to sign a release for me to get their info.

In small towns, people make all kinds of compromises with these matters. The ideal and the real can have some considerable space between them. People who think that their information is truly private when they see a therapist don't understand that insurers, creditors, or even potential employers may yet access their information if they were served by any facility that gets government funds or any provider who is reimbursed by Medicaid or Medicare for their care.

It's a real mess. I also noticed that, in many, many situations the privacy of the poor was treated quite differently than those with more funds. If you can actually afford to sue a private therapist, you can collect on breaches of confidentiality. It is much harder to sue the government.

A previous poster talked about the poor pay of counselors (psychologists and psychiatrists make more) and MSWs and the "minefield" they must walk to just to their jobs. It's tough.

That said, I don't think professionals are as careful as they should be about confidentiality. I once actually overheard a counselor on call take a crisis call when she was dining at Red Lobster. I was appalled to hear her say between bites, "Well do you actually have a plan to kill yourself or is it just one of your ordinary bad days." She could have at least taken the call outside. A little cold clam chowder would not have killed her. I could imagine the poor soul on the other end listening to her spoon clinking against her bowl.

In my opinion, unless she/he lives in a very small town and there is no other chance of employment, the LW should simply resign the position. If she/he is a licensed therapist and has had theraputic contact with the co-worker in the last few years, there is simply no other ethical way around this because she cannot have a dual relationship.

If I have to wear pantyhose, you should to. You are in for a real treat.

If you get to wear a white shirt without a bra, I should get to as well. I hate bras.

If the job requires skirts for women employees, men better kilt up.

BTW, do you bring your dog to work with you?

Quoting you:

"so -- while LW seems to be trying to find a way to reconcile staying employed and working with this sociopath ... and Cary is advising him on how to compartmentalize this knowledge under lock and key -- most people do not believe that such attempted "reconciliation" is either possible or ethical ..."

Right. Absolutely right. Furthermore, I would be surprised if Cary did not know this. Sometimes he simply blows it. However, see my letter below about why I think the LW edited out the info.

Here is what I think happens sometimes: First, it stands to reason that the LW is probably a reader as well. The LW may often post at Salon. I know if I were to write a letter asking for advice here that I would be self-consciously searching my memory for any letter of the past that might contain enough information about myself for another reader to ID my ID if you will. I would worry that my writing style might be recognizable. This is a real risk. Salonistas are not stupid.

To put it bluntly, I believe I know who wrote the Kitty letter. (I am not going to tell.) This is a bit of an incestuous community here. We get to know one another if only by nick if not by actual name. So if I were going to write asking for advice, I would be extraordinarily careful how I phrased my letter, selecting with paranoia perhaps what I put in and what I left out. I might also try to adopt a different writing style. The easiest would be to copy Cary. After reading over and over his discursive replies, I think I could do a good job of it. Some people may even see this as a challenge of sorts.

Also, consider how brave the LWs are. Look at the way we lacerate their characters, parse their every sentence, accuse them of dishonesty and even diagnose them with disorders. I give a bit of credit to every LW. They get the good and bad of a most unusual experience; they get to see how others see them.