first problem with dr. melfi is that she is either a psychologist who can prescribe medicine (only in a couple states this is possible and NJ is not one), or she's a psychiatrist who has zero medical equipment and looks in all regards like a psychologist. in reality, she should have had to refer tony out for medication
about carmela. when they were in session together, things are basically up for grabs as far as legally speaking, however melfi and tony should have discussed it first. however yes when she comes in alone, unless tony explicitly says they can talk about him, they can't. and once again, even if tony gives up rights to medical information, any good psychologist wouldn't give up information like she did without a really, really good reason.
she also lets it be known to her friends that she is seeing tony soprano as a patient. if something like that ever slipped out she would need to talk to a lawyer. she might be obligated to tell tony. she might be obligated to tell on herself to the medical board. she couldn't just be like well shucks oops
finally, the way she closes the sessions i think is ok. because she has been enabling him for a long time and instead of dealing with why she was seeing someone she knew was a psychopath and potentially dangerous to her she totally took the easy way out. of course professionally this is patient abandonment and not ok, but in the context of the series it makes sense why she reacted this way. seeing him was fulfilling some kind of need in her and when her cognitive dissonance became strong enough she dropped him like a hot potato.
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