The other pill.
April 19, 2011 7:06 PM Subscribe
Ethical for psychologist to cite medication as a condition for continued work with a client?
The background is that I've been getting support and help for healing and recovery through and from PTSD and major depression. And, yes, I have tried to express and communicate this with the party in question.
Earlier this month, during a week of tempestuous events and precipitous moods, where I felt very, very low—due to a (more finalized) major move, a loss in the family, and other challenges—I felt too afraid to physically leave the house and get myself to a therapy appointment, after a break in seeing the therapist. When I tried to reach them, and they said they could not talk over the phone, but only in person, and during the phone tag process itself, I felt very abandoned, and while I did call a hotline, due to my current situation I do not have much in-person support. The saving grace was that I was able to reach and ended up calling and speaking with a friend.
Also in the past weeks, I've shakily but nonetheless attended a graduate school open house; signed up for local social groups including classes at a free school coming up later this month and next; applied to (still more) jobs and scheduled/showed up for actual in-person job interviews; and bought a self-help workbook, which is actually tremendously helpful. I am trying to adjust to changing circumstances. I am just not very fast or magical right now. Support is not just important for me right now, it's necessary.
When I tried to explain why it upset me to not be able to talk or reach the therapist, or why I felt I had been let down, or that my confidence and trust in sharing so much with the therapist had felt somehow not important, the therapist seemed cold and clinical. I was trying to process that particular moment in time. I wanted someone who could both not take my emotional responses personally and also help me understand them, and put them into perspective, and do it in a balanced, skillful, and caring way. I felt sad that they did not offer me more advice and tools, and got/get the sense as though I was/am more resourceful at finding things that were helpful than the therapist (books, conference calls, writing my own plans and lists, recovery plans for major life changes, grieving, trauma healing). I hoped a therapist could help me make plans and write out something visually, as a way to work together while in session. (I am not a CBT-is-all person, nor am I a process-only person. I want to get "better", meaning stronger in my self, regain my sense of confidence, that sure-footedness and energy, and I would like a treatment plan, or something like a recovery plan, lists, writing assignments, something I can see and feel like I can manage and accomplish.) Based on how they reacted, the therapist also seemed defensive and at a loss, in what seemed an awkward response to what I was trying to explain. They acted almost put out, even offended, with little "hhuh" exhale noises, the kind that I heard from classmates in middle and high school when they tried to show disdain for something, as though I was questioning their professional ego, rather than someone sharing feelings when feeling vulnerable and hurt in a therapeutic working relationship where it is and can be scary and painful. (I hate it sometimes.) In sharing, I also expressed that I am not sure if the therapy is a good fit for me, as well as concern that I didn't feel I was improving in learning how to manage triggers, stressors, etc.
In trying to talk with the therapist about this more recently, I asked for referrals since I was not sure I wanted to continue work with the therapist, and it began to appear as though the therapist did not want to work with me—seemingly because I took the energy to share that I felt hurt in the first place, and why. Responding to my communication about sharing and wanting their input, they expressed that they would be willing to work things out collaboratively, too, but cited conditions, including the following: "I am willing to do so, but only under the condition that you will start taking anti-depressants." I appreciate boundaries and limitations. In the past, the therapist had been reachable and able to talk if they had been near the phone, to talk during worse moments earlier this year. This was helpful. The new response felt off, and it seemed in a voicemail message, as I'd noticed before, there was a sort of exasperated tinge of anger to the tone of their voice, when I'd left a message previously asking if they could please call me. For my own reasons, when someone sounds angry, I think it is both unsafe for me, and also to be avoided. It is profoundly disappointing for me when it comes from someone who is a therapist and whom I gradually took the risk to open up to, since I took some time before making sure I felt comfortable enough with the person to do so. I also felt that it showed a lack of maturity, both professionally and as someone in the feeling realm, as someone seeking a high degree of emotional intelligence, intuition, and maturity in venture like therapy.
I want in therapy someone who can help me feel, tolerate, and process feelings. Someone who can process interactions, and also someone who is more, in a sense, mature than me as client, in a teaching and tool-sharing sense, who can see the larger picture and both facilitate and be someone who is invested in the process as the therapist. (Is this wishful thinking? Well, I know this is something that would help me, since I know that therapists are working professionals and it's a job and they are human, all, and I would like to work with someone skilled and sensitive, and who is also good at feeling their own feelings and knowing how to process and be with them...)
I had expressed that I wanted referrals to a psychiatrist, and last week the therapist said that they would get back with me regarding names for people they felt would suit me.
Is it ethical for a psychologist to name the taking of medication as a condition of treatment?
This person also sometimes refers to me as "fragile" and made statements like, "Well, ___ makes sense, based on your childhood."
Where I am, it is hard to find a good fit for a therapist, but in general I find it is hard to find a therapist who is a good match.
I'm struggling with it, and have called two people to whom I'd been referred by a healthcare provider, but have not yet connected with them. I made these calls about a week ago.
For the past several weeks, and after some life changes, I've thought about and felt that the therapist was not a good fit, and did not match my needs for shaping some of the therapy session. I wanted some more direction and a little more reassurance about the process, I suppose.
I feel unsettled about this, and feel it's important to have a consistent person with whom to work. Trying to share all of what I've taken the risk to share with this person again, with another person, feels like too much right now. However, with my admitted reservations about a good fit, I also want to make sure that I'm not somehow...hurting myself more in the process of trying to get continuous care.
The main question is, I guess, is it ethical to get this sort of ultimatum of "I will only work with you if..."? I already felt resistant/questionable about the therapist.
In some ways, I feel I am doing better in spite of having a therapist, or in spite of being in therapy. Some days certainly are better than others. And, it may be that I am less tolerant of what I perceive as blanket or canned statements (e.g. repeated "I'm so sorry"s) from people, or a therapist, than most. Help me get some clarity on this, as I'm too close and simultaneously a little too hurt/detached (as in, it's as though I have already ended the therapeutic relationship with this person, and in other ways, I feel like a fool for having been hurt and vulnerable to hurt, to caring, about a therapist in the working relationship, since for me sharing a lot makes me feel intensely vulnerable and resultantly able to be hurt by whomever I've shared with. Maybe that's when the work gets good, or doesn't, or I find out the hard way that I cannot be met in that way in therapy, or it never worked in the first place, or I find out it is a horrible idea and it's best to make another plan entirely.)
Important to mention, too, is that I am open to and considering medication (after looong consideration), but will need that referral from a therapist or someone, or otherwise find an affordable and trustworthy physician/psychiatrist/NP, and that the therapist ___self asked if I would like names, and that they would find some names and let me know...a week ago. This person also mentioned that they knew of psychiatrists, before I ever started sharing anything, for lack of a better word, "riskier" (personal) with them. So, I am confused when this becomes both more pressured and also a condition of treatment. I cannot control when I find a psychiatrist or other person able to prescribe medication, and I also find it...not respectful of who I am or my own decision-making process. I don't know, something just feels off to me.
Is it dumb for me to have gotten to a point in therapy where I can be hurt by an action/inaction of a therapist, and to care what they think? And is it dumb to want a therapist I work with to care enough that they take care not to hurt me, or to understand that they might? Or at least have the vocabulary and skill to talk about it in therapy-like terms with me? (Whatever that means.) Will I become weird and reactive like this when I feel emotionally vulnerable with a therapist, or is it just with this particular person?
Is it best to no longer work with the therapist? I do need a schedule, and going to therapy helped create a schedule for me. It is just that sometimes I don't leave necessarily feeling resolved or "better" after an appointment, not to say that therapy isn't work, but somehow this all feels like more stress than it's worth. Why do I have so much conflict with a therapist? And the idea of finding a new therapist feels unmanageable right now. Is therapy just not for me? Ultimately, I regret opening up to this person and the risk was not worth it after feeling like my feelings were not safe. And now I feel as though I am being forced into an ultimatum of having to act in a way conscribed by the therapist. It's uneasy at best. Is it not okay to need and get emotional support from a therapist? I do not feel supported right now. The therapist is now telling me how much worse I am and instead I am feeling stronger in the days not seeing them, and in spite of their messaging, like going to a job interview recently, or going to a busy shopping area to look into a repair for something. Things I felt terrified to do, but did. How did therapy get to be more stressful than a job interview? I have no idea. And somehow therapy seems to be almost the opposite of doing these things. Honestly, I have more motivation at this point to go to a job interview than to go to therapy.
The background is that I've been getting support and help for healing and recovery through and from PTSD and major depression. And, yes, I have tried to express and communicate this with the party in question.
Earlier this month, during a week of tempestuous events and precipitous moods, where I felt very, very low—due to a (more finalized) major move, a loss in the family, and other challenges—I felt too afraid to physically leave the house and get myself to a therapy appointment, after a break in seeing the therapist. When I tried to reach them, and they said they could not talk over the phone, but only in person, and during the phone tag process itself, I felt very abandoned, and while I did call a hotline, due to my current situation I do not have much in-person support. The saving grace was that I was able to reach and ended up calling and speaking with a friend.
Also in the past weeks, I've shakily but nonetheless attended a graduate school open house; signed up for local social groups including classes at a free school coming up later this month and next; applied to (still more) jobs and scheduled/showed up for actual in-person job interviews; and bought a self-help workbook, which is actually tremendously helpful. I am trying to adjust to changing circumstances. I am just not very fast or magical right now. Support is not just important for me right now, it's necessary.
When I tried to explain why it upset me to not be able to talk or reach the therapist, or why I felt I had been let down, or that my confidence and trust in sharing so much with the therapist had felt somehow not important, the therapist seemed cold and clinical. I was trying to process that particular moment in time. I wanted someone who could both not take my emotional responses personally and also help me understand them, and put them into perspective, and do it in a balanced, skillful, and caring way. I felt sad that they did not offer me more advice and tools, and got/get the sense as though I was/am more resourceful at finding things that were helpful than the therapist (books, conference calls, writing my own plans and lists, recovery plans for major life changes, grieving, trauma healing). I hoped a therapist could help me make plans and write out something visually, as a way to work together while in session. (I am not a CBT-is-all person, nor am I a process-only person. I want to get "better", meaning stronger in my self, regain my sense of confidence, that sure-footedness and energy, and I would like a treatment plan, or something like a recovery plan, lists, writing assignments, something I can see and feel like I can manage and accomplish.) Based on how they reacted, the therapist also seemed defensive and at a loss, in what seemed an awkward response to what I was trying to explain. They acted almost put out, even offended, with little "hhuh" exhale noises, the kind that I heard from classmates in middle and high school when they tried to show disdain for something, as though I was questioning their professional ego, rather than someone sharing feelings when feeling vulnerable and hurt in a therapeutic working relationship where it is and can be scary and painful. (I hate it sometimes.) In sharing, I also expressed that I am not sure if the therapy is a good fit for me, as well as concern that I didn't feel I was improving in learning how to manage triggers, stressors, etc.
In trying to talk with the therapist about this more recently, I asked for referrals since I was not sure I wanted to continue work with the therapist, and it began to appear as though the therapist did not want to work with me—seemingly because I took the energy to share that I felt hurt in the first place, and why. Responding to my communication about sharing and wanting their input, they expressed that they would be willing to work things out collaboratively, too, but cited conditions, including the following: "I am willing to do so, but only under the condition that you will start taking anti-depressants." I appreciate boundaries and limitations. In the past, the therapist had been reachable and able to talk if they had been near the phone, to talk during worse moments earlier this year. This was helpful. The new response felt off, and it seemed in a voicemail message, as I'd noticed before, there was a sort of exasperated tinge of anger to the tone of their voice, when I'd left a message previously asking if they could please call me. For my own reasons, when someone sounds angry, I think it is both unsafe for me, and also to be avoided. It is profoundly disappointing for me when it comes from someone who is a therapist and whom I gradually took the risk to open up to, since I took some time before making sure I felt comfortable enough with the person to do so. I also felt that it showed a lack of maturity, both professionally and as someone in the feeling realm, as someone seeking a high degree of emotional intelligence, intuition, and maturity in venture like therapy.
I want in therapy someone who can help me feel, tolerate, and process feelings. Someone who can process interactions, and also someone who is more, in a sense, mature than me as client, in a teaching and tool-sharing sense, who can see the larger picture and both facilitate and be someone who is invested in the process as the therapist. (Is this wishful thinking? Well, I know this is something that would help me, since I know that therapists are working professionals and it's a job and they are human, all, and I would like to work with someone skilled and sensitive, and who is also good at feeling their own feelings and knowing how to process and be with them...)
I had expressed that I wanted referrals to a psychiatrist, and last week the therapist said that they would get back with me regarding names for people they felt would suit me.
Is it ethical for a psychologist to name the taking of medication as a condition of treatment?
This person also sometimes refers to me as "fragile" and made statements like, "Well, ___ makes sense, based on your childhood."
Where I am, it is hard to find a good fit for a therapist, but in general I find it is hard to find a therapist who is a good match.
I'm struggling with it, and have called two people to whom I'd been referred by a healthcare provider, but have not yet connected with them. I made these calls about a week ago.
For the past several weeks, and after some life changes, I've thought about and felt that the therapist was not a good fit, and did not match my needs for shaping some of the therapy session. I wanted some more direction and a little more reassurance about the process, I suppose.
I feel unsettled about this, and feel it's important to have a consistent person with whom to work. Trying to share all of what I've taken the risk to share with this person again, with another person, feels like too much right now. However, with my admitted reservations about a good fit, I also want to make sure that I'm not somehow...hurting myself more in the process of trying to get continuous care.
The main question is, I guess, is it ethical to get this sort of ultimatum of "I will only work with you if..."? I already felt resistant/questionable about the therapist.
In some ways, I feel I am doing better in spite of having a therapist, or in spite of being in therapy. Some days certainly are better than others. And, it may be that I am less tolerant of what I perceive as blanket or canned statements (e.g. repeated "I'm so sorry"s) from people, or a therapist, than most. Help me get some clarity on this, as I'm too close and simultaneously a little too hurt/detached (as in, it's as though I have already ended the therapeutic relationship with this person, and in other ways, I feel like a fool for having been hurt and vulnerable to hurt, to caring, about a therapist in the working relationship, since for me sharing a lot makes me feel intensely vulnerable and resultantly able to be hurt by whomever I've shared with. Maybe that's when the work gets good, or doesn't, or I find out the hard way that I cannot be met in that way in therapy, or it never worked in the first place, or I find out it is a horrible idea and it's best to make another plan entirely.)
Important to mention, too, is that I am open to and considering medication (after looong consideration), but will need that referral from a therapist or someone, or otherwise find an affordable and trustworthy physician/psychiatrist/NP, and that the therapist ___self asked if I would like names, and that they would find some names and let me know...a week ago. This person also mentioned that they knew of psychiatrists, before I ever started sharing anything, for lack of a better word, "riskier" (personal) with them. So, I am confused when this becomes both more pressured and also a condition of treatment. I cannot control when I find a psychiatrist or other person able to prescribe medication, and I also find it...not respectful of who I am or my own decision-making process. I don't know, something just feels off to me.
Is it dumb for me to have gotten to a point in therapy where I can be hurt by an action/inaction of a therapist, and to care what they think? And is it dumb to want a therapist I work with to care enough that they take care not to hurt me, or to understand that they might? Or at least have the vocabulary and skill to talk about it in therapy-like terms with me? (Whatever that means.) Will I become weird and reactive like this when I feel emotionally vulnerable with a therapist, or is it just with this particular person?
Is it best to no longer work with the therapist? I do need a schedule, and going to therapy helped create a schedule for me. It is just that sometimes I don't leave necessarily feeling resolved or "better" after an appointment, not to say that therapy isn't work, but somehow this all feels like more stress than it's worth. Why do I have so much conflict with a therapist? And the idea of finding a new therapist feels unmanageable right now. Is therapy just not for me? Ultimately, I regret opening up to this person and the risk was not worth it after feeling like my feelings were not safe. And now I feel as though I am being forced into an ultimatum of having to act in a way conscribed by the therapist. It's uneasy at best. Is it not okay to need and get emotional support from a therapist? I do not feel supported right now. The therapist is now telling me how much worse I am and instead I am feeling stronger in the days not seeing them, and in spite of their messaging, like going to a job interview recently, or going to a busy shopping area to look into a repair for something. Things I felt terrified to do, but did. How did therapy get to be more stressful than a job interview? I have no idea. And somehow therapy seems to be almost the opposite of doing these things. Honestly, I have more motivation at this point to go to a job interview than to go to therapy.
This post was deleted for the following reason: poster's request -- jessamyn
I think it's perfectly reasonable for a therapist to say that they can't help you if you aren't following their prescribed course of action.
Think about it. If this was a lawyer and you went and, against their advice, talked to the police about a crime you were a suspect in, I'd fully expect them to fire you as a client. Because how can they serve you if you reject their expert opinion.
I'm not saying anti-depressants are right or wrong for you. I'm just saying that if you don't value their judgment...then you should be working with someone else whose opinion you do value.
In short, I think it's perfectly ethical for them to suggest a course of action and, if you reject it, for them to refer you to someone else.
posted by inturnaround at 7:30 PM on April 19, 2011 [8 favorites]
Think about it. If this was a lawyer and you went and, against their advice, talked to the police about a crime you were a suspect in, I'd fully expect them to fire you as a client. Because how can they serve you if you reject their expert opinion.
I'm not saying anti-depressants are right or wrong for you. I'm just saying that if you don't value their judgment...then you should be working with someone else whose opinion you do value.
In short, I think it's perfectly ethical for them to suggest a course of action and, if you reject it, for them to refer you to someone else.
posted by inturnaround at 7:30 PM on April 19, 2011 [8 favorites]
Yes, it is ethical. No doubt about it.
posted by Chocolate Pickle at 7:37 PM on April 19, 2011
posted by Chocolate Pickle at 7:37 PM on April 19, 2011
In the past, the therapist had been reachable and able to talk if they had been near the phone, to talk during worse moments earlier this year. This was helpful. The new response felt off, and it seemed in a voicemail message, as I'd noticed before, there was a sort of exasperated tinge of anger to the tone of their voice, when I'd left a message previously asking if they could please call me.
Are the calls you mention in the question part of your regularly scheduled sessions? If not, what sort of policy does your therapist have about unscheduled calls? I ask because it sounds like there may be a mismatch of expectations about the frequency of these calls. Below some point, and the therapist should handle them as they come, as best as possible, to ensure you are getting appropriate care. Above some point, you need to be scheduling more frequent appointments instead of calling, to ensure you are getting appropriate care.
posted by Marty Marx at 7:42 PM on April 19, 2011 [3 favorites]
Are the calls you mention in the question part of your regularly scheduled sessions? If not, what sort of policy does your therapist have about unscheduled calls? I ask because it sounds like there may be a mismatch of expectations about the frequency of these calls. Below some point, and the therapist should handle them as they come, as best as possible, to ensure you are getting appropriate care. Above some point, you need to be scheduling more frequent appointments instead of calling, to ensure you are getting appropriate care.
posted by Marty Marx at 7:42 PM on April 19, 2011 [3 favorites]
Generally, it is ethical for a therapist to insist that a treatment plan be followed in order to keep seeing you. There may be a lot more background here that would be apropos, but speaking from my own personal experience, if you do not trust or respect your therapist, it's okay for you to fire him or her.
It is entirely possible that your sensitivity to all this might be because you desperately need meds (I speak as one who has been in your position, so no judgement on my part.) Medication can help you be calm and settled enough for talk therapy to actually be of use. What you can do is on your own make an appointment with a psychiatrist (your regular physician ought to be able to give you a referral, honestly) and then let the psychiatrist refer you to a different therapist after he makes his determination whether or not meds would be helpful in your case. It is the psychiatrist who has the training to make that determination medically, so I think you may want to start there.
As to support, if you have good friends or family members who are willing to be there for you, I have found that is as good or better than a therapist at least in the short term.
posted by St. Alia of the Bunnies at 7:48 PM on April 19, 2011 [2 favorites]
It is entirely possible that your sensitivity to all this might be because you desperately need meds (I speak as one who has been in your position, so no judgement on my part.) Medication can help you be calm and settled enough for talk therapy to actually be of use. What you can do is on your own make an appointment with a psychiatrist (your regular physician ought to be able to give you a referral, honestly) and then let the psychiatrist refer you to a different therapist after he makes his determination whether or not meds would be helpful in your case. It is the psychiatrist who has the training to make that determination medically, so I think you may want to start there.
As to support, if you have good friends or family members who are willing to be there for you, I have found that is as good or better than a therapist at least in the short term.
posted by St. Alia of the Bunnies at 7:48 PM on April 19, 2011 [2 favorites]
(also it may help you to know that therapists are trained to maintain certain boundaries, which those of us who are ultrasensitive will indeed perceive as them being uncaring or cold. Being aware of that might help you manage the expectations. I don't personally agree with the theory but knowing about it in advance does help.)
posted by St. Alia of the Bunnies at 7:50 PM on April 19, 2011
posted by St. Alia of the Bunnies at 7:50 PM on April 19, 2011
I say this in the nicest possible way, but for a less sophisticated therapist, you might just be too much. You are critiquing the way they breathe, the fact that they won't receive an unlimited amount of unscheduled (and unpaid for) phone calls, and you are refusing their professional advice. You two are not a good match, I'd find another therapist.
posted by speedgraphic at 7:51 PM on April 19, 2011 [13 favorites]
posted by speedgraphic at 7:51 PM on April 19, 2011 [13 favorites]
Is it dumb for me to have gotten to a point in therapy where I can be hurt by an action/inaction of a therapist, and to care what they think? And is it dumb to want a therapist I work with to care enough that they take care not to hurt me, or to understand that they might?
None of this is "dumb." But neither is it unethical or wrong for your therapist to be irritated by you, they're human and they can't entirely turn off their emotions. With all due respect to how their behavior made you "sad" and what courage it took for you to "share" that with them, they still have the right as professionals to be firm in their boundaries and not cater to every need of their clients, especially when they explicitly told you they can't consult over the phone.
posted by jayder at 7:54 PM on April 19, 2011
None of this is "dumb." But neither is it unethical or wrong for your therapist to be irritated by you, they're human and they can't entirely turn off their emotions. With all due respect to how their behavior made you "sad" and what courage it took for you to "share" that with them, they still have the right as professionals to be firm in their boundaries and not cater to every need of their clients, especially when they explicitly told you they can't consult over the phone.
posted by jayder at 7:54 PM on April 19, 2011
One of the ways we measure our importance in other people's lives is how they prioritise our own needs over their own. You seem to be disappointed you are not a priority in their life, expecting contact when with them on your schedule and thinking a week to wait for referral is too long (it isn't, really). Your therapist also has a life and a job and this is a paid relationship you have with them. Is the therapist paid at their normal rate for these phone calls and researching your referrals? From my interpretation of what you have written you do not respect their professional boundaries and are overwhelming them (and us, that is a pretty big text dump up there).
If your therapist had discussed medication as a condition of treatment in the first meeting, that would raise my eyebrows but not necessarily disqualify them. The fact that they are making that determination after several sessions with you, using the years of education and professional experience to evaluate your immediate needs makes me think you should take their advice very seriously. Mental illness IS an illness, it has a biological component to it and often needs treatment through medication before a patient can be stabilised enough to learn coping skills. You simultaneously want someone to offer you advice and support while you ignore their advice and criticise their support (even down to their breathing).
If your therapist has a high caseload of high-needs patients they may want to re-balance their caseload and that is very professional of them. They do not owe you a perfect patient-therapist relationship where they simply listen passively and avoid offending you.
posted by saucysault at 8:39 PM on April 19, 2011
If your therapist had discussed medication as a condition of treatment in the first meeting, that would raise my eyebrows but not necessarily disqualify them. The fact that they are making that determination after several sessions with you, using the years of education and professional experience to evaluate your immediate needs makes me think you should take their advice very seriously. Mental illness IS an illness, it has a biological component to it and often needs treatment through medication before a patient can be stabilised enough to learn coping skills. You simultaneously want someone to offer you advice and support while you ignore their advice and criticise their support (even down to their breathing).
If your therapist has a high caseload of high-needs patients they may want to re-balance their caseload and that is very professional of them. They do not owe you a perfect patient-therapist relationship where they simply listen passively and avoid offending you.
posted by saucysault at 8:39 PM on April 19, 2011
Mod note: From the OP:
Lest it seem I am not open to trying new and different things: I moved. I asked for the psychiatrist referrals, so I could start meds. I do not have insurance, therefore no PCP, therefore no easy referrals. Please be aware that not everyone has access to affordable healthcare. I kept everything in the original question, and thought of omitting what was read as criticizing someone's breathing, and yes I'm a little close to it. It is something I'm trying to get more clarity around. Getting a prescription for medication, and starting the process to work with someone to monitor them, and figuring that into expenses will not happen immediately.posted by jessamyn (staff) at 8:40 PM on April 19, 2011
I realize that whatever happened with the therapist became a larger misunderstanding than it needed to be, compounded by two weeks' time where I moved/left for two weeks trying to wrap up a move/see if I felt safe at my old place of residence, coinciding with a time where the therapist was away for the first week of that two-week period. In fact, the therapist emailed me to check in. I am good at managing my expectations. I am well aware of professional and other boundaries, including my own. I don't know if it's clear, but what felt jarring for me was that there was a moment when I needed support, and reached out to re-schedule/talk briefly by phone, and I did not hear from the person. So, I called a hotline and a friend. I think I mentioned this in the post.
I do not call (on) the therapist as a matter of course. In fact, I avoid it most of the time, or do not think to call them. The situation intimated at for the post had the following factors:
1) happened after the death of a family member
2) needed more support
3) trouble getting to therapy office, so tried to call to both explain I may be late/maybe have option of paid phone session/communicate why I was not there, etc.
4) triggers in housing situation
5) recent big move
6) previous two-weeks without talk therapy (save for one email to/from therapist about returning and meeting again for next appointment)
7) loss of familiar environs and social network (see #5), read: no friends where I currently live, totally different, still adjusting, not permanent, but adjusting
Lastly, the communication about medication came just today. Please be kind. I know I may sound very sensitive. I felt at the time that I was losing everything at once. Feelings are not always accurate, or can be a result of something other than just what is immediately occurring. I understand. Previously, when I called (not a common, for me, pull of resources or so-called unbillable hours of phone consultations, no), the calls were at most five or eight minutes. My style of working with the therapist is usually very cordial, distant, as-needed and it is only recently that I noticed that I actually feel emotionally vulnerable with this person. I wanted therapy to be brief and to the point. In general, I am somewhat terse.
But, the medication was not their idea. It was a problem of feeling that the therapist did not follow through on what they'd said in earlier meetings, changed meeting dates and times. I don't know. It feels important to have consistency with a therapist. Perhaps what I mean is not easily conveyed on Metafilter.
This thread is closed to new comments.
posted by Neekee at 7:25 PM on April 19, 2011