should i contact my friend's therapist reagarding decisions my friend is making?
January 10, 2009 12:20 PM   Subscribe

Could/Should I contact my friend's therapist to deter my friend from making bad decisions?

My friend has chronic depression, and she has been seeing a therapist and has been on medication on and off for the duration I have known her (3.5 years).

We connect on a very emotional level - both of us have suffered some level of depression and we have been supporting each other during good times and sad times.

After knowing her for some time, however, I have noticed that she makes a varied level of bad decisions when she is going through emotional difficulty, and she becomes very stubborn in believing that her decision is the best one for her, and she starts to cling onto some hope that I find it very dangerous.

Right now, she is going through difficult times - I am hesitant to go into details to keep her (and my) privacy, but she has been telling me about some of the changes she is considering of making, and I don't think these are going to be positive changes - if anything, these changes have potential to really devastate her in the end.

I've mentioned my disapproval, but as usual, she comes back with an answer of "we'll see, I think it will be fine though."

Something similar has happened in the past - she made some decision, I warned her of it, but she pursued anyway and turns out it was a bad idea after all. But none of the past decisions are as bad as ones she's thinking of making right now. At this point, I am very concerned about her, but I feel there is very little I can do to change her mind.

I am aware that I could be wrong about this whole "her making bad decisions". Maybe it will be good for her, and after all she is the one who knows about her and her life the most. Maybe I should let her make these decisions.

But for some reason, I cannot just let it go like that.

I am wondering if it would be a good idea to consult her therapist about this - to inform the therapist about some of the changes my friend is thinking of making, how and why I disagree with them, and how I am concerned.
But I know that this is crossing a line - I will be invading my friend's private life, and this could go very wrong.

I am feeling quite helpless in this, and any opinions/suggestions are appreciated.
posted by anonymous to Human Relations (34 answers total)
If she is a danger to herself or others (a physical danger, not just a her-life-may-suck sort of danger,) then yes, contact someone. If not - what do you expect the therapist to do with the information? (Not a rhetorical question - is it something the therapist could actually act on? Do you just want someone else to agree with you?)

Do you have your own therapist? This sounds like a question you should take to him/her if you do - they will be able to give you a much clearer picture of the limits and ethics surrounding the situation.
posted by restless_nomad at 12:32 PM on January 10, 2009

It's hard to say without more information about these decisions. But unless they're on par with: "I will quit my job, tear a hole in the roof and wait for God to rapture me up," or "I think it'd be a great idea to start shooting heroin!" I think you've already exhausted your legitimate influence.

You've told her that you think it's a bad idea. You've hopefully given the reasons you think the choices / changes are dangerous. That's what a friend can do.

Talking to her therapist sounds a little invasive and manipulative: though maybe you talk to her therapist all the time, and thus this is less strange than it comes off as. It really seems like crossing a line to me.

If /you/ have a therapist, it might be a good idea to talk to him/her about the whole situation.
posted by LucretiusJones at 12:36 PM on January 10, 2009

If the friend is a capable, rational person, then you've done everything you can do. I know it hurts, but sometimes people have to fuck up all by themselves. Helping them can sometimes prolong the agony.

I think it's great that your friend has a friend like you. I really do. Sometimes, though, people have to do things, and mess up, and all you can do as a friend is watch them do it, and be there for them at the other side.
posted by Solomon at 12:43 PM on January 10, 2009

Your friend's therapist must abide by client confidentiality rules of his/her profession and the laws of his/her jurisdiction,* so most likely will not be able to even confirm that your friend is a client, without receiving a signed waiver from your friend permitting this.

In some cases, concerned individuals (family members, friends) send letters and leave voicemail messages to loved ones' therapists, but this forces the therapist to have to decide whether to reveal the communication to the client (most do) or keep it private (which then stresses the therapist/client relationship).

If your friend were a threat to to herself or others, and you submitted a communication warning about this, the therapist again would have to contact your friend to determine the truthfulness of the communication.

*Rules may vary somewhat depending on licensing and jurisdiction requirements
posted by terranova at 12:43 PM on January 10, 2009 [1 favorite]

Short of behavior like threatening violence to others, I do not see how what you are thinking of doing would be a good idea.

I would recommend that you talk to your own therapist about this, because with them you can share more details about what's going on and perhaps get better perspective than I can provide.

Your friend gets to make bad decisions, even very bad ones (like, say, joining a cult and heading into bankruptcy). Any influence you try to exert, beyond telling your friend what you think, is likely to seriously harm your relationship with your friend, and is I believe unlikely to accomplish what you want, which is a change in your friend's behavior.
posted by zippy at 12:44 PM on January 10, 2009

I am wondering if it would be a good idea to consult her therapist about this - to inform the therapist about some of the changes my friend is thinking of making, how and why I disagree with them, and how I am concerned.

Do you know for a fact that your friend isn't already discussing these matters with her therapist?

Anyway, that's probably an academic question; I would expect (and I will be interested to see what our professional therapists here say) that unless you have knowledge that your friend is in some sort of immanent physical danger (or is going to place someone else in immanent physical danger), her therapist simply cannot discuss her treatment with you due to their professional code of ethics. You won't be able to invade your friend's private life, because the conversation with her therapist won't even get that far.

I am feeling quite helpless in this

This is the real issue here. You ARE helpless. You cannot force your friend to make the choices you think she ought to. It is unpleasant -- frustrating, scary, upsetting -- to acknowledge our helplessness in the face of others' actions... but as I said here, sometimes our helplessness is simply a fact. (Free will's a bitch sometimes, you know?) There are, however, constructive ways you can choose to deal with these feelings -- talk to your own therapist, do yoga/meditation, etc. Maybe this is the way to find how to strike that tricky balance between being a supportive friend without necessarily endorsing all the choices our friends make.
posted by scody at 12:44 PM on January 10, 2009

Sorry, my first sentence should say "Unless your friend is threatening violence to others ..."
posted by zippy at 12:44 PM on January 10, 2009

You sound very controlling. These decisions may work for her, you admit that yourself, and yet you just can't let it go?

I think you need to be talking to your OWN therapist. You are not in charge of her decisions and trying to exert influence over her in this manner is not acceptable.
posted by sondrialiac at 12:46 PM on January 10, 2009 [1 favorite]

This is wildly inappropriate. Short of life or death decision making, or decision making that could ruin someone else's life (e.g., 'my friend is going to Target tomorrow to kidnap a child') absolutely, positively not. The fact that you're considering this at all is cause for concern. Other people's mistakes belong to them, they aren't up for grabs by the general population.
posted by A Terrible Llama at 12:48 PM on January 10, 2009 [2 favorites]

It's great that your friend has you looking out for her, but I'm not sure that talking to her therapist is a good idea. What I would suggest is to talk to her again, tell her how much you care, and how worried you are about the actions that she plans to take, and try to get her to promise to to talk to her therapist about them herself before acting. That way you get the input of the therapist without having to do anything sneaky.
posted by 5_13_23_42_69_666 at 12:51 PM on January 10, 2009

Unless your friend is thinking of doing something to harm herself or others, I doubt the therapist will even talk to you about it at all. She probably can't even acknowledge that your friend is a patient.
posted by fructose at 12:53 PM on January 10, 2009

posted by OmieWise at 12:55 PM on January 10, 2009

A therapist is not a guardian. Your friend has (and should maintain) control over what information she shares with the therapist and which aspects of the therapist's advice she chooses to follow or ignore.
posted by troybob at 12:58 PM on January 10, 2009

I would rather give you the benefit of the doubt then suggest that you may be "controlling" or invasive. You sound to me like a caring friend- but don't contact her therapist. If you can walk along side her as a supportive companion- as she makes mistakes or finds successes- then you are doing all that you can and, possibly, more than enough.
posted by hellboundforcheddar at 1:03 PM on January 10, 2009

Well, first of all you're very nonspecific as to the actions your friend is taking here, but really- what is the therapist supposed to do here? Frankly, this is none of your goddamn business- and way unethical.
posted by dunkadunc at 1:07 PM on January 10, 2009

You also need to consider the harm you could cause in the therapist-patient relationship here. If you were to contact the therapist and (a) the therapist did not share that interaction with your friend, but then your friend found out about it, or (b) the therapist did share the interaction and your friend was disturbed by it, you could be introducing trust issues between them, perhaps damaging whatever long-term work they've done together.

If you want to participate in that interaction, you need to ask your friend's permission first.
posted by troybob at 1:18 PM on January 10, 2009

In almost all cases when a friend is going to do something you consider stupid, you can't do anything more than talk to them about it.

In a small proportion of cases when a friend is going to do something you consider life-threateningly stupid, you need to call the police or social services or stage some kind of physical intervention to prevent a suicide, etc.

I can't think of any situations that would fall between the two. Neither kind of scenario involves contacting a friend's therapist.
posted by game warden to the events rhino at 1:23 PM on January 10, 2009

Going to her therapist behind her back may not only destroy your relationship with your friend, it may also kill the trust she has with her therapist. Please don't go to her therapist.
posted by kellyblah at 1:43 PM on January 10, 2009

But for some reason, I cannot just let it go like that.

You should probably find out why with your own therapist. You've done what you can do for your friend, and any more constitutes codependent behavior, which is a not a good state to be in for either of you. Your friend is making her own decisions with her life and those decisions have nothing to do with you.

I can relate, as I have a friend whom I feel is making some really messed-up judgments on what to do with her life right now, but she'll never get to a different place if her friends constantly interfere with her discovery of the consequences of bad decisions. Sometimes a person just has to hit bottom.

If she's a viable physical threat to herself or someone else, I would contact a trusted family member of hers (or some other outside person who can intervene) and get help. Not her therapist.
posted by droplet at 1:49 PM on January 10, 2009

Could you just try to get the friend to bring up the issues / possible changes with her therapist? If you think it would help, you might even consider giving the friend a letter -- open, so the friend could read it too -- to give to the therapist.
posted by amtho at 1:51 PM on January 10, 2009

Talk to experienced therapists, and you'll find that the most common groups of individuals who attempt to influence client/therapist relationships are:

(a) parents, whose adult children are making decisions the parents don't like;
(b) adult children, whose parents are making decisions the children don't like;
(c) rejected suitors, whose former SO's are making decisions the ex-suitors don't like; and
(d) spouses, whose partners are making decisions the spouses don't like.

The most commonly-given explanation by these groups for "needing" to interact with the therapist is that the therapist "needs to hear the other side" or "needs to know what's really going on" (i.e., what the third party perceives). Consciously or otherwise, the third party is attempting to insinuate himself/herself into the therapist-client relationship and have a more powerful influence over the client's life.
posted by terranova at 2:10 PM on January 10, 2009 [2 favorites]

You should go see the same therapist and PAY to tell the therapist about this dilemma, and go ahead and use names. It's your problem you're experiencing, not your friend's. You have no idea what is going on in your friend's head.
posted by peter_meta_kbd at 2:11 PM on January 10, 2009

This is wildly inappropriate. Short of life or death decision making, or decision making that could ruin someone else's life (e.g., 'my friend is going to Target tomorrow to kidnap a child') absolutely, positively not. The fact that you're considering this at all is cause for concern. Other people's mistakes belong to them, they aren't up for grabs by the general population.

Yes, exactly. A Terrible Llama is right on.
posted by grapefruitmoon at 2:37 PM on January 10, 2009

posted by Flunkie at 4:07 PM on January 10, 2009 [1 favorite]

Just to quibble with the above viewpoint on client/therapist relationships -

I've observed that the client/therapist relationship, especially in Narcissistic or Borderline Personality type cases, is often useless or actively harmful, because the client, as part of their pre-existing behaviour patterns, will almost always present themselves in the best possible light, and the victim - often by flat-out lying (eg, this is the terrible thing *I* did to someone else, but I'm going to tell you they did it to *me*).

I know someone who was BPD, but had *enough* self-awareness, to see the description, and realise that was them (any idea how *big* that is for a BPD type? That's not flattering at all!) and in a moment of self-confession, brought it up with their therapist!
Unfortunately, (due to their usual behaviour) their therapist thought they were fiiiiiine! Don't be so harsh on yourself!
Some outside reference, contact with family, friends, every-single-ex-or-current-partner would have confirmed the pattern. Instantly.

Eventually, her GP, her Doctor, ie the person who had to stitch her up all the time, rang the therapists offices (there were several working for the same group, in the same building), and demanded that she be reassigned to a different therapist, as the current one was 'useless', and I think gave the new therapist 'the rundown'.

As a teenager, I had a therapist, want to put me on anti-depressants. I've been depressed since. I was not depressed then (but we were sitting and talking about "every bad thing that has ever happened in my life" every session :P ).
Communicating with any of my friends, family, teachers (does she seem a little down?) would have confirmed this was not the case.

So - what's my point? It's not a wrong impulse you have there, but unfortunately, the system is broken. There isn't an established communication route by which you can do that.
I personally think, that if someone had the kind of self-representation problems mentioned above, that I'd talk to the therapist, about having a 'check-in' with other people in my life. Just an email report, or a 5-10 minute phonecall with a couple of the people closest to me - I think it would make recovery for (especially) NPD & BPD cases easier, knowing that it'd be easier not to lie, than to lie. Usually it's the other way around. After developing a good therapeutic relationship to start with (except again, possibly an initial interview with close-friends/family/partners etc, so it doesn't all start off on the wrong foot).

The only way you could ethically do this I feel, is to ask your *friend* if you can raise this matter with their therapist. Yes, they will probably feel pissed off at you - is it serious enough that you are willing to risk that? And the high possibility they say no anyway?
Maybe say something along the lines of "Look, I know you've made your own decision, but I'm kind of concerned about 'X'. It sounds weird, but... could I talk to them about my concerns? Either your therapist will know that you've made a lot of progress {or something to imply that your concerns may be old concerns?} and my concerns are paranoid, or you can talk to them about it, but either way - I then promise to drop the subject, and support you in whatever you're doing."

If it's a good therapist - they'll first talk with your friend about "How did it make you feel when your friend wanted to talk to me like that?" ie 'they don't respect my opinions', lack of authority, left out, etc etc etc, and then after they've dealt with that (possibly a few sessions), they may start discussing the concern itself.

That's the best hypothetical scenario I can think of. Are you willing to risk it?
posted by Elysum at 4:25 PM on January 10, 2009

It would be good to suggest to your friend that she discuss these plans with her therapist. If the plans are really bad, or if the plans are generated in the manic phase of bipolar disease, it's the therapist's job to advise.

You can help your friend by listening, by going for walks, or whatever would help her get exercise and sunshine, and just being a friend.
posted by theora55 at 4:32 PM on January 10, 2009

No - do not go the same therapist. The therapist would then have the obligation NOT to tell your friend what you said and at the same time make sure he/she wasn't disclosing anything to you that your friend said in counseling. If the therapist knew what was going on, he or she would refuse you as a client and refer you to someone else.

You can always leave a voice mail or write a letter to give information to a therapist. However, you will get no direct response at all. Mostly likely, the therapist will tell your friend about the contact - and your friend might get mad that you are interfering. Furthermore, therapists will respect a client's freedom to make their own choices. He or she might help your friend explore the consequences of their choices but if your friend is as committed to this path as she seems, the most the therapist can do is to be there to pick up the pieces afterwards. And finally, if this is a big decision, it has probably already come up in the therapy. So, you can give the therapist the information but it is unlikely to prevent the tragedy that you see coming.
posted by metahawk at 4:38 PM on January 10, 2009

I generally wouldn't come between a person and their therapist. Suicidal and homicidal credible threats are the exceptions.

Also, tell your friend, "the first rule of therapy club is you do not talk about therapy club." Seriously.
posted by ikkyu2 at 6:13 PM on January 10, 2009

Elysum: I've observed that the client/therapist relationship, especially in Narcissistic or Borderline Personality type cases, is often useless or actively harmful

You don't understand therapy, Elysum. Stop giving advice.
posted by ikkyu2 at 6:15 PM on January 10, 2009 [2 favorites]

The most you could do besides giving your friend your opinion---as you've already done---is do as others have mentioned and ask your friend if she's willing to at least run her life-change plans by her therapist. If she doesn't agree, or you are still concerned, you can ask her if she'd be willing to take you with her for a part of her next therapy visit so you can share your concerns with the therapist, with your friend in the room.

Beyond that, being a loving friend who continuously brings truth into your friend's life is a wonderful can never go wrong combining love and truth...and more love.

posted by mumstheword at 6:52 PM on January 10, 2009

Tell the therapist. Let them make the decision what to do.

Also, tell your friend, "the first rule of therapy club is you do not talk about therapy club." Seriously.

What the hell does that mean?
posted by gjc at 9:07 AM on January 11, 2009

If you can divorce yourself from the specific considerations underway (which may take some time and require you to step back a bit at first) then why not simply have a discussion with your friend in a calmer time pointing out that you sometimes get very frightened for her. Ask her what is okay for you to do when things that are happening in the heat of the moment really scare you and and she doesn't seem to be listening.

If she says she'd rather you mind your own business then live with that, it is her choice. If she says "You know sometimes I do get pretty screwed up don't I? Maybe you could do/tell X when that happens" then you have permission to do what she asked the next time it comes up.

It is great that you want to help. But her decisions have to remain her own.
posted by meinvt at 12:15 PM on January 11, 2009 [1 favorite]

Elysum: I've observed that the client/therapist relationship, especially in Narcissistic or Borderline Personality type cases, is often useless or actively harmful

You don't understand therapy, Elysum. Stop giving advice.

ikkyu2 - While I appreciate and respect your medical advice
In this case, I don't appreciate your ad hominem attack.

How about attacking the concept I put forward instead?

Are you saying you haven't ever seen anyone use their therapist purely as an ego booster, and run rings around them in terms of 'what really happened'? Uh, well I have.
You can say that those people aren't effectly using their therapist, but duh - that's why they're in freaking therapy!
Sometimes they do have moments of self-awareness, and wish to change - I have not seen the standard model of therapy to be effective in those cases.
I think it is one of the reasons, that very few forms of therapy, other than say, DBT, are at all effective in BPD/NPD type cases, and how that reflects into similar circumstances by individuals who otherwise don't fit those disorders.

Do I have my issues with mental health care? Well duh, I've interactacted with the mental health system.

Personally, I really like my current therapist, and find them quite effective. I have seen the benefits that various, and specific forms of therapy have accomplished in myself, and others.
I see no conflict between that and warning others about the blindspots, for which the standard models of therapy do not work well.
posted by Elysum at 9:07 PM on January 11, 2009

Client confidentiality is a cornerstone of the counseling relationship. If you call your friend's therapist, s/he will neither confirm nor deny that your friend is even a client without your friend's permission. Even if you were her spouse. Even if you were her parent. Even if you were her identical twin and shared a telepathic connection.

Please know that if you intervene, your friend will know about it. Therapists are required to disclose any and all communication or contact they have with other people regarding their clients, even if they don't speak with them directly.

As a counselor in training, I recommend that you not contact the therapist unless your friend is acting in ways that might cause harm to herself or other people.

Personal anecdote: My mother was diagnosed with bipolar disorder when I was 5 years old. When I was 17, I once had to inform my mother's physician that she was in the middle of a manic episode because she would not. I'm talking, chatting and surfing the Internet for 4 days straight without sleeping, then shutting off our circuit breaker because she was afraid "They" would get information about us through the electrical outlets. My mother was not able to care for herself, and she certainly wasn't able to take care of her kids.

If she is a custodial parent who is endangering her children, you may be able to hotline her, but that is about the best you can do. It really is all out of your hands. Speaking as a codependent myself, that can be the hardest thing to deal with.
posted by mynameismandab at 10:40 PM on January 11, 2009

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