Therapist's professional boundaries in conflict with school's request--help?

July 12, 2012 7:53 PM

How do I deal with the conflict between my therapist's professional boundaries and the information my college wants? Also, how to deal with the trust issues this is creating?

I withdrew from college last fall due to some trauma-related personal issues. I applied for readmission for this fall and was rejected. I'm appealing this decision, as my application was compiled in March and I've got some major indicators of progress since then. (Received the only A in a tough summer school course at the school in question, glowing-bordering-on-hagiographic recommendation from the prof, etc.)

I met with the dean after I was rejected, and he said that the decision was primarily due to the fact that my therapist appeared to be trying to "telegraph" something with the letter she'd written. It was a really wishy-washy letter, and I had felt like it was a little undermining at the time. I probably should not have submitted it, but I needed something from her in my application.

I already had a new (much less ambiguous) letter of support from my therapist when I met with the dean regarding my appeal, and I gave it to him that day. In the new letter, she was pretty clear that she supported my readmission effort this time, though I'm not sure it was clear enough that she believes I'm able to succeed with a full-time course load this fall. (I tend to think that the dean was looking for the line, "I believe that X can be successful with a full-time course load this fall," and it wasn't there exactly but could be inferred.) The dean was really positive about everything, and I thought that I'd be hearing back about a decision this week, but I haven't.

Apparently someone in the counseling services office at my school left a message with my therapist's office yesterday asking for her to call back regarding the letter. The caller did not say what she specifically wished to discuss.

My therapist is uncomfortable responding to this call because she feels like this whole process has been damaging to our therapeutic relationship (it has) and she doesn't want to put me in the position of wondering what was said. She says that in most cases, she won't offer opinions like this without a subpoena. (She has said this before.) She said that, at most, she'd be willing to leave a voicemail response reiterating her support for my reinstatement; an actual conversation would go beyond her professional boundaries.

This does not seem very supportive to me. At this point, I am having trouble trusting my therapist's ability to communicate with my school in such a way that it doesn't undermine my chances of readmission. Based on my conversation with her today, I honestly don't know whether I can trust her to make unambiguous statements about my abilities when asked. She kept saying she'd be supportive, then gave examples of things she'd say in therapist-speak with so many qualifiers that...well, it sounded like she was hiding something. (I don't think there's anything to hide here; I'm awesome and healthy and college isn't that hard.) I have not yet signed a release allowing her to leave the voicemail or discuss things with the school; she was uncomfortable letting me sign it as concerned as I am.

Therapist and I discussed the possibility of me calling the counseling services office to explain that she has a policy of not discussing clients' treatment without the client's awareness of the scope of the conversation, and to ask what information is being requested. I'm not sure if that makes me look bad. Does it? I'm also thinking of offering to let the counselor who called meet with me for her own evaluation, since my therapist isn't going to be that forthcoming regardless.

This call may just be about the fact that my therapist ran out of personalized envelopes for the new letter and they want to verify that she actually wrote it, but I kinda doubt it.

What should I do at this point in order to help my readmission application and repair the massive amount of damage this has done to my ability to trust my therapist? At this point, I'm kind of pissed that I've been paying for $100/hr conversations with someone who isn't going to help me with this.

Throwaway email: readmitit at gmail dot com

posted by anonymous to Education (19 answers total)

Have your therapist arrange to make the call with you there?
posted by Matt Oneiros at 8:09 PM on July 12, 2012 [3 favorites]

Can you ask her to recommend someone who can do an outside evaluation of you for the purposes of this letter? Can you have a psychiatrist write the evaluation instead? Meeting with the counselor from the school is also reasonable, provided that your school counselor won't have the ability to do anything to your file beyond saying "yes she's ready" or "no he's not ready." There have been a few people out there who have been really messed up by college counselors causing them trouble with the school administration.

For what it's worth, I have never had any of my therapists write anything like this; it's always been MDs that sign off on evaluations for disability paperwork, return-to-work letters, etc. If I have my therapist talk to someone for a someday return to college for grad school, I'm sure it'll be a very difficult thing to try and figure out - it's one thing for them to confer with another treatment provider for the purpose of providing me treatment, and it's another to confer with an administrator for the purpose of deciding if I'm OK to enroll in their school. Even the filling out of forms and writing of letters can get really touchy.
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 8:13 PM on July 12, 2012 [3 favorites]

she won't offer opinions like this without a subpoena

...this would be if someone ELSE were trying to access your information without your permission.

she has a policy of not discussing clients' treatment without the client's awareness of the scope of the conversation

...but you're aware of the conversation....

I would say write a letter to the therapist saying, essentially, "I release [therapist] to discuss my treatment with [University]'s representatives as they directly relate to readmission requirements."

If she's having a phone conversation with the admins and they ask her something outside the scope then she could say, "I can't discuss that". They might be looking for specifics, like, "are they a danger to themselves or others".

I would also be upfront with your therapist as you give her this letter - "I feel as though you are trying to prevent me from getting back into college. I would like to trust you to speak with the administration as per my request. College readmission is part of my mental growth and when you block my attempts at readmission -without giving me an underlying reason - it makes it difficult to believe you have my mental growth in mind."
posted by Lt. Bunny Wigglesworth at 8:15 PM on July 12, 2012 [7 favorites]

Have her schedule the call while you are there and on speakerphone. Then all three of you can have the discussion together. She may be nervous about outright saying that you can handle a full class load because what if you get so stressed at midterms you go on a shooting rampage on campus? The Virginia Tech situation has made campuses nervous about students who are suspended with mental health issues, and has made therapists even more cautious about making statements with absolute certainty (hence the therapist "double-speak").
posted by MultiFaceted at 8:26 PM on July 12, 2012 [1 favorite]

Response by poster: Does your therapist actually believe you're ready for full-time readmission?
posted by Anonymous at 8:30 PM on July 12, 2012

Does your therapist have some kind of supervisor? As you are having a disagreement over her "professional boundaries", it may be useful to talk to a third party.
posted by acidic at 8:37 PM on July 12, 2012

It seems to me that the much bigger issue here is that your therapist hasn't said she believes that you are ready for readmission. I'm not a therapist, but I feel like a good therapist would either, a, tell you that you aren't ready to go back and offer to work with you to develop other options for you for next semester that help you reach your goals, or b, write you a completely positive letter. This middle ground seems really unprofessional and completely unproductive.

I would also be upfront with your therapist as you give her this letter - "I feel as though you are trying to prevent me from getting back into college. I would like to trust you to speak with the administration as per my request. College readmission is part of my mental growth and when you block my attempts at readmission -without giving me an underlying reason - it makes it difficult to believe you have my mental growth in mind."

Yeah, seriously. If there is some reason she doesn't support your readmission, I think (again, I'm not a therapist, but come on) that she needs to communicate to you what that reason is so that you can work on it. Do you have impulse control or anger management problems that are making her nervous about speaking directly with you? If so, that's a problem in and of itself. I think you really need to talk to her about this without regard to the administrative stuff- does she believe you are ready to go back full-time, why or why not? What coping skills or resources does she think you need to be successful? Is there something about your particular college that she thinks is a bad choice or situation for you? Talk about all that stuff and she what she says.
posted by Snarl Furillo at 8:37 PM on July 12, 2012 [3 favorites]

It doesn't make sense that she's written two letters of support and now decides that she can't respond to your school's voicemail. If she doesn't respond, this certainly won't help your chances of admission, nor will it help repair your therapeutic relationship. It also makes zero sense that she's willing to leave a voicemail but draws the line at an actual conversation. It seems to me that this is part of her job description. If she feels you aren't ready you should be told as much, and if I were you I'd point our that you aren't clear about her murky boundaries. Be direct and tell her that you feel you cannot trust her, and that you feel as though she is not supportive of you.
posted by Sal and Richard at 8:52 PM on July 12, 2012 [1 favorite]

So if I understand this correctly, you voluntarily submitted your therapist's opinion on your mental health as part of your admissions application?

Pardon me if this sounds rude, but what were you thinking? HIPAA strictly guards against a mental health counselor disclosing information you discuss in counseling unless it pertains directly to your health or is requested by subpoena (as your therapist rightly alluded to). Basically, you don't have to worry about anybody knowing about what you discussed in therapy, unless you decide to tell them about it, which it sounds like you did...

It would be very surprising to me if it is not illegal to use someone's health history as a determining factor in college admissions. Look into the laws in your state. It feels very weird for your college to insist that your counselor (especially one employed by them) give a stamp of approval to your health before your application can be considered.

For future reference, never give away medical information to anyone who is not a licensed health professional.
posted by deathpanels at 8:54 PM on July 12, 2012 [5 favorites]

Maybe the school is being weird and your therapist doesn't want to give them any more details about you because, as she said, she has told them she supports your reinstatement and is willing to reiterate it, but no more as part of her standard policy. It is possible that the school administration is not being explicit about what they are looking for, and she doesn't want to get involved in some weird game.

Before you push for your therapist to engage with the administration more find out what the exact policies are for reinstatement. Is there an ombudsman for your school? Contact their office and see if you can get any more information or guidance - it sounds like you don't exactly know what is going on here, your therapist isn't clear on that either, and the administration is not being transparent.

Don't guess what anyone involved is thinking, ask clearly and try to get it in writing.

Also don't talk to the counseling office.
posted by newg at 8:56 PM on July 12, 2012 [1 favorite]

deathpanels: It's not an admissions application, it's an application for readmission after medical withdrawal. I don't know of a university that DOESN'T require a letter from a therapist/doctor in order to be considered for readmission. It's part of the agreement that students make when they take medical leave-- they're allowed to continue their studies at the same school (and therefore not lose all their credits) if they can prove that their medical issue has been resolved.
posted by acidic at 9:10 PM on July 12, 2012 [7 favorites]

Get a letter from a proper doctor. Drop your therapist. She's creating a problems and drama you can't afford.

I'm so sorry. Try not to let the weirdness undermine the good work you've done with this therapist already, but do drop her and have a proper doctor liaison on your behalf with the university.

Also, you might want to look into a lawyer to help with your appeal - it is totally reasonable to hire legal counsel for that process.

Good luck.
posted by jbenben at 10:49 PM on July 12, 2012 [3 favorites]

The therapist who treats you should NOT be the evaluator signing off on your readmission paperwork! What on earth. Those are two totally different things; and generating a report for your school is totally outside the parameters of your therapeutic relationship!

Explain to the dean that your therapist realized (a little late!) that this involvement is completely unethical and inappropriate and will not continue. Find a psychiatrist to get a diagnostic evaluation from. One visit will do. Pay him or her out of pocket for the hour, and they should write whatever you need them to write.

You probably ought to dump the therapist too, because she sounds deeply confused about her job responsibilities. (You were too, but it's not your job to know these things, and it definitely is hers!)
posted by fingersandtoes at 11:09 PM on July 12, 2012 [18 favorites]

I retract my previous advice and endorse the advice of fingersandtoes, who sounds like they know what they're talking about.
posted by Snarl Furillo at 11:41 PM on July 12, 2012 [1 favorite]

At this point, I'm kind of pissed that I've been paying for $100/hr conversations with someone who isn't going to help me with this.

You've been paying for therapy, not for testimony (one way or the other) regarding your ability to be successfulnat school. Your therapist sounds moderately distressed that, as you've acknowledged, your therapeutic relationship has been ruined by this paperwork. You don't even sound sure that she thinks you can so this thing that you think you can. Unfortunately you're kind of stuck now. I would make clear to your therapist that you will be ending your therapeutic relationship because of the damage this back and forth has done. During the conversation I would show that you regret this, that you understand that the 'legal' stuff has compromised your ability to work together, and I would ask for referrals to other therapists. Explain that your doing this in order to release her to speak fully with your school. Then, if you want one, find another therapist. There's no need to find "a proper doctor" (whatever that means) since your therapist is fully competent to provide an opinion to your school, the school is expecting to talk with her, and restarting the evaluative process with someone new is going to take longer.
posted by OmieWise at 2:59 AM on July 13, 2012 [4 favorites]

I work in mental health and I can sort of understand where your therapist is coming from. There are times when clients want us to communicate with third parties in ways that may not be in their best interest (e.g. wanting a therapist to participate in a court case on their behalf when the therapist's honest testimony may actually harm their case or reveal things they would rather have kept private). At that point, it becomes difficult to balance the principle of "do no harm" with that of respecting the client's autonomy. As someone else mentioned above, there are also potential consequences for her if she makes a recommendation and then something happens later (e.g. Virginia Tech), which may explain the way her letter is phrased.

As far as the voicemail versus conversation issue, I think there is a pretty significant difference and that your therapist may be trying to protect you (as well as herself) by being willing to do one but not the other. In a voicemail, she's going to have more control over what is presented and how. In a conversation, there's no telling where the line of questions will go, she has to think on her feet about how to respond honestly while not doing unnecessary harm to you, and she may (possibly correctly?) feel that being put in the position of having to refuse to answer questions may make you look worse rather than better. She also has to deal with the possibility that something she says off the cuff in that phone call may have unintended consequences that cause you to become angry enough to sue.

All of the above explain why many therapists would be reluctant to give statements like this without a subpoena, even when released in writing to do so by their client. It creates a very problematic dual relationship for a therapist to also be put in the role of evaluator. The two relationships are often kind of antithetical and, as you have found out, rapport can really suffer. Probably the most appropriate thing your therapist could have done would have been to explain clearly why she would not generally discuss things with a third party and to give you a referral for a few other mental health professionals who would be able to evaluate you.

At this point, finding another such professional (probably a psychiatrist) and having them do an eval, or having a meeting with someone in the school's counseling office in order to let them evaluate you may be the way to go in fixing things with the school. As far as regaining trust with the therapist, I think if this has been a positive relationship with this one exception, maybe you honestly confront and process the feelings in session and then determine whether you can move forward or the relationship has been irreparably damaged. I suspect this incident may have an impact on your trust of therapists in general, and you're likely to end up processing it in some form even if you switch therapists, so if she's been otherwise helpful, trying to confront your feelings with her may be worth a shot.
posted by scandalamity at 4:47 AM on July 13, 2012 [6 favorites]

deathpanels: HIPAA only prevents those things without the patient's consent. If the patient says it is OK, health care professionals can discuss whatever they want.
posted by gjc at 6:26 AM on July 13, 2012 [2 favorites]

One more thing - it doesn't have to be a psychiatrist; a psychologist is fine, probably. Find out what your school wants, credentials-wise. When you search, look for someone who offers diagnostic services, not just treatment. If it's not clear from their practice description, just ask the front desk or whomever you wind up talking to if they can do a diagnostic evaluation for the purpose of generating a letter supporting your school readmission. Let there be no confusion as to what you are there for.
posted by fingersandtoes at 7:56 AM on July 13, 2012 [1 favorite]

A clinical social worker is also probably fine. In most states (all?) where psychologists are certified to diagnose and assess, social workers are as well.
posted by OmieWise at 8:26 AM on July 13, 2012