I have been thinking about this in regard to a post on another part of the forum.

Do you think at a certain point a therapist has an ethical obligation to reccommend a higher level of care if you need one and he/she is not helping you, or you are getting worse? I don't mean abandoning you but reccommending outpatient treatment, PHP, groups, inpatient, or even referring you on?

I find it a bit strange looking back that my therapist never addressed my very low functioning. In the fall she made a comment about how I only seem to get worse, and eventually during our painful rupture in Feb made a comment about how I am "too sick" for her to know how to help me alone. But she never referred me anywhere or talked to me about how badly I was doing except these times. It was my pdoc who told me I needed more specific help, outpatient at the hospital, because my functioning was so bad. I have done way better since I have been there, but it makes me wonder why she never encouraged/referred or even suggested I needed more help than she was able to provide, until the end.

Now that I'm doing therapy at the hospital now where they are more used to people with more serious mental illnesses it makes me wonder why Ex-T saw me for over 5 yrs without reccommending I get additional help. I honestly think I was too sick for her, maybe that's part of what happened (although that still doesn't make sense because she still wanted to see me). My pdoc made a comment about how I shouldn't be frustrated because it takes a long time to work your way up from "a mental ilness as severe and low functioning as yours has been for a long time." The psychologist also made a comment about how she wished they had sent me to the hospital for treatment earlier before things had gotten so out of control. I have been working again since Feb but things like agoraphobia and horrible self-care and the picking/self-harm get so much worse when they aren't treated. I don't get how my ex-T just told me it was up to me to decide I wanted to do something about them, and I spent all that time with my ex-T trying to snap out of it while things snowballed. Even at the hospital I keep saying it's my fault that things got so bad and I couldn't fix them, and they keep trying to tell me that mental illness is real and it's not my fault because it's hard to get over these things on your own, especially if you never learned how to care for yourself.

It just makes me wonder why we never talked about/worked on this stuff. Why we never addressed my horrible self-esteem and self-hatred issues, my urges to hurt myself, and my low level of functioning in general. It was more like every time I quit a job or got a medical withdrawal for school she'd be mad at me. Same for the self-harm. I went through 15 jobs in our last year of therapy, got evicted from 3 places for bad cleanliness issues, made myself physically ill from my eating habits, dropped every term of school, and started self-harming to the point of needing stitches again. I just wonder why she was never concerned and never considered maybe I COULDN'T just snap out of it.

I'm finally getting better very, very slowly. But things had gotten SO SO bad and low functioning.