The termination letter:

It is now necessary for me to end my treatment with you. This will specifically include medication management, psychotherapy, and crisis intervention.

I will make sure that you have two months of your current medication. You need to find another psychiatrist to manage her medication. I will either mail you your ADHD medications or electronically send other medications to the CVS across from my office unless you designate a different pharmacy.

It will be up to you to decide whether or not you wish to continue individual psychotherapy with another therapist. I do not recommend that your therapy be unstructured and determined by what you feel you need. It needs to be very structured and oriented towards learning to manage your feelings. Dialectical Behavior Therapy would be an example of the type of structured therapy you could benefit from. Cognitive behavior therapy would also be an acceptable structured therapy. Continued mindfulness practices would also be helpful.

Should you experience any psychiatric emergencies, you will need to call 911 or go to your nearest emergency room.

Your financial stability is a crucial component to you being able to access the mental health resources you will need to continue your treatment. In order to help you with that, as well as to do what I can do to give you no reason to have any further contact with me, I am writing off any outstanding balance you owe me.

The depth and nature of your attachment to me and the manner in which you have fairly consistently attempted to maintain that attachment is the core issue that in my opinion is unresolvable.

I do not wish to restore a relationship that is inconsistent with an appropriate doctor-patient relationship.

Specifically, I believe that you were seeking a relationship with me that you were lacking anywhere else in your life and that need intensified recently with the losses of your grandfather and uncle.

Despite my attempts to set limits on the frequency, method, and content of your contacts with me, you were not able to limit yourself resulting in my having to block your phone number in order to stop the number of phone calls and incessant text messaging. Even when you were limited to being able to just email me, you used the mail in much the same manner that you use text messaging.

On my end, I experienced this as you invading my privacy, being disrespectful, verbally abusing me, and frankly defying my authority as your physician.

The content of many of your communications felt like manipulative guilt trips. I began to feel like I was in a relationship with a very needy woman who would not take "No" for an answer and who was constantly trying to do whatever she could do to maintain the relationship at all costs. It feels as if you are addicted to me.

Clearly, this is not a normal interaction one would expect between a doctor and his patient.

Even though you apologize for your unacceptable behaviors, it isn't long before you resume them. Your promises to do better are empty.

There is nothing you can do to change my decision.