[SevenMile]

I'm new here and I found this site in my search to find some way to get perspective on a situation that I find myself currently in. I will try to state this as briefly as possible and apologize if it is lengthy.

I've been in therapy for a number of years and have seen a few counselors. The first one I started seeing when I was 17 after I was referred by child protection to see someone. I eventually disclosed that I was being abused by my father and that it had happened for a number of years. I saw this counselor for 4 years and during this time she diagnosed me with PTSD and depression, but she noticed some things about me and had some concern with dissociation so she sent me to a specialist to be evaluated. It was during this time that this counselor was diagnosed with breast cancer and subsequently left her practice, so I was referred to a new person.

I saw this new counselor very briefly, mostly because not long after I moved out of state with my (still) abusive family and began college. I was in my early 20's by then and still had a very difficult time breaking away from my family in spite of the negative treatment I was receiving. After an initial failed attempt at school because of medical issues, and taking a few years to recover, I started school again but this time moved into the dorms at the university. At this time I began to struggle even worse with anxiety and depression and so I once again sought the assistance of a counselor in the community. I have now seen this counselor for seven years.

When I first started seeing her, I was hesitant and initially refused to have records sent from the first counselor. I had this naive idea that I could go in, tell her I was depressed and anxious, come up with this great plan to work through it, and that'd be it. I didn't want her to know that I was abused, that I still had contact with my family, or that my first counselor began to suspect dissociative disorders. I was wrong about this being a "quick fix" and it took about three years of therapy to even begin talking with this counselor. But as I said, it has now been seven years and in this time I have began talking and trusting more readily, she has had the time to observe my behavior and actions, and has also done a number of assessments and evaluations to make sure that she had as much information as possible about what might be going on with me. I still have a diagnosis of PTSD and depression, and through her observation and assessment I was also diagnosed with DID.

As I progressed in therapy, I found that things in my past were starting to fill in. I was feeling things I didn't have an explanation for, and some of the triggers I used to have no rationale for began to make sense. But about two years ago I hit a major roadblock, as I began processing something that happened that was extremely traumatic. My functioning ability was lessened, my symptoms got worse, and I'm still having a hard time. But even with this, I saw this as progress though it hurts extremely bad. Prior to seeing this counselor, I lacked the capacity to feel much of anything and went through my life mostly "going through the motions." Now I am beginning to acknowledge the things in my life and feel the hurt that I've experienced.

Flash forward to today. Because of the length of time that I've seen the counselor I'm seeing, the agency she works for began to look at my file. Without meeting me and going strictly on what is in my file, they made the determination that I was being inaccurately treated. They stated that my counselor did not provide assessment to assist in diagnosis, even though she had me take the MMPI and MCMI just a couple of years ago. They also did not believe my statements regarding the abuse I went through, stating "if her father is that bad, she would not have contact with him." As a result, they used this information to state that I had borderline personality disorder (as they do not believe DID exists) and feel that I should be placed in an inpatient residential treatment facility where I can receive DBT therapy and then referred elsewhere to a counselor that can more appropriately treat me. In spite of my counselor's objection to their decision, they continue to insist that I suffer from borderline personality disorder even though every test they've had me do (including the MCMI) shows that the borderline scale is extremely low. However, as I said they have stated they do not believe DID is a valid diagnosis so it seems more like they don't know what to do with me. In addition, there was a complaint filed against a counselor locally (in another agency) because of unethical boundaries with a client who also suffered from DID. The agency my counselor works for believe that my diagnosis as it is could be a potential liability of a lawsuit against their agency in light of what happened with this other counselor in the community. So they want me gone.

I'm really feeling lost as to what to do. My counselor very much objects to their decision and together we have filed a letter of appeal. However, it also seems like even if the appeal goes through that they only thing they may relent on is my ability to see the counselor I'm currently seeing. They are still insisting on inpatient hospitalization for DBT treatment because they refuse the DID diagnosis and insist I must be borderline. The information I have on the place they want to send me states that hospitalization will be "at least 90 days" and possibly up to 180 days. I just feel like I don't know what to do. I feel like I'm being improperly treated and don't know what to do. Part of me wants to just bail on therapy completely but I also truly want to get better and work through some of the trauma I've gone through. But maybe it's ok, what they're doing? Like I said, I really feel lost and don't know what to think or do anymore.

[sunrise]

Hi SevenMile and welcome to PC.

I'm sorry you are going through all that. Your counselor sounds like she is on your side and going to bat for you. Do you have to do the inpatient treatment? Can you just say no? They can't have you committed unless you are a danger, can they?

But maybe it's ok, what they're doing?

I think anytime something is done against the client's will, that it's not OK (unless there is danger). It sounds like they aren't listening to you or your counselor, who knows you well, so that doesn't seem OK at all. Do you think what they are doing is OK? I don't think an accurate diagnosis can be made unless they assess you in person.

What will happen if the appeal letter you and your counselor wrote is successful? Would it mean the agency will no longer recommend you have inpatient treatment? If the appeal is not successful, do you have to either have inpatient treatment or quit seeking services at the agency?

Is there any way you could continue seeing your counselor for therapy but not through the agency so you don't have to deal with them?

[wonderingmary]

This really sounds like a bad situation. I wish I knew what the legalities involved are -- I think they vary from location to location. I wonder if there is some "client advocacy" organization in your area that might be able to intervene on your behalf, or at least give you advice on what your options are. I wish I could offer something more specific.

[Luce]

Woah. That is some very, very tough stuff you are going through.
My first question is: Do you have the option of not accepting the inpatient treatment, or do these people have the ability to have you involuntarily committed?
Second question: can you appeal to experts in the field of dissociative disorders? Can you get second / third opinions to counter theirs? I know there is a committee working on the dissociative disorders section in the new DSM - perhaps an email to them could put you in contact with someone who can help.

If I were your therapist I would not want to stay with that agency, that's for sure. Working for people who don't trust or respect your professional judgement is not anyone's idea of an ideal job.

The are differences, but your story is quite similar to my own. What happened in my case was my therapist left her agency and moved to private practice, where I saw her for another 3 years.
I truly hope this all works out well for you. It must be a very scary place to be in right now.

[pachyderm]

Originally Posted by SevenMile

Flash forward to today. Because of the length of time that I've seen the counselor I'm seeing, the agency she works for began to look at my file. Without meeting me and going strictly on what is in my file, they made the determination that I was being inaccurately treated. They stated that my counselor did not provide assessment to assist in diagnosis, even though she had me take the MMPI and MCMI just a couple of years ago. They also did not believe my statements regarding the abuse I went through, stating "if her father is that bad, she would not have contact with him." As a result, they used this information to state that I had borderline personality disorder (as they do not believe DID exists) and feel that I should be placed in an inpatient residential treatment facility where I can receive DBT therapy and then referred elsewhere to a counselor that can more appropriately treat me. In spite of my counselor's objection to their decision, they continue to insist that I suffer from borderline personality disorder even though every test they've had me do (including the MCMI) shows that the borderline scale is extremely low.

On the face of it this sounds to me like malpractice on the part of the agency.

[SevenMile]

Thank you so much for the responses everyone. It at least helps me feel a little less crazy that there are others acknowledging that this is a difficult situation. I mean, it feels really wrong to me what they are trying to do but then I thought maybe it's not if they paint it as being "in my best interest."

To answer some of the questions being answered, here's what I know so far. First, my counselor is very much on my side and wanting to fight them on this decision. She has told me that she believes this decision is coming from them for two reasons; the first, the director of the agency has a personal issue against her (she didn't elaborate) to the point that she has had to seek legal advice on a possible hostile work environment lawsuit, so they are trying to prove that she has been incompetent in her handling of me and second, the publicity of inappropriate treatment toward this other DID client by the therapist in this community has them scared of treating anyone with DID. It is easier for them to label me borderline in order to access services at this inpatient treatment center (they treat women who are borderline or have substance abuse issues, and I have neither) and then send me to another clinic after hospitalization so they can avoid any possibility of liability in the future by treating "someone like me." Of course, the ridiculous thing about all of this is that the counselor who was found to have inappropriate boundaries by the state board with this DID client not only got to continue seeing her current clients but was even allowed to continue seeing this same DID client if it was mutually agreed upon. So the fact they want to see me sent elsewhere at the mere possibility of potential problems (even though there has not been any problems thus far) seems really weird to me. Right now, the best that my counselor is hoping for in the appeal is that they allow me to continue seeing her. However, even if they say I can continue seeing her they are still requiring inpatient treatment. Whether that means they would go through a commitment process, I really don't know. But I'm not sure what grounds they could do that on, considering I'm not a threat to others and though I'm extremely depressed I do not have a history of suicidal attempts or hospitalizations.

As it stands right now, my counselor is fighting their decision but in some ways is relenting on inpatient treatment. Prior to their decision I had agreed to enter inpatient treatment for the purpose of doing intensive trauma work because I want to find a way to stop the little voice in my head that sends me back to my family to be hurt by them. She has told me that, although she doesn't feel it will be particularly helpful to be send to the treatment center they are sending me to because it is not trauma focused at all, she thinks maybe getting out of town and away from the firestorm while the complaint and appeal is being done may be in my best interest. But now that I was given information on this inpatient center and what they do and finding out that I would have to be there at least three months in an inappropriate setting, now I am wanting to back out of this. I mean, being hospitalized (in a lot of ways, involuntarily) in a place that treats people for things I do not need help in really seems like a waste of time to me. I don't need to learn how to stop using drugs and alcohol because I don't have issues with it. I don't need to learn life skills like balancing budgets, things they teach there, because I don't have issues with that either. And I don't need DBT therapy. I'm very familiar with it, until I hit that roadblock I referred to I was in my internship to receive my masters degree in counseling and where I worked I ran a DBT group and trained other staff in how to use DBT with troubled youth. It's not that I don't think I need help; I just don't agree with the help they are wanting to send me to.

Right now, the stance the agency is taking is that I either go to this center they are wanting to send me to or I will not be receiving any services from their agency. In fact, several months ago (before they made this decision) I told my counselor I wanted to again try medication because even if I have not found medication to be helpful in the past I wanted to at least see if it could help my worsening depression and anxiety. The agency dictated who I was "allowed" to see, so last week I saw the psychiatrist that they set me up with. After going, I found out the reason I had to see this guy was because he was the psychiatrist who was part of the committee who made this determination. And the 40 minute appointment for medication help was actually 35 minutes of interrogation and 5 minutes of focus on medication. Those 5 minutes consisted of asking me what I wanted to be put on, and when I told him the only medication I found minimally helpful was Zoloft, he asked me what dosage I wanted to be put on. When I stated that I did not know anything about dosages and what might help, he responded by saying "oh sure you do, you've been at this long enough." Needless to say, the appointment was a joke.

I'm at a point where I don't know what to do. I'm not even sure who to contact in order to find some sort of advocacy on my behalf. Last night I started thinking that maybe I should ask for a second opinion, or to have myself evaluated by someone completely independent of the agency. But I did that, again just a few years ago, and the trauma specialist I saw for several months said that I had PTSD, DID, Depression, and some schizoid features (I'm apparently high on the schizoid scale of the MCMI as well.) I'm also feeling like I'm stuck behind a rock and a hard place though, as I have finally found a counselor I really feel connected with and I feel I am making progress with. And to be given an ultimatum of "go receive inpatient DBT or be forced to stop seeing her"...I just end up wondering if I should listen to them and do what they tell me so that I can at least continue seeing her. It just seems so...wrong.

But this is what I'm struggling with. I seem stuck between not sure if I should fight this (and if so, how to even go about fighting this decision when they seem so intent on staying with their opinion) or if I should just relent and do what they tell me so at least I could hopefully continue seeing the same counselor.

[SevenMile]

I wrote a reply but I think my computer ate it. Oh well, it certainly shows how new to this I am.

Thank you for the replies, it really helps me feel relieved that maybe I'm not crazy in thinking what they're doing doesn't seem right. I'll try my best to answer some of the questions.

First, it seems right now that the most my counselor is hoping for in the appeal is that they continue to allow me to see her. She doesn't agree with the assessment that I have borderline personality disorder, but she isn't really fighting inpatient treatment. Her rationale for this is that prior to their decision we had been talking about trying inpatient treatment for trauma, so that I could be in a safe place to begin working on some of the unconscious messages I have and work through some of the things that are in my past. I was initially hesitant to this but agreed that I would try it. She's also not fighting the inpatient hospitalization by them as well because she thinks that maybe it would be best to have me out of town for a while so that she can continue to fight them so that I'm no longer caught in the middle of this 'firestorm.'

My issue with that is this; the inpatient program they want to send me to I don't feel appropiately addresses the issues I'm having. The treatment is not trauma based at all, but instead is designed for women with borderline personality disorder and/or substance abuse issues. They focus on things like sobreity, how to take care of yourself (ie. managing a budget, applying for employment, daily living skills like hygeine and taking care of yourself, etc.) and DBT. But I do not have issues with these things. I do not have a substance abuse issue, I take care of myself, I am not self-destructive or have impulse control problems. In addition, when I hit the 'road block' that I referred to earlier, I was in the process of completing my internship for my masters degree in counseling and as part of that placement I facilitated DBT groups and taught other interns and staff how to co-facilitate DBT. So I know how to emotionally regulate myself, remain mindful, etc. I think there are aspects that could probably be helpful. But an inpatient hospitalization for at least 90 days? I just feel it's unnecessary and there must be another way.

I just feel like I'm at an impasse and not sure what to do. The agency is insisting I am borderline, even though they've never met me, and they are standing firm that I need to be hospitalized and then sent elsewhere. My counselor has told me that she feels this decision was based on this other case in the community of poor boundaries coupled with a personal issue that the director has with her (which apparently was bad enough that within the last couple of years she had to hire a lawyer to consult on a possible hostile work environment complaint.) In doing so, they've created an environment that feels so toxic that I'm extremely uncomfortable even seeing her right now (they have granted permission for me to see her once weekly until 'appropriate arrangements can be made.') Several months ago I decided I should try medication again, even though I have found minimal success with it. After having an appointment with a female doctor there (I'm more comfortable with women) the agency decided last month that they wanted to dictate who I could see, so they cancelled the appointment and forced me to see this other guy. I was a little frustrated with it but decided I would play along because I really just wanted to get some help in dealing with this worsening depression and anxiety. I saw the psychiatrist they set me up with last week and it was a 40 minute appointment where 35 minutes of it was an interrogation and then 5 minutes was focused on putting me on medication. I found out in the middle of the appointment that he was the psychiatrist who sat in on the meetings and helped in forming this decision about me. Needless to say the appointment was a joke. He even had me "pick out" the medication I wanted to be placed on and then asked me what dosage. When I stated I did not know anything about dosages and stuff like that, he responded by saying "oh sure you do, you've been at this long enough." I left there in tears, as it has become very evident that they are not interested in helping but in getting me out of there by any means necessary.

So I'm feeling quite stuck. I'm not sure if I should continue to fight, particularly the hospitalization as I really don't feel it would be helpful or appropriate to what I need treatment for. I also don't even know how to go about fighting their decision if it seems that what they're doing is wrong. I mean...it feels like what they're doing is wrong, but I second guess myself a lot and wonder maybe it's just me and what they're doing isn't so bad after all. Also, I really have a connection with my counselor and want to continue seeing her. So I wonder if maybe I should just do what they tell me in hopes that "giving in" will allow me to continue seeing her after hospitalization. But even that just feels wrong, to have to go and seek treatment that I know isn't appropriate just to get help. And it still doesn't address the intensive trauma treatment that my counselor and two other trauma specialists have already said I need.

Maybe I should see if I should talk to the ombudsman here, see if there is someone who could advocate for me on my behalf. Or see if it would be possible to have some sort of independent evaluation done. I don't know...

[pachyderm]

Judging solely from what you write, SevenMile, and this is my take only: I do not see why you are so uncertain about this. These people smell to me a mile away. I do not understand in any case why they are so insistent on your having inpatient treatment that would last for several months. My reaction is to get away from these people as far as possible -- especially if you can find some way to keep your counselor.

[Luce]

Sevenmile, I hope you can find the courage to stick to your guns on this. You are pretty clear on the reasons why this proposed 'treatment' will not be helpful for you, and YOU know you far better than these people who have a different agenda do. Their decision making does not seem to be based on 'your best interests' at all, but rather their own ignorance and fear of a lawsuit.

I hope you find a way to not let decisions about YOUR life to be made on that basis.

[wonderingmary]

Originally Posted by pachyderm

Judging solely from what you write, SevenMile, and this is my take only: I do not see why you are so uncertain about this. These people smell to me a mile away. I do not understand in any case why they are so insistent on your having inpatient treatment that would last for several months. My reaction is to get away from these people as far as possible -- especially if you can find some way to keep your counselor.

I agree with Pachyderm that this agency is not working in the best interests of your mental health. But, unlike Pachyderm, I can understand your uncertainty, after having finally found a therapist you can connect to. But I really think that, hard as the decision may be, it would be in your best interests not to consent to the hospitalization. I think the therapist will understand and respect your decision, especially if you tell her how much you appreciate her (which you probably already have done), and that she will try her best to refer you to another therapist. And I would guess that eventually, after this big mess at the agency has been cleared up (which could take a couple of years) or she has switched to another group, you could resume working with her.
I am really sorry you have gotten involved in this big mess that sounds like the agency head letting his ego/personal problems interfere with client best interests. I am sure that the going will be tough for you for a while, but you are clearly a very intelligent person with a good head on your shoulders. Please keep making the effort to listen to that good head to help guide you when your emotions tempt you to do something hazardous (like accepting the hospitalization).

[sunrise]

SevenMile, please don't go to the inpatient treatment when you know it's wrong. You don't have to go. It is very coercive that the agency would try to get you to go by saying you can't see your current counselor anymore if you won't go. They are holding the "carrot" of your therapeutic relationship over your head to coerce you to go. IMO, they are being unethical on many levels. If it were me, I might go speak with a lawyer at a local, free legal aid clinic, such as at a law school. It might be helpful to hear what they say, even if you are not intending legal action. Another source of information and support might be your local chapter of NAMI. They are advocates for the mentally ill, who are a vulnerable population that many try to take advantage of. Here is the national site for NAMI:
http://nami.org

wow, i am so sorry for the situation you have been put in. i definitely wouldn't consent to hospitalization where they are just trying to force you into another diagnosis that doesn't fit. it doesn't make sense to go just to get out of the firestorm either. that would be a waste of your time and the hospital's time & resources to help people who really need their help. it doesn't sound like there is any guarantee that even if you went to the hospital the agency would continue to let you see your therapist afterwards. have you talked to your T about the possibility of seeing her outside this clinic in a private practice basis even if you're her only private client?

someone posted this link here awhile ago tell: therapy exploitation link line. the resources section looks particularly good. i do think you would benefit by talking to a lawyer that specializes in these sorts of cases if you can't somehow see your T outside this agency. of course there is also the option of finding another T but i can totally understand why you wouldn't want to do that. i do think either fighting this or switching Ts is a better option to being manipulated by this agency.

Seems to me the agency is using you to carry on its vendetta against your counselor. My thought is for you find a different therapist.

I also think you should talk to the ombudsman about the procedure for filing a complaint against the agency for what I perceive as the unethical manner in which you case is being handled.

Good luck.