[TinaL]

So, my therapist is trying to introduce a new case management program in the clinic and to the clients.
Since, I might be needing some services he said for example: Since I have social phobia.. so instead of meeting in the office we could meet at a restaurant and have a session.
I have mixed feelings about this. It doesn't feel right...it feels like mixing something that might not be there, be there... It seems to personal..

Ok, I will say it. It's not a date! Why would I want to be outside the therapeutic office with the T?
Isn't that a way to cause some issues... I don't know.

Comments!!

[googley]

If you don't want to do it, say so. I also would not want to meet my T outside the office. Your T should respect your wishes. I'm sure he'll understand.

Therapist who utilize case management techniques and use rehabilitation, often do things out of the office as a way of building social skills.

Now, even tho I have certification in case management, my agency will not allow me to do things like this with clients. They say it's not within the "therapist's" role to do so.

I can see how it can certainly be therapeutic and useful... As a client, I can also see how it's awkward. But I've been 'out and about' with my T. And once you get past the awkwardness of being out and about with T, it felt kind of nice for me. To have them see me outside of the office to give me real-life demonstrations of how to manage social stressors, etc.

[TinaL]

I understand stormyangels what you're saying. And, my fear is what needs to be worked on. To be clear, I would not want to meet anyone... T is a safer person to starting that..
So, I am afraid of social situations. T and I have discussed this. He says it would be an extension of the therapy I already get in the therapy office.

[Omers]

I had one T that would meet with me about once a month for lunch. It was a really wonderful experience for me and very helpful. She was trying to understand my PTSD and how I tried to keep myself safe.
Another T and I met for breakfast once a little while after our last session. That too was a really good experience for me.
Massage T and I went to a park together once. We talked about the different flowers and she taught me about some of the other plants. We also just sat on a log next to each other watching a stream go by. It is a treasured memory.
Oh, and I went to a conference with a T once! That one was a little weird. It was a conference on depression and about half of the people there knew her. She introduced me as a student she was mentoring... which was partly true... she did help me a lot with my psych classes.
It isn't anything you would have to do until you were ready. For me, the conference was 'blah' but all the other experiences were really helpful.

My therapist and I are constantly outside her office. We go to the park, go to eat, get ice cream, go for walks, things like that. It has helped SO much more than just sitting in a small office and talking face to face. It has improved my social skills a lot, my interpersonal skills a lot. It might be a scary thing to think of meeting your T outside the office, but what if you just gave it a try once or twice to see how it goes?

[TinaL]

I like the comments and you all are making me see a little of your world in this context. It would be a huge challenge for me to take this on. Is it enjoyable for the T and what do they get out of it?

[my3sns]

I met mine at a park once to allow "little lisa to pkay"

[Wren_]

I imagine they get the joy of seeing a client growing and healing and being able to adapt to new situations and experiences? seems that's part of what they would get out of it anyway I wish I could do something like that with my T, I hope you try it and that it helps you.

[PTSDlovemycats]

Why don't you bring this up with your T? Let T know your thoughts and concerns...

[TinaL]

Yes, I will but he only brought up on Thursday

[Omers]

They get out of their office too! I know that I nice days I can sit in an office and long to be outside. I know in therapy I long for things to be more "normal". I can't help but think that T's have similar feelings.

[Butterflies Are Free]

I once asked my T if she would go with a walk with me(in her neighborhood) because I had seen her do it with another client. It was nice. We both enjoy nature and I liked the fact that we were just walking together like regular people.

Originally Posted by TinaL

Is it enjoyable for the T and what do they get out of it?

This is for *you*, not T. It is a way to help T help you learn and grow and heal. It doesn't matter if they enjoy it or get anything out of it, any more than it matters if they enjoy sitting in their office or get anything out of it.

I like to think that good T's DO enjoy their work, and my T has told me how much our work together has helped *him* grow, but that's not the point. My therapy is about ME, and your therapy is about YOU. THAT is the point.

As for seeing T outside of the office....it's really hard for me to imagine. My guess is it would feel awkward at first, and then okay. My T only does therapy in his office, though, so I guess I'll never know for sure!

I'm guessing that casemanagement works much differently in my area. Here, casemanagement is more about helping a client access services, coordinating the different services and providing advocacy and support. It really doesn't have anything to do with providing indepth psychotherapy. I'm not saying that some therapists don't "get out of their offices" for real life situations. Just think about therapists who work with people with agoraphobia--they often take their clients into the community to do exposure therapy.

A casemanager might take a client into the community to expose him/her to social opportunities or teach him/her how to access a certain service, but it really isn't anything like indepth therapy. And it isn't a weekly thing. Recently the casemanagers in my area were told that they can no longer provide "direct services". For example, the casemanagers often took a client to a doctor's appointment, but now they can only help the client make arrangements to get to their appointment (all due to my State's severe fiscal problems and aren't about to change back again). Clients often receive traditional psychotherapy and also have a casemanager, but they frequently only get therapy every other week rather than weekly unless he/she pays privately.

I work with children who have severe mental illness, and they might receive an intensive casemanager (ICM) for a period of a year or so. The ICM makes sure that all the individuals (individual psychotherapist, psychiatrist, pediatrician, school personnel, respite workers etc) working with the child and family are on the same page. This program is also available for adults with severe mental illness, but it doesn't mean that the individual doesn't also have a therapist who deals with the mental health issues, unless of course, it's determined that the individual doesn't benefit from individual therapy and then he/she receives groups on developing coping skills and crisis intervention but NOT individual psychotherapy. I wonder if your therapist is suggesting a different model than this one?

Originally Posted by TinaL

So, my therapist is trying to introduce a new case management program in the clinic and to the clients.
Since, I might be needing some services he said for example: Since I have social phobia.. so instead of meeting in the office we could meet at a restaurant and have a session.
I have mixed feelings about this. It doesn't feel right...it feels like mixing something that might not be there, be there... It seems to personal..

Ok, I will say it. It's not a date! Why would I want to be outside the therapeutic office with the T?
Isn't that a way to cause some issues... I don't know.

Comments!!

For me the problem would be that I am a female and my T. is a male and we are both married. It would feel way to ackward. What if we saw people who knew us? What would they think? I wouldn't want to have to explain who he was. Now I don't have social anxiety issues so I would see no reason for this. So it would be a boundary issue for me. Now my T. said to me that he would like to see me in social situations. That it would help him...help me. He suggested I go to a group therapy session he has.

[TinaL]

Originally Posted by Jaybird57

I'm guessing that casemanagement works much differently in my area. Here, casemanagement is more about helping a client access services, coordinating the different services and providing advocacy and support. It really doesn't have anything to do with providing indepth psychotherapy. I'm not saying that some therapists don't "get out of their offices" for real life situations. Just think about therapists who work with people with agoraphobia--they often take their clients into the community to do exposure therapy.

A casemanager might take a client into the community to expose him/her to social opportunities or teach him/her how to access a certain service, but it really isn't anything like indepth therapy. And it isn't a weekly thing. Recently the casemanagers in my area were told that they can no longer provide "direct services". For example, the casemanagers often took a client to a doctor's appointment, but now they can only help the client make arrangements to get to their appointment (all due to my State's severe fiscal problems and aren't about to change back again). Clients often receive traditional psychotherapy and also have a casemanager, but they frequently only get therapy every other week rather than weekly unless he/she pays privately.

I work with children who have severe mental illness, and they might receive an intensive casemanager (ICM) for a period of a year or so. The ICM makes sure that all the individuals (individual psychotherapist, psychiatrist, pediatrician, school personnel, respite workers etc) working with the child and family are on the same page. This program is also available for adults with severe mental illness, but it doesn't mean that the individual doesn't also have a therapist who deals with the mental health issues, unless of course, it's determined that the individual doesn't benefit from individual therapy and then he/she receives groups on developing coping skills and crisis intervention but NOT individual psychotherapy. I wonder if your therapist is suggesting a different model than this one?

I am not really sure how to answer this. But I do suffer from agoraphobia. It has not gotten as bad as it was in 2004. But, I really have a hard time getting out without my panic getting me.
This is what T wants to help me with. That was the one example he gave me in concordance with the case management.

[TinaL]

Originally Posted by Readytostop

For me the problem would be that I am a female and my T. is a male and we are both married. It would feel way to ackward. What if we saw people who knew us? What would they think? I wouldn't want to have to explain who he was. Now I don't have social anxiety issues so I would see no reason for this. So it would be a boundary issue for me. Now my T. said to me that he would like to see me in social situations. That it would help him...help me. He suggested I go to a group therapy session he has.

I don't think I would have that problem. But, I would just be nervous around people... a group is a good idea. I am not sure T has the time to do that. I can always suggest it tho.

[sunrise]

Tina, is your therapist also your case manager? If so, I think this is not uncommon. I think case managers often meet off site with their clients. Recently, I did an internship at an agency and each client had a case manager who was also their therapist. The case managers/therapists would sometimes meet the clients at their homes, at restaurants, at the mall, or even went to a baseball game. They went a variety of places. It helped the case manager see the client out in the "real world" and know better what they needed help with. They could see better how the client functioned than in the agency office. (That is what the case manager gets out of it.) Or if the client was not getting out because they were intimidated about using the public transportation system, the T would go with them and practice riding the bus. I think it can be helpful to some clients. Even if you just have a regular therapy session in a new location, it can help give you a "new view" on your problems, just by changing the scenery. At my last session with my T, we went on a walk in a lovely area, and it was just what I needed. We sat on a bench for a while and talked and watched the passers by; it was just what I needed.

If you feel uncomfortable meeting your T outside of his office, could you tell him? He probably would like to know and would respect your wishes.

My T has said several times that she likes being outside and doing thigs more than being in her office. She also has said several times that she likes seeing all the progress we've made since we started doing the outside stuff.

[unaluna]

My t is in a hirise, and I would feel horrible and awful and lonely as soon as I left his office, which was right next to the elevator. Once he came out the building front door right after me, and asked me which direction I was heading. I was speechless, I hadn't made up my mind yet, but I wasn't going to turn down an opportunity to walk with him! So we walked arm in arm half a block to the corner then went our separate ways. Next session I told him how awkward it was for me, that I had just grabbed on for dear life! Another time he was leaving a nearby coffee shop shortly before my appointment and I called out to him and again we did the arm in arm thing, this time much more comfortably. I expect the next time I see him outside or at the elevator I will just be normal, as I feel much better leaving both the session and the building.

[TinaL]

Originally Posted by sunrise

Tina, is your therapist also your case manager? If so, I think this is not uncommon. I think case managers often meet off site with their clients. Recently, I did an internship at an agency and each client had a case manager who was also their therapist. The case managers/therapists would sometimes meet the clients at their homes, at restaurants, at the mall, or even went to a baseball game. They went a variety of places. It helped the case manager see the client out in the "real world" and know better what they needed help with. They could see better how the client functioned than in the agency office. (That is what the case manager gets out of it.) Or if the client was not getting out because they were intimidated about using the public transportation system, the T would go with them and practice riding the bus. I think it can be helpful to some clients. Even if you just have a regular therapy session in a new location, it can help give you a "new view" on your problems, just by changing the scenery. At my last session with my T, we went on a walk in a lovely area, and it was just what I needed. We sat on a bench for a while and talked and watched the passers by; it was just what I needed.

If you feel uncomfortable meeting your T outside of his office, could you tell him? He probably would like to know and would respect your wishes.

Yes, T would also be my case manager.

[TinaL]

I know T will respect my wishes if I choose not to do this. But, I think it's worth exploring it more and talking more about it before I decide.