[tinker10]

A new therapist told me she requires that I give her consent to talk to my psychiatrist in order to treat me. Not because I have something especially wrong with me or have demonstrated any kind of instability. My meds are under control for years and I'm voluntarily seeking therapy for childhood issues. And we just met. She knows nothing about me or my reliability.

This strikes me as paternalistic and intrusive and implies from the get go that I can't be trusted to know myself or be truthful and forthcoming in therapy. Honestly, it strikes me as kind of controlling. She is asking me for a great deal of trust, since I would be allowing her to communicate with my psychiatrist at her discretion, while at the same time she's telling me I can't be trusted to communicate with her. This seriously rubs me the wrong way.

She claimed that this was simply the proper standard of care, and patients felt empowered by being compelled to sign off on this and have various caretakers communicate. She said that any therapist I went to would demand the same thing.

In this situation I would feel "managed" and inappropriately out of control of my care.

Is it true what she says, that anyone who's anyone is handling things like this? Is this a new trend? Has it been codified somewhere? I have been to other therapists and this has never been true. I'm not going back to her because she's kind of a weirdo in other respects. But I'm curious about potential other new therapists and their potential positions on this. What are your experiences?

[autotelica]

I find it a little strange that she makes it a requirement, but I understand the desire to have access to your psychiatrist (and vice versa). The two are functioning as your mental health "team"--treating your issues with different strategies. Sometimes those strategies can conflict.

My pdoc and psychologist are not on the same page right now. The former thinks I'm riddled with anxiety. The latter thinks I'm fine in this department. If my pdoc keeps insisting I'm feeling emotions that I swear I'm not feeling (which is the height of rudeness...but I digress!), I'm going to ask that my therapist contact him so she can straighten him out. She knows me a trillion times better than he does. In my opinion, it would be irresponsible for him to NOT consult with her over something like that. There have also been times when my therapist felt I needed a change in my medication and in those cases, I gave her permission to kibbutz with my pdoc. Always with good results.

There is a little "cat and dog" hate between the two professionals, I think. But like I said, I trust my therapist much more than I do my pdoc. I think some therapists probably like playing the heavy for their patients (mine would be one of them!) So your therapist may be used to playing this role. But I think you should be able to tell her it's not necessary if you don't want her to.

Where do you live? I'm in the Midwest and here, no one can compel you to sign a release to get treatment. It might be an individual psychologist's policy, but it's certainly not ALL psychologists policy. I have seen three psychologists and never had to sign a release.

I choose to have my T talk to my doc, and for the most part it has been helpful.

yeah, but that's a CHOICE, Lola. I made the same CHOICE once, but I would also resent being told I HAD to sign.

Originally Posted by My kids are cool

yeah, but that's a CHOICE, Lola. I made the same CHOICE once, but I would also resent being told I HAD to sign.

sorry, I know it was a choice... I too would n't like being forced into it. I just wanted to let the OP know its not necessarily a bad thing, they choose to do so.

[elliemay]

Originally Posted by autotelica

I find it a little strange that she makes it a requirement, but I understand the desire to have access to your psychiatrist (and vice versa). The two are functioning as your mental health "team"--treating your issues with different strategies. Sometimes those strategies can conflict.

My pdoc and psychologist are not on the same page right now. The former thinks I'm riddled with anxiety. The latter thinks I'm fine in this department. If my pdoc keeps insisting I'm feeling emotions that I swear I'm not feeling (which is the height of rudeness...but I digress!), I'm going to ask that my therapist contact him so she can straighten him out. She knows me a trillion times better than he does. In my opinion, it would be irresponsible for him to NOT consult with her over something like that. There have also been times when my therapist felt I needed a change in my medication and in those cases, I gave her permission to kibbutz with my pdoc. Always with good results.

There is a little "cat and dog" hate between the two professionals, I think. But like I said, I trust my therapist much more than I do my pdoc. I think some therapists probably like playing the heavy for their patients (mine would be one of them!) So your therapist may be used to playing this role. But I think you should be able to tell her it's not necessary if you don't want her to.

Situations like this illustrate why having these two professionals communicate with each other is a good idea.

In my opinion, a good idea is a good idea, whether it's rubs me the wrong way or not.

It's about picking your battles here really - and there are so many legitimate battles to fight.

I'm just not sure this is one of them.

Now, if your therapist wanted to talk to your family or something.... that's a different story. that's a fight I would take on, or simply refuse care.

[stopdog]

I would not see one who had "requirements". I do not have an md at all so there would be no permission for me to give, but if I did, I would not.

[Anne2.0]

In general for the past 20 or so years, there has been a great deal of research work on "collaborative" care or management models in mental health work. If you google collaborative mental health or psychiatry or psychology or the like, you'll find all kinds of research studies. When I was in law school 20 years ago and ran around with a bunch of clinical psychology students, they talked about this all the time, and they still do, and some of the people that are still my friends work in what many consider to be innovative programs and projects that emphasize a model where various treatment providers (including MD's who are not psychiatrists, in the case of people with chronic pain or disease, including cancer, fibromyalgia) all work together and share information. The idea is that increased communication between providers (not really a paternalistic checking up on) actually helps patients and there is research suggesting that this is true. One person explained it to me like this, for example: the psychiatrist, in a case meeting, reported that he noticed that client X seemed much less anxious and self reported fewer anxiety symptoms after her therapy sessions were increased to 2 times per week. The pain intervention specialist said that the client was able to skip a nerve block shot because she was experiencing less physical pain during this same period.

You might experience this from other therapists, but it is far from the norm. Personally, as a professional who often works with other professionals, I find that collaboration is always better than everyone p*ssing around his or her individual turf, and that the professionals who enjoy collaboration are among the best that I have ever known.

I could see how you might respond reflexively rather than reflectively to a per se policy, however. I typically get my back up at suggestions that I *must* do one particular thing. Then I was diagnosed with a medical condition that really had only one option, and that has helped me understand that sometimes a "must" can actually be, as elliemay said, a good idea. I think that the problem with this approach for you is your interpretation that its purpose is somehow negatively tinged-- but it is you that is putting this spin on it. I have found a lot of value in reflecting upon more information and time on the choices I am thinking about making.

[learning1]

If your meds have been stable for years and the reason you're seeking a psychologist doesn't have to do with that right now, it doesn't make sense to suddenly require you to sign away your rights to privacy I think. If there was a reason for them to communicate in the future, you could always allow it then.

I would resent it being a requirement for sure. When I first told my pdoc I started seeing my t, (well he knew I was going to see one but I ended up with a t not on the list he gave me) he asked for her name and number and I gave it to him. I told t that I gave him her card and asked if he'd called her, and she said no, but even if he had, she wouldn't be able to discuss anything about me without my written consent. I said it didn't bother me and I'd sign if she thought it would be helpful. But she said as far as she was concerned, he was managing my meds fine and she didn't see any reason to talk to him unless I wanted her to specifically.

[adel34]

The community mental health center I go to is big on colaboration. You have the case manager that writes the treatment plan and is the client's main point of contact. Then their individual therapist, therapists that run groups, psychiatrist, and primary care doctor. All of these resources could potentially be accessed right in one place. I have therapy, groups, and starting next week, will have my primary health care at this place. When I did my intake, they encouraged me to sign many releases, both for everyone at the center to communicate with one another, but also for them to communicate with past treatment providers, social security (I'm on SSI), the residential facility I live at, ETC. They did not require it, but said that if I didn't sign the releases then it would be much harder for them to treat me.
I felt comfortable with this, because I know they just want to be as helpful as possible.

[critterlady]

My T asked me at our first meeting if I would allow him to talk to my PCP (who was handling my meds at the time). I signed because I thought it was a good idea, but he didn't require it as a condition of my therapy.

Since the, I started seeing a pdoc for my meds and neither one has asked to speak with the other. I'd be okay with it, but they both seem happy to continue independently with me keeping both of them in the loop.

My T and Pdoc have always had my permission to consult with each other on my care, but they haven't had to do it very often. It's not like they'll be on the phone every other week talking about you. This is mainly in the case you do become unstable/unsafe and they need to collaborate in order to best help you through a crisis.

Generally, any time my T has called my Pdoc, or vice versa, I've actually been sitting right there in the room and could hear their discussion. It isn't a conspiracy against me; they simply have my best interests in mind and it is incredibly helpful for them to be on the same page. I've seen them both for about 8 years now, and this has only happened 4 or 5 times in all these years. It is NOT a common event.

It is quite common and general beneficial for caregivers to collaborate on a patient's care these days. My husband's doctors consult regularly concerning medications, treatments, surgeries, etc. to be sure they are providing the correct and best medical treatment for him. Personally, I feel fortunate to have a T and Pdoc who choose to work with each other on my behalf; their collaboration has kept me safe and on a path on continual improvement.

Perhaps you can reframe your thinking about this as allowing your doctors/therapists to work WITH you as a team rather than thinking about it as a loss of control.

[tinker10]

I can see that if collaboration works well then it can be a very good thing with providers sharing information in a way that benefits the patient.

I have had a bad experience with collaboration. I had a mysterious illness for several years (the mystery has since been solved) and collaboration between my doctors meant that two or more of them concluded that I was crazy and that there was nothing really wrong with me (there was). That diagnosis of malingering was put into my medical record for everyone to observe, and I had a hard time after that finding a physician to take me seriously.

My educational background is such that I can understand any illness or treatment in virtually as great a level of detail as a physician.

All of this makes me very wary of being managed by doctors and other providers who hold conversations about me in my absence. The connection of therapist, with whom I will share some pretty private stuff, to physician makes me especially wary.

A therapist would have to earn my trust in order for me to sign that paper, not just demand that I sign the second we met.

[wotchermuggle]

This is called giving informed consent. Since you have to okay it, it's totally up to you. Any therapist I have seen has started out with NO CONSENT, until I felt comfortable giving it. If you don't want to, then tell her so. Not every therapist requires this.

[stopdog]

If it were me, I would simply find another one to go to and not mess with this one.

[wotchermuggle]

Originally Posted by tinker10

A new therapist told me she requires that I give her consent to talk to my psychiatrist in order to treat me. Not because I have something especially wrong with me or have demonstrated any kind of instability. My meds are under control for years and I'm voluntarily seeking therapy for childhood issues. And we just met. She knows nothing about me or my reliability.

This strikes me as paternalistic and intrusive and implies from the get go that I can't be trusted to know myself or be truthful and forthcoming in therapy. Honestly, it strikes me as kind of controlling. She is asking me for a great deal of trust, since I would be allowing her to communicate with my psychiatrist at her discretion, while at the same time she's telling me I can't be trusted to communicate with her. This seriously rubs me the wrong way.

She claimed that this was simply the proper standard of care, and patients felt empowered by being compelled to sign off on this and have various caretakers communicate. She said that any therapist I went to would demand the same thing.

In this situation I would feel "managed" and inappropriately out of control of my care.

Is it true what she says, that anyone who's anyone is handling things like this? Is this a new trend? Has it been codified somewhere? I have been to other therapists and this has never been true. I'm not going back to her because she's kind of a weirdo in other respects. But I'm curious about potential other new therapists and their potential positions on this. What are your experiences?

I'm concerned that she said that any other therapist would ask the same thing. Don't get pushed around. You're paying for a service remember.

I think (due to experience both as a client and as a provider) that many therapists will ask a client if they are willing to sign an agreement for communication between the people providing their services. I am torn on this issue. I think that "hidden" or "secret" commuication is harmful and paternal.

When I was asked this question by a therapist, I said that I'd sign the agreement with provisions. Of course he asked what the provision was. After signing the agreement, I wrote below my signature this statement: Dr. . .. . has my permission to contact Mr. . ... MSW, my former therapist to discuss issues related to my treatment and possible changes in the direction of my therapeutic ttreatment. HOWEVER, this conversation is NEVER to take place without me being being present. They will conduct this conversaton by conference call and they agree that I will be a contributing member of this converstation.

Many people say, "Well, why would they ever really talk trufully about what what they think or feel about your treatment if you are listening in?" Guess what I say? "Why would anyone AGREE to have a conversation happen without them being a present and contribuing member

People . . .do you really believe or think that people who are providing your care should be allowed/permitted to talk about YOU without you having imput on the information? If a person who is treating you truly believes/ is invested in the diagnosis that they are advocating for, why in GOD'S NAME WOULD they believe or think that you shouldn't hear or be a part of that converstation????

[autotelica]

Originally Posted by Jaybird57

Many people say, "Well, why would they ever really talk trufully about what what they think or feel about your treatment if you are listening in?" Guess what I say? "Why would anyone AGREE to have a conversation happen without them being a present and contribuing member

People . . .do you really believe or think that people who are providing your care should be allowed/permitted to talk about YOU without you having imput on the information? If a person who is treating you truly believes/ is invested in the diagnosis that they are advocating for, why in GOD'S NAME WOULD they believe or think that you shouldn't hear or be a part of that converstation????

I wouldn't want my therapist saying any ole thing to my pdoc. And usually, she does call his office when I am sitting beside her so that I can weigh in on the conversation.

However, sometimes she can't reach him when I am sitting beside her. It doesn't freak me out to know that she and the pdoc talked about me at their convenience, because both are kind enough to fill me in on what happened later. And I trust my therapist to represent my interests. If I feel like she got something wrong, I can tell her so.

I would prefer that I be included in all the conversations, but sometimes this just isn't possible. So no, for me it is not a requirement. I guess I'm either too trusting or indifferent to get wound up about who said what when.

[feralkittymom]

If I trust a therapist while in the room, my trust doesn't diminish when outside the room.

[~EnlightenMe~]

I did have collaboration between my Pdoc, my xT, and my PCP, but I chose to let them exchange information, and I did appreciate it. I haven't been in therapy long enough with my new T to even think about it, but I tell him what meds. I am on, and my health issues. I trust them, so if they needed to collaborate, it wouldn't be an issue for me.

However, I think that not having a choice feels intrusive.

Maybe you can decide for yourself, if she had asked you what you thought about signing a consent form and had explained the reason why, do you think you would have done it? Do you prefer that your T doesn't talk to your Pdoc? Can you take the intrusiveness of not having a choice out of the decision process whether you would be okay with this or not? Then, go with YOUR choice?

Just a thought. Let us know how it goes

I would prefer that I be included in all the conversations, but sometimes this just isn't possible. So no, for me it is not a requirement. I guess I'm either too trusting or indifferent to get wound up about who said what when.[/quote]

I agree with you. Sometimes, especially during emergency or crisis situations, there isn't time to plan a conference call. But you know what? In most situations, at least most day to day therapeutic situations, there is time to plan and implement a conference call. As a provider, I KNOW how much more comfortable it is to talk without the client present. But guess what? Much more is accomplished if everhone is on board!

You know what the difference was between my current therapist and my previous therapist? My current therapist told me that she would NEVER call any other provider without me being in the room when she made the call AND she insisted on me making that a stipulation on the signed consent. What a relief that was for me. What a lifting of a trust issue.

[feralkittymom]

As a provider, I KNOW how much more comfortable it is to talk without the client present. But guess what? Much more is accomplished if everhone is on board!

Your assumption that everyone would not be on board unless present feels paternalistic to me . And if you are more comfortable talking without the client present, again, I think this reflects more upon your concept of yourself as a provider than necessarily about your clients.

Would you mind specifying what kind of provider you are?

Originally Posted by feralkittymom

Your assumption that everyone would not be on board unless present feels paternalistic to me . And if you are more comfortable talking without the client present, again, I think this reflects more upon your concept of yourself as a provider than necessarily about your clients.
Would you mind specifying what kind of provider you are?

I guess I'm confused about why you would think that someone who wants to be "present" during personal/treatment orientated conversation is being demanding or unrealistic. Being a part of our treatment plan is critical in all forms of mental health care. Unfortunately, that isn't the case in many situations. Clients are included in the "team meetings" but there are "AFTER" team meetings" where the clinicians REALLY talk about their prejudicies. Personally and professionally, I feel no hesitation to talk to the teens and/or their families about what I feel is going on. BUt when clinicians ask for "blind" confidential agreements than I think that they are the ones who are not being honest. Just my take on the situation.

Being PATERNALISTIC means allowing others to manage or upsurp personal responsibiity. I gently suggest that you look up the definition of Paternatisitc when it comes to making personal decisions.

The term paternalisic means that an individual feels that other people are acting "parental" in their interest toward them. I don't know about you, kittyferalmom, but I don't want anyone acting PARENTAl toward me in any conversation that regards my mental and/or medical care!!! I'm sorry if my experience doesn't match yours. Take care and I hope you find what you are looking for.