Bloody Ethics

MLS,

I am sorry if what I will say is not helpful to you, but this sounds to me like one of those threads you post as sort of a defensive reaction to posting something positive about your therapist.

My T and I have had "termination" conversations, but it doesn't mean that we are in fact terminating. I think my T occasionally brings it up to see how I am feeling about the issue, it's sort of a touchstone for how therapy is going. At least one of your previous posts mentions how it is impossible for you to tell your
T certain things or talk about your feelings. But as the client, your responsibility here is to ask your T to explain what she means.

I have to agree with scorpio's response. It's not unethical to see a client once a week for a year.
It sounds more like she finds herself not keeping boundaries with you, maybe because she is found of you and sees the attachment growing and she is worried about this. However it is her job to maintain boundaries and really she needs to explain what is unethical - does she feel she is encouraging an unhealthy attachment of some sort? Again this would be her issue and you really need to discuss with her how you feel and find out what it is that she thinks is unethical.

here where I live and work we are supposed to terminate if the client is not progressing..

I work at a crisis center where the treatment is .....supposed .....to be short term...last no longer than about 6 months at the most..

we hold meetings where in part we evaluate the clients willingness to do the work and their progress on their goals...if there is no willingness to do the work or there is no progress being made on their goals then we terminate the client.

one because you cant force someone to work on their problems if they do not want to

two sometimes no progress means theres more issues then we can deal with, that the client needs are those that need long term treatment options like a different treatment provider on some insurance plans clients dont have the option of having more than one mental health treatment provider..so in order to get them the help that they need we have no choice but to terminate so that their insurance will allow them to seek out a new treatment provider better suited for their problems.

three sometimes lack of progress means the client needs longer term mental health treatment of an inpatient facility or specialized program facility..

four we have a waiting list literally ten plus pages long.. we cant get to those that need and want our services if we continue to waste time on someone that isnt progressing for any of the above reasons.

five sometimes a treatment provider or a client will feel the need to terminate for personal reasons...example at one point I was having PTSD issues as a result of a work related trauma.. I ended up having to terminate with some clients who showed a homicidal wish/tendency/or statements even when it was stated in jest or to get the point across, it still activated my PTSD issues around that work related trauma. for my own sanity and stability I could not work with those kinds of issues until I had my personal life back on track.

six sometimes we terminate when we see a client is not progressing because they have developed a dependancy/or crush on the therapist. it is so easy to fall into the trap of believing a therapist will fix the problem or fall in love with a therapist. we are not doing the client any good by promoting their dependence on us. therapy is meant to be a tool to help the client gain more independence and stability with .....their...dealing with their problems.

there are many more reasons where it is ethical for a therapist to terminate treatment for example...

the person has met all their goals/solved the problems they came in with and so their coming to therapy becomes just a habit on a friend level not a client therapist level,

conflict of issues...treatment providers here must terminate if they accidentally end up in a situation where a client isnt progressing because there is conflicting /head butting/ fighting/ clashing of feelings between the treatment provider and the client...

insurance reasons...many insurance plans will only allow a set number of therapy sessions, sure sometimes a treatment provider can advocate for the client and ....apply....for more sessions, but that doesnt necessarily mean they will get the more time with their treatment providers. especially if the persons insurance is medicaid or medicare..

financial difficulties...sometimes treatment providers terminate with a client when they have gotten behind in their payments...its expensive to be in therapy and its expensive for a treatment provider to provide all their services..it is not always helping the client if seeing them is just making their financial burdens worse.

even our local hospitals mental health unit terminates with a client due to things like their meds are on track, they have completed their goals, they are no longer a danger to their self or others, they need longer term care in the state mental hospital facility, their insurance has a cap of how many sessions they are allowed,

I could go on and on with all the different reasons why its ethical/ok for a mental health treatment provider to terminate treatment here in the USA...

She actually said I think it would be unethical for me to see you once a week anymore and that we should try wind it down. Things are different here and I think questions are raised if you see your therapist for a long time.

You know Scorposis, today I actually thought a lot about this and I think that she herself is uncomfortable with her own behavior. We are very close and she told me that she wants to see me everyday but she can't and she misses me when I don't see her. We are more like friends than anything. I know everything about her family. The last appt went over by 45 mins because we talk so much and I think that t herself is worrying about her own behaviour. She knows that I am training to be a t so we talk a lot about that, she often wants to hug me. I think because I am in training she thinks that we are friends
Thank you GTGT
I just wish that this wasn't happening to me again. the last t did this too after a year and actually t is old ts supervisor so maybe she told old t to terminate me too.

I just read through that link and it does sound like my t is following the ethic guidelines as she is cbt orientated; which means she is time limited. I think our relationship has moved beyond a therapeutic relationship and she is worried about that.

She said that it would be unethical, she said that she sees a vast improvement in me.She said she feels like she would be just taking my money but she asked if I have seen improvements and I said yes, a lot and then she said we should start to wind down and maybe see her once a month. I agreed because I want to see how I get on away from therapy for a month but then I want to go back to seeing her once a week but t will probably not allow that now because she thinks she is being unethical.

Your post is helpful Anne
I need constructive criticism here. I do feel like I can't talk to her about certain things and maybe that is because we are too close.
I agreed to taking a month of to wind things down so I suppose I could have said t I need to see you as I think I still have lots to work on, the words were there but again they would not come out.

maybe t feels she is getting too attached to me?

She said that it would be unethical, she said that she sees a vast improvement in me.She said she feels like she would be just taking my money but she asked if I have seen improvements and I said yes, a lot and then she said we should start to wind down and maybe see her once a month. I agreed because I want to see how I get on away from therapy for a month but then I want to go back to seeing her once a week but t will probably not allow that now because she thinks she is being unethical.

Obviously it's quite plausible that there are other things going on behind this (what you and others have stated), but just going on what she said (above), it sounds like what she means by 'unethical' is continuing therapy when you are well enough to do without it. It is actually considered 'unethical' to do this, therapists are supposed to check in with you, and when you're well enough to not 'need' the therapy anymore, the goal of course is to wind down.

So this is what I see from the above, nothing more, nothing less.

However, as I say, there may well be other issues behind this that she did not share. But as it seems she didn't mention the friendship thing, etc., I think it's important that you check in with her about that, to make sure that that's the case. At the moment it seems you are making this assumption, but she has not said as much. Maybe she's fine with the nature of the relationship she has with you, but sees that you've improved a good deal, enough to wind down therapy -who knows.

I have a feeling you're going to say you don't feel comfortable asking her this (or some version of it) , but it would be the only way to know for sure.

She did say at the end, she was not abandoning me but it feels like that, it feels like everything was not real between us. My depression is gone thanks to t but I still have lots of other things going on that we barely talked about.
You know maybe I should have just pretended that I was not ok
I will ask her when I see her next, this just came out of the blue, I think I am in shock. I think that we will see each other at events and social meetings now we are both in the same profession and maybe she wants to distance herself. This is only speculation but I can't help think up excuses because I feel abandoned again.

Do ask. You need to know what her reasons are vs speculation.
Also, let her know she has helped a great deal but you have more to work on and would appreciate a referral to another t. to deal with these issues.
But DO have her explain her decision, otherwise you are left forever speculating. It is an abandonment when it is not a mutual decision, sorry but I think she needs to own that one. Sometimes we have to abandon places, even people, for our own reasons, but it doesn't make it "not" just because we say so or convince ourselves otherwise.
From what you have written, it could be she has personal feeling for you that she feels will interfere with treating you further. In that case, termination is necessary. Or, as someone else suggested, length of therapy is a factor in her particular school of therapy. Or, something else. No matter what the reason, you are entitled to be told the reason in a way you can understand; you may not agree or prefer to imagine but that seems unhealthy.

I'm sorry you're going through this - there's nothing unethical about seeing a client once a week, and personally I think there's sometimes an unrealistic attitude about the length of time needed. I've been in therapy for six months and barely got started.

However, I also think it sounds like your T is behaving quite unprofessionally in terms of some of the things she's saying and doing, e.g. going over time, saying she'd love to see you every day. I really don't know what she's playing at, to be honest, and I think you deserve better care.

I don't mean to sound like a victim here but this has happened twice with me, I got close maybe too close to these two therapists and they got scared and ran for the hills screaming termination. I am losing faith in therapy and therapists.
I have huge abandonment fears, everyone leaves me including these, I open up my wounds for them to rub salt in them.
It feels like she is drawing me in and spitting me out

I'm sorry Monalisa. This sounds so painful and I have felt similar to your statement:
From what you say, I keep thinking she has some kind of countertransference thing going on at her end. It sounds more like SHE is the one having trouble continuing the relationship rather than anything that you have done. Hope your next session will shed some light on this for you.

I don't mean to sound like a victim here but this has happened twice with me, I got close maybe too close to these two therapists and they got scared and ran for the hills screaming termination. I am losing faith in therapy and therapists.
I have huge abandonment fears, everyone leaves me including these, I open up my wounds for them to rub salt in them.
Quote:

It feels like she is drawing me in and spitting me out

I don't blame you for feeling that way at all, and it's not playing the victim. And the reality is, she has drawn you in and spit you out whether she intended it or not and all cos she can't keep her sh i t together!? It makes me mad.

She knows the place you came from in regards to ex-T and how it affected you, therefore there should be extra emphasis on her making sure those wrongs were righted by her. Why do feelings scare therapists so much? They get emotionally invested in a client and they run for the hills? Why are they so uncomfortable with their own emotions? Yes, her boundaries were like chocolate on a hot day but that's her problem and it was up to her to monitor that all along. Not just have a realisation one day, panic and think terminate terminate terminate! Always at the cost of the client.

My perspective is.... therapists are humans first (most of them lol) and naturally empathic humans, there is a rescuer in each one which needs to be kept in check because therapists can't rescue, they can only walk beside you. As they walk beside you on your journey they are naturally going to find clients they feel attached to or whom they love and personally i think that is ok. Love is a beautiful thing. But, especially because they love a client, they should be mindful of keeping the boundaries to protect both client and therapist so that things like your situation don't happen.

Sorry for the rant MLS but you know this stuff makes me angry lol

I think it has really hit me today. I feel abused all over again. I trusted t and she just totally abused my trust knowing the affects it would have on me. She knew how to work me how to get me to open up and how to love me but then take it all back.
She said I could ring her this week but I want to cut all ties with her, I know she can't be trusted. She let her feelings get in the way

I know it's hard right now, but I hope you can keep in mind that this does not negate your work together and the relationship you have.

She did the right thing in asking you how you felt about it, from what you say, she didn't just say "I am going to wind down/we have to wind down" -she checked in with you. She's not forcing it, but if you don't tell her that you need to keep seeing her and why, I think it's going to feel this way. You haven't given her a chance, you know? If you want to work on other things I would think if you tell her, she would be open to it.

It is an abandonment when it is not a mutual decision, sorry but I think she needs to own that one

This is not the impression I got from what the therapist did/said. She checked in with her, asked her what she thought. If monalisasmile tells her that she wants to continue because she needs to work on x,y,z (which she didn't) and the therapist said they have to wind down anyway, that's something different. But this is not what happened.

Whoa...

These are the facts, from what you have said actually happened in that session:

1) She said she didn't think it was ethical to continue because you're doing so much better. She thinks you should start winding down.

2) She asked you how you felt about that.

3) You said you feel you've gotten a lot better, too.

4) You agreed to winding down.

That's it. Everything else is speculation. In my opinion, you are not giving her a chance to *not* 'abandon' you. You did not say you did not agree to winding down. You did not say you wanted to continue, nor explain why this is the case.

I don't see how the therapist is some sort of villain here, when you agreed to wind down and didn't her tell why you think this wouldn't be good for you, she's not a mind reader.

I do understand that the very fact that she brought this up is very painful, I get that. But she stated her opinion, now it's up to you to share with her how you feel and go from there.

It's very possible that, if you tell her you do not think it's a good idea to wind down, because you still need to work on this, that and the other, she will agree to this. I think you've declared abandonment without giving her a chance to do otherwise.

It seems to me that there is also a piece here where she trusts you. She raised termination because she thinks you are doing well and have made progress (you agree, I think that you have made progress). You didn't say, "I have these things I need to work on, T, I'm not ready for termination yet." She trusts you to tell her that you're not ready for termination if you're not.

She trusts you to be straight with her. She trusts you to tell her what's going on with you. She trusts you to let her know if something she suggests is not going to work for you.

I don't think it is fair to say that she knows that suggesting termination will have negative effects on you. She can misjudge the situation, but from her shoes, she thinks you have done the work you set out to do and now it's time to terminate. The goal of therapy isn't to continue it into perpetuity (although if you're going to be a T, it might make sense to continue on a less frequent basis as a way to process what your clients evoke in you).

It's not a violation of trust for a T to suggest termination. If you don't want termination, you have to speak up and tell her.

You know Anne, I really didn't want to hear that but I needed to hear it- That she trusts me to tell her I am not ready for termination. She did only suggest it but I agreed to it, I didn't say, no t I am not ready for this because maybe a part of me knows that my therapy is done. But I am not done with her, she is like the mother I never had and it will hurt so bad when I have to stop seeing her.
She has encouraged me every step of the way and even encouraged me to become a t. I know this won't be easy on her either but I do think she knew it would hurt me, the termination but therapy cant last forever.
I suppose somewhere along the way I handed over all the power to t and let her take charge of everything. She does trust me and we do have a good relationship so maybe I could ring her and tell her that I am not ready for this yet.

It really sounds like there is some counter-transference going on.

Yes, there is, t is very fond of me. I doubt she would admit to counter transference but I know it's there. She needed the hugs more than I did.

Ugh...I'm not trying to be political, but this sort of thing is why I hate excessive government and/or insurance company involvement in medical care. I see a T at a private counseling group. I do pay out if pocket but on a sliding scale. It is worth it to me. My file is private, and only my T and I have a say in my counseling. I have been seeing my T on an almost weekly basis (weekly on average but sometimes more and sometimes less) for 1.5 yrs.

I'm so sorry that you have to deal with this...is seeing a private T on a sliding scale an option there and for you?

You indicate that you want to stay with her primarily because she is like a mother for you. I think where this is hindering you, though, is that you seem to feel that if you share certain things with her, she will no longer play this role, she will not care, not like you, etc.

There is so much you keep from her... I can't imagine bottling all of that stuff up, even in the course of therapy, or especially then.

I wish so much there were something I could say that would help you believe that no matter what you say, she will still care about you, like you very much, want to help you. And if you do share these things, you will likely come to feel a lot better, and will have the experience of sharing them with someone who won't judge you, will not take it personally, and will stick with you.

You seem to go in cycles where she's either all-good or all-bad, and right now it's not good (triggered by your last session). But despite how you're feeling now, I hope you can leave the door a little open for the possibility of sharing with her things you've been keeping bottled up for so long

This sounds to me like t does not understand how to fix what is actually going on. T is taking up all the space in the relationship, which is the pattern of your abuse. She tried to give you more space by going over time, but when you wouldn't take it then to talk about yourself, she decided to try the opposite tactic, and cut off all time? But each way, you react very elastically, and say whatever she wants to do is alright - she must be doing it because SHE needs it. This is false.

That was the dance we had to do with our parents. It is not how we have to act with our ts. They are trying to find a way to break INTO our pattern of acting and reacting. After a while, if every t acts the same way, we begin to realize, it's us, not them.

Hey content, I am currently seeing a t in private practise and over here we have to pay out of pocket regardless as there is no insurance cover for therapy and this is where ethics come into place. There is a tight watch on ts and how many sessions clients have because some ts can take advantage of vulnerable people and continue therapy for their own benefit(money)
It sucks but it is the way it is here unfortunately.

MLS just a thought... even though your T is primarily CBT orientated, which is time limited doesn't she also use other approaches? I see you've made great leaps in therapy but i think you are also on the edge of doing some really deep work if she allows it. I don't think you are finished.

You know hankster, you should be a t cos your insight is amazing. I think we have had a similar upbringing, catholic, right? Well we both know the guilt and the shame this brings on us. We almost feel guilty for spending time and money on ourselves, so selfish
As hard as it is for me to admit this but maybe this is my fault for not being more pushy with t and letting her talk about her stuff when I wanted to tell her things. This has happened with two ts so the likelihood is that it is me and not them.