Is this malpractice?

My therapist and psychiatrist for over 8 years terminated me.
A few months ago I wasin a temporary bad financial situation, so I told my doctor I couldnt see her for a few visits, she insisted that because I was so "special to her" (she often says that she considers me like a son) that I needn't pay and I could pay her back when I had the money.
Unfortunately I'm using my money right now to help my sick mother in a couple of months she will get her SSI disability money and a years worth of back pay (she will gets tens of thousands of dollars which she will share with me).
But my doctor wouldn't wait.
It seems that for the first 6 years she was the best therapist one could ask for but recently in the past two years, has been getting greedy and money oriented.

She did the following questionable things:

-said "she loved me" as in affection not romance, and that I was "like a son to her"
-accepted expensive gifts from me for her two daughters
-agreed to officiate my wedding (it will be in Miami Beach no less (I'm in NYC) She would pay for her own travel expenses.
- refused to write only a month's worth of prescriptions when it would take two months for me to see a new psychiatrist. These prescriptions include the Benzodiazepines Xanax and Klonopin (the latter which I take daily at the high dose of 8 mg. a day) Benzos are treated as Schedule II drugs in NY so I can't get refills, as well as Adderall.
-when I asked her what to do to avoid withdrawals she told me I could get the scrips from the ER!
I simply went to her office and stared her down and got the scripts.
-she gossips about me (for example she told me she was talking about me to my ex-psychiatrist but refused to say what she said about me)
-the majority of later appointments in the last couple of months where filled with her repeating the phrases "I don't work for free" and "where's my money"

I feel so stupid, I really misjudged her character, but she really changed in 8 years.

So is this malpractice or not?

So let me get this straight, after 8 years, and her seeing you for free for months even, your plan is now to try to sue her and destroy her career over a list of nice things she did for you?

Definitely boundary violations but not sure about malpractice. Many of our doctors would not write long term scripts especially since you are on multiple benzos. We often refer the patient to the ER but they will only get a few day supply there as well.

As far as talking with other psychiatrists does she have a release...

Do you think it is possible that she is upset because initially she agreed to help you out because you were in a difficult place financially. Now you appear to have money but are helping your mother out. Has your mom actually been approved for SSI and will be getting the money. If not she may be afraid that you are going to keep incurring the debt.

This may sound nasty. Pay the woman. You really didn't think that you could receive professional services at no cost indefinitely did you? If you have the money to help your mother, then you have the money to pay your Pdoc. I am certain that she feels disrespected by your lack of payment when you are financially supporting someone else. I would be livid if someone told me that they were giving money to someone else while I was providing a service at no cost that I could charge $200 an hour for.

There are people here who know more about it than I do..they may have a different opinion...
I don't see anything here that would stand up as malpractice. I'm not sure there is even enough here to take to a licensing board.

Remember in legal cases..it's not so much about who is right or wrong...but it's about what you can prove...and how damaged you are. They won't consider only your word for it- regarding verbal agreements. She will have her own version of events, too.

Did you get any agreement in writing..that she signed?

Looks like you owe her. You plan on paying her, right?

In my amateur knowledge, I understand:
. Accepting expensive gifts is contrary to their ethics.
. Likewise entering into dual relationships, of which traveling to officiate at your wedding certainly qualifies. (mazel tov, by the way.)
. The payment plan needs to be clear, written and understood,and not because "she loves you."
. Your sessions should be for your benefit. Argument: "I don't work for free" and "where's my money" doesn't pertain to your mental health.
. She needs written consent to talk with other providers.
. I know nothing about medication beyond there's a protocol for withdrawal for many medications. Holding needed medications "hostage" sounds out of bounds.
. On your end, you owe her money for services.

It's a business relationship bounded by strict guidelines.

I'll speculate that your failure to make repayment your priority is a strong factor in this recent deterioration of your relationship. That said, she never should have allowed such a loose relationship from the onset. The problems you face now is why it's unethical.

A once-ethical provider or a relationship can go out of bounds at any time. Sounds like you've recognized this and have taken steps to get away from her.

For more information, you can contact TELL: Therapy Exploitation Link Line

You got too close to these people. They must be kept at a professional distance.

You said basically the same thing back in February of this year

http://forums.psychcentral.com/psych...evastated.html

I don't really blame your T for getting annoyed about no payment, as its been 6 months (probably longer, since you said in that thread that you were already not paying) and now you are helping out your mother.

If you cant afford therapy for the long term (and I'd say 6 months is definitely long term) then you need to sit down and have a conversation about it with her.

It doesn't sound like malpractice to me, but I do think she could have stricter boundaries and be able to bring up the subject of money in a more sensitive way.

If upset and concerned about it, I would file a complaint with the appropriate licensing board and then check with a lawyer in my jurisdiction if I wanted to go further with it.

No it does not sound like malpractice. It does sound like she violated boundaries by accepting expensive gifts and officiating a wedding. In doing this tbe lines got blurred until she became frustrated that she wasn't getting paid - then she tightened them and now you're hurt. Terminating over non payment is not malpractice from what I know, she is a professional and should be paid. The prescription situation is out of her hands, they are controlled substances so i think her advice to go to the ER is what other doctors woukd do.

The boundary issues are different and i suppose she could face disciplinary action if you
wanted to file a complaint. I have no idea what the consequences would be, but I'm guessing they wouldn't be too serious. Unfortunately she should have had more professional boundaries from the start, but I don't think that excuses your obligation to pay her.

I don't know about overt malpractice, but there might be issues with continuity of care in addition to potential ethical issues. I don't know the whole story, but a patient who abruptly withdraws from some of those medications could be at serious risk (i.e., seizures). But, since she gave you the scripts, you are not being put into danger, so no harm was done from that aspect.

It's a good thing you got the scripts because going to the ER does not guarantee that you will get the medication you need. People who go to the ER when they need scheduled drugs are sometimes suspected of "drug-seeking". Unfortunately, the DEAs drug-seeking criteria describes how a non-addicted mental health patient suffering from abrupt withdraw from psychotropics might behave normally in that situation.

That's alarming to me. Not only that, she'd be sending you to the ER for a non-emergency. Continuance of a prescription is not an emergency. It is preventable and known and can be managed outside of the emergency realm as opposed to an accident/unknown health problem. In fact, it's mismanagement of healthcare resources and requiring someone to get non-emergent care at an ER would either waste taxpayers money and resources, insurance money, or both, plus community healthcare resources.

Are you looking into these things because you are angry and want revenge? I'm not judging. I'm just wondering if you might better off moving on since you are on your way to getting your treatment needs met. This could be worked through in therapy.

Good luck.

Boundary violations yes , malpractice no. Good luck.

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Sorry for your pain. There are a lot of boundary violations there but I don't know about rules and laws concerning what counts as malpractice, speak to a lawyer.

None of these were an issue until this T stopped giving you free therapy and so that makes me wonder if this desire to sue is driven by some revenge or even just a desire to manipulate. She has done a lot for you so far.

You're right, I changed my wording. Anyways, I don't support revenge plans, so I'll stay out of it.

Also I disagree these are even examples of boundary violations. These are more like boundary crossings, which in 8 years of therapy are going to happen. I think if the original poster files a complaint it will not hurt the therapist in the least, it will however damage any chance of reconciliation, so I would recommend not going there.

I'm not a fan of revenge either Petra.

p.s. I edited my original post to leave your quote out

OP, I hope this is not prying but why are you on 8mg Klonopin daily? Is this a temporary thing?

Here's some more info on how your ex-therapist is in fact not unethical Dual Relationships, Multiple Relationships, Boundaries, Boundary Crossings, & Boundary Violations in Psychotherapy, Counseling & Mental Health - by Ofer Zur, Ph.D.

This link explains the difference between boundary violations and boundary crossings. Here's an example, therapist accepts your gift of a BMW, boundary violation, vs therapist accepts your gift of toy (twice in 8 years) worth $70, boundary crossing. Therapist kisses you and grabs your butt, boundary violation, vs therapist hugs you, boundary crossing. Therapist starts a romantic relationship with you, boundary violation, vs therapist attends your wedding, boundary crossing. Therapist offers ongoing free sessions to new good looking client, boundary violation, therapist agrees to see old long term client for free while they get on their feet after losing a job, boundary crossing.

As you can see, big difference. One is ethical and a part of normal therapy and one is not. But you weren't hurt by her nice actions. You weren't hurt by her seeing you for free, or attending your wedding...

No she saw me free for one month
I've been paying her ever since up till the last visit

It is nasty because I have been paying her, up until the final session

Your OP sounded like you hadn't been paying her for some time. So there was no agreement that she was going to see you for free?

If she really talked about you with your ex-psychiatrist without your written consent, that's enough to make a complaint to an ethics board based on lack of confidentiality.

For the rest of it, it was a bit hard for me to follow exactly what happened.

From your post back in February it seems that there has been a problem with the insurance paying late and her having to wait to be paid after the fact. This seems to be an ongoing problem-- of either not being paid or paid late-- since you have posted about it over the course of 8 months. You said that she seems to becoming "greedy" and "money hungry" and complaining about not getting her fee. If she were being paid on time, I can't imagine she would be complaint about not being paid. Are you suggesting she is making this up? Or complaining about a situation in February that hasn't been an issue even once in the last several months? Perhaps she is upset that she isn't being paid ON TIME instead of not at all. Even if we have loving relationships with our T's, it's still their job and they need their fees in order to pay their bills-- especially if she has young kids at home to pay for. I don't really see where she is being unreasonable. Is there any more to the story, like was there an argument or something else that happened between you?

Zur uses his pulpit as an actively fervid advocate for looser boundaries between therapist and client down to rejecting the long-held idea of the slippery slope. His writings are, like everything else, a guy's opinion.

Beyond ethics rules and guidelines for each professional organization, providers explore and debate these issues themselves, with no universal consensus.

Unlawful and/or Unethical Dual Relationships

Boundary Crossings and the Ethics of Multiple Role Relationships - by Gerald P. Koocher, Ph.D. and Patricia Keith-Spiegel, Ph.D.

The less nasty of my therapists violated (or crossed) a number of boundaries, hosting a party for single clients (I couldn't attend) and other match-making, attending my outside event, inviting me to a family occasion and even encouraging my joining a small in-home congregation where she was a member. (Nothing cultish.)

I can't claim long and devastating damage. However it contaminated the professional purpose of the relationship--I was her sycophant both in therapy and out. Though I had my own social currency, this definitely was not a relationship between equals. I'm certain this looseness affected how she treated me, maintaining a sort of idealized "friendship" that never was. In retrospect, it feels delusional on her part, and I don't think she should have used her practice to quarry for social contacts.

Someone else apparently reported this therapist because she received a warning from her state licensing board.

She was being paid on time, I'm afraid the scope of the whole thing is too complicated to write in a post. And yes there is much more to the story, it was naive of me to think I could explain it