[SarahSweden]

I´ve seen a psychiatric nurse training to become a therapist for some months now and I always felt it would be temporary and that she wont´be able to help me. There´s no real chemistry and she doesn´t have the skills to offer proper therapy.

The other day she asked me about how I feel about our contact and as she´s within public health care I´ve never shared with her what I think about the sessions with her. She´s in a position where she´s also evaluating me for a possible psychotherapy and by that I´ve refrained from critique in any form.

But as she now wanted to hear what I think and also because she has never been supportive or warm towards me I decided to fill out a WAI form (Working Alliance Inventory) and write a few comments to that and send that to her by post. The WAI score was of course low and indicated a bad alliance.

Now I´m expecting her to get back to me in some form, either by talking negatively about me when consulting with the psychotherapist or that she won´t try to get me a proper alternative to a psychotherapist either. She works in a facility within public health care where there are a range of other counsellors and similar.

I think this is rather common even if it´s not outspoken as at least here in Sweden, they can easily refer to a "medical evaluation" done by some random doctor and then deny a patient treatment or offering a treatment the patient doesn´t want or won´t be helped by.

What are your thoughts on this?

[Anastasia~]

You spoke your truth and were being authentic. I do understand that you are worried she will screw things up for you. I hope not. I hope they listen to you and how you feel and factor that into their decision. Please keep us posted, if you want. Take care.

[satsuma]

I hope it turns out ok, Sarah. It's interesting that the nurse was evaluating you for possible therapy. Do you know what kind of criteria they are using? Is it evaluating to see whether they think you are likely to benefit from therapy, or evaluating to see which therapy would be the best fit? I'm not sure how these things work in Sweden.
I hope you are doing ok

[here today]

Is that would you would do if you were her? Retaliate if someone gave you a negative review?

There's some (not much) interest here in the U.S. in "Feedback Informed Therapy" in which therapists do actively solicit feedback in order to try to improve the therapy. Maybe/hopefully that is where she is coming from.

I always think it is good to give feedback to professionals, including negative feedback. In principle, someone intelligent and knowledgeable in their field and associated expectations should be able to see their own strengths and weaknesses, but in reality is far from that simple. I also think that good constructive feedback can motivate many people quite effectively to develop themselves. Of course no one actually likes to hear negatives but it is a way to raise awareness and remember it since often people tend to quickly block out negative perceptions even if they have fairly objective ones about themselves. Giving a professional feedback can be a form of performance appraisal, and service providers are pretty much the employees of the clients they serve, even if the client does not pay them directly but an agency pays for it. So I would not feel bad about the critique for a second in a way that I offended her, if the feedback was fair and based on your experience!

And I agree with here today - someone with a reasonable conscience and desire to do well should not react to criticism by making things difficult for the critic behind the scenes. If she does that, then I would say she has much more issues to work on than just not being competent to provide therapy yet. Of course many incompetent and insecure people do just that, but it should not reflect you and and feature about you, more how their own passive aggressive and shady approach.

One thing I wondered reading the OP - why is it necessary to rely on someone like this nurse to find a new therapy provider? I am not familiar with the public healthcare system in Sweden - do patients have no choice in who they see, you cannot approach the pros yourself for your needs? If that is the case, I understand. I grew up in a European country that had that sort of healthcare system during my time and we could not even freely choose a GP, let alone specialists. That's a bit like when someone is job hunting and relies on formal connections, letters of recommendation etc. Not a very wise idea to offend someone with power in that situation.

I think it's hard to predict how this nurse will react based on some posts, without knowing her and how she handles her business, and even knowing someone quite well, it can be tricky to guess how they act behind the scenes. Given what you said about her "abilities" I wonder if she is a good person to refer you to other professionals with good skill and integrity? I personally think that no therapy is better than bad (or even useless) therapy.

[SarahSweden]

Thanks. I think what will happen is that this nurse will blame the outcome on me, on some diagnosis or similar. It´s just that they can easily hide a decision behind medical standpoints which can be formulated just for the reason of saving money and keeping clients away from health care.

Originally Posted by Anastasia~

You spoke your truth and were being authentic. I do understand that you are worried she will screw things up for you. I hope not. I hope they listen to you and how you feel and factor that into their decision. Please keep us posted, if you want. Take care.

[SarahSweden]

Thanks. They have a system of first letting a patient get different kinds of short-term interventions like short-term therapy. Then a patient has to go through several of those steps for the facility to ensure that they have done what they can for this actual patient.


By that it takes many months and years to even get an evaluation for psychotherapy and that evaluation is done by a nurse or similar together with a doctor. They meet with the board of the psychotherapy unit.


I don´t know the specific criteria, a lot has to do with a lot of people waiting to get access to psychotherapy and what also matters is how severe they think your symptoms are.

Originally Posted by satsuma

I hope it turns out ok, Sarah. It's interesting that the nurse was evaluating you for possible therapy. Do you know what kind of criteria they are using? Is it evaluating to see whether they think you are likely to benefit from therapy, or evaluating to see which therapy would be the best fit? I'm not sure how these things work in Sweden.
I hope you are doing ok

[SarahSweden]

Thanks. No, I really hope not I would act in such an immoral way if I saw patients and one of them evaluated me in a negative way. But doctors, nurses, therapists within public health care are protected by the system and they can easily make a statement about a patient which the patient doesn´t have any influence on.


I mean, this nurse can easily formulate something that hinders me from getting psychotherapy and then I won´t have a chance to do anything about it.

Originally Posted by here today

Is that would you would do if you were her? Retaliate if someone gave you a negative review?

There's some (not much) interest here in the U.S. in "Feedback Informed Therapy" in which therapists do actively solicit feedback in order to try to improve the therapy. Maybe/hopefully that is where she is coming from.

[SarahSweden]

Thanks. We have a very lousy mental health care system which makes it impossible to approach a therapist directly. We can, but then it´s only if we pay out of our own pockets, not within public health care.

Here perhaps 1% of all those in need of longer therapies get access to such care and you have to go several steps to get evaluated. Staff within public health care do as much as they can to keep people away from care as there´s a huge lack of resources. We don´t have an insurance based system and we can´t call a therapist and ask for an appointment.

I don´t have a choice in this, I was referred to this nurse after my former nurse quit and I´ve stuck with her as there´s a lack of staff as well. It can take a year or so to switch facilities and even if a patient tries that, there´s no guarantee to get proper care at another facility either.

As you say a professional doctor or therapist would use negative critique as a way to try to improve their way of meeting with clients or improving their techniques. But not many are interested in that, they often see patients as "difficult" as an explanation to a very big system error. They protect themselves that way, by blaming the patients when treatments aren´t working.

Originally Posted by Xynesthesia

I always think it is good to give feedback to professionals, including negative feedback. In principle, someone intelligent and knowledgeable in their field and associated expectations should be able to see their own strengths and weaknesses, but in reality is far from that simple. I also think that good constructive feedback can motivate many people quite effectively to develop themselves. Of course no one actually likes to hear negatives but it is a way to raise awareness and remember it since often people tend to quickly block out negative perceptions even if they have fairly objective ones about themselves. Giving a professional feedback can be a form of performance appraisal, and service providers are pretty much the employees of the clients they serve, even if the client does not pay them directly but an agency pays for it. So I would not feel bad about the critique for a second in a way that I offended her, if the feedback was fair and based on your experience!

And I agree with here today - someone with a reasonable conscience and desire to do well should not react to criticism by making things difficult for the critic behind the scenes. If she does that, then I would say she has much more issues to work on than just not being competent to provide therapy yet. Of course many incompetent and insecure people do just that, but it should not reflect you and and feature about you, more how their own passive aggressive and shady approach.

One thing I wondered reading the OP - why is it necessary to rely on someone like this nurse to find a new therapy provider? I am not familiar with the public healthcare system in Sweden - do patients have no choice in who they see, you cannot approach the pros yourself for your needs? If that is the case, I understand. I grew up in a European country that had that sort of healthcare system during my time and we could not even freely choose a GP, let alone specialists. That's a bit like when someone is job hunting and relies on formal connections, letters of recommendation etc. Not a very wise idea to offend someone with power in that situation.

I think it's hard to predict how this nurse will react based on some posts, without knowing her and how she handles her business, and even knowing someone quite well, it can be tricky to guess how they act behind the scenes. Given what you said about her "abilities" I wonder if she is a good person to refer you to other professionals with good skill and integrity? I personally think that no therapy is better than bad (or even useless) therapy.

[Anne2.0]

Originally Posted by SarahSweden

The other day she asked me about how I feel about our contact and as she´s within public health care I´ve never shared with her what I think about the sessions with her. She´s in a position where she´s also evaluating me for a possible psychotherapy and by that I´ve refrained from critique in any form.

But as she now wanted to hear what I think and also because she has never been supportive or warm towards me I decided to fill out a WAI form (Working Alliance Inventory) and write a few comments to that and send that to her by post. The WAI score was of course low and indicated a bad alliance.

I could see how it might turn out that this nurse may retaliate for what she sees as negative feedback.

On the other hand, as long as you've been posting here, it seems to me that you have repeatedly not told your therapists how things are going, or given them the negative feedback you've shared here. You've often said, when others suggested you share it, that you couldn't or shouldn't or wouldn't do that for one reason or another.

From my perspective, this represents progress for you, to be honest about the "alliance" or feelings to your mental health providers. It's possible that this nurse also feels the alliance is bad but your willingness to acknowledge it may be perceived in the way I do and may actually improve your prospects for therapy. One reason she may have asked for this feedback (and I think it's unlikely that someone would ask if she's truly afraid of the report) is because she thinks it might help her either help you better or might help her move you along to another provider.

Sometimes the worst possible scenario doesn't occur, and things and people aren't always perfectly predictable. On the other hand, our expectations about people and events can shape how things turn out, aka "self fulfilling prophesy."

[SarahSweden]

Thanks. Yes, I hope the nurse will agree on how I feel about our working alliance and that she realises that putting two people together won´t always result in a good match.


I´m though afraid that she´ll use my feedback in a negative way, they easily see it as not being compliant and just wanting to make a fuss about things. But I wrote in my comments to her that I don´t feel therapeutically "held" and that I don´t feel validated, nor emotionally understood by her. I didn´t mention anything about her as a person and I didn´t make any references to something she said or did, I just wrote about how I feel about our work together.

But I´ve already noticed, that´s partly why I decided to send her the WAI form and my comments, that she has a tendency to explain me being a patient within psychiatry is because of me. She doesn´t acknowledge the fact that a majority of people think psychiatry lacks resources and a solid way of working with patients.

Originally Posted by Anne2.0

I could see how it might turn out that this nurse may retaliate for what she sees as negative feedback.

On the other hand, as long as you've been posting here, it seems to me that you have repeatedly not told your therapists how things are going, or given them the negative feedback you've shared here. You've often said, when others suggested you share it, that you couldn't or shouldn't or wouldn't do that for one reason or another.

From my perspective, this represents progress for you, to be honest about the "alliance" or feelings to your mental health providers. It's possible that this nurse also feels the alliance is bad but your willingness to acknowledge it may be perceived in the way I do and may actually improve your prospects for therapy. One reason she may have asked for this feedback (and I think it's unlikely that someone would ask if she's truly afraid of the report) is because she thinks it might help her either help you better or might help her move you along to another provider.

Sometimes the worst possible scenario doesn't occur, and things and people aren't always perfectly predictable. On the other hand, our expectations about people and events can shape how things turn out, aka "self fulfilling prophesy."

[coolibrarian]

Sarah,
You have no control of what that nurse (or anyone else) thinks of you, nor can you control what they say or might say. You only have control over what you say and do in relation to the nurse's actions or statements. Focus on that. Kramar.

[Anne2.0]

Originally Posted by SarahSweden

But I´ve already noticed, that´s partly why I decided to send her the WAI form and my comments, that she has a tendency to explain me being a patient within psychiatry is because of me. She doesn´t acknowledge the fact that a majority of people think psychiatry lacks resources and a solid way of working with patients.

But surely there are things that you could do differently to improve your relationship; I think you've already begun by telling her your honest opinion.

But what a "majority of people" (which may or may not be true) think is also an opinion, and what does that have to do with your care? This is definitely an opinion, not fact, and so what about generic opinions about psychiatry? She may likely disagree with this opinion, but the point is, how can your needs be met with the psych resources that exist? What kinds of resources might work for you? What's the best way to work with you, and are you doing your part to use the resources provided to you so they will be most helpful?

[here today]

Originally Posted by SarahSweden

. . .
. . .
But I´ve already noticed, that´s partly why I decided to send her the WAI form and my comments, that she has a tendency to explain me being a patient within psychiatry is because of me. She doesn´t acknowledge the fact that a majority of people think psychiatry lacks resources and a solid way of working with patients.

But isn't there something about you, which is a reason that you are a patient within psychiatry? I would expect that she would see that as her job, to try to help with that, within the limitations as they exist. Is there anything that you can see that she could personally do about the limitations? I think they are system-wide. Sucks, but that's the way it is.

[Ididitmyway]

As coolibrarian said, there is nothing you can do to control what people think of you and what they do. You did what you did and it's already done. However, the nurse reacts, there is nothing you can do about it, and you don't know yet at this point how she will react. May be it won't be as bad as you afraid it might be, but may be it will. Since you don't know, take one step at a time. Postpone your worry until you see the result. If she doesn't retaliate, there will be nothing else to worry about, and if she does, try to fight it in whatever way you can.

I understand that your national healthcare is heavily controlled by the government, but I lived in the similar system back in the Soviet Union. Though I am sure it was not exactly like the Swedish one, there were ways to get what you wanted. It wasn't easy, but it was possible. Whenever we didn't get the services we needed, we'd go through hierarchical structural channels though complaint processing. It took a good amount of assertiveness and persistence, but it worked. Not always, but often it worked and we'd get what we needed.

I am sure there are channels you can use in your system as well in the worst case scenario. Every system has it. But it's not time to worry about it yet IMO. When you don't know what will happen, the best thing to do is just to wait and, meanwhile, to focus your mind on something enjoyable.

[coolibrarian]

Ididit, I have one thing to say to you: Лучше поздно, чем никогда regarding the persistence it took to get help в Советском Союзе.

Yes, I speak/read/write, with varying degrees of success (and/or competency, lol): Russian, Swedish, French, German, Italian, Spanish, Croatian, and ASL!

[Ididitmyway]

Originally Posted by coolibrarian

Ididit, I have one thing to say to you: Лучше поздно, чем никогда regarding the persistence it took to get help в Советском Союзе.

Yes, I speak/read/write, with varying degrees of success (and/or competency, lol): Russian, Swedish, French, German, Italian, Spanish, Croatian, and ASL!

Ха-ха! LOL Приятно поговорить с кем-то на родном языке. Спасибо

..and I've always been envious of people who are so multi-lingual. Great job!

[feileacan]

Originally Posted by coolibrarian

Лучше поздно, чем никогда regarding the persistence it took to get help в Советском Союзе.

Yes, I speak/read/write, with varying degrees of success (and/or competency, lol): Russian, Swedish, French, German, Italian, Spanish, Croatian, and ASL!

Another ex-soviet-unionist here Although my set of languages is a bit different and Russian is definitely not my first nor my best language. But this much I still understand

[WishfulThinker66]

NO! This nurse cannot hold anything against you or act upon any anger or resentment they might have. It would be unprofessional to do so and they would be jeapardising their career. I am pretty sure they would not risk it. They would also be a pretty messed up person to think they were perfect and that every review or critique of them would be positive. No, if this individual were at all professional and had any sort of interest in their future career they would not take any action or attempt to punish you.

[coolibrarian]

Originally Posted by feileacan

Another ex-soviet-unionist here Although my set of languages is a bit different and Russian is definitely not my first nor my best language. But this much I still understand

Hey! I am not from the USSR. I am from the USA! But studied Russian много лет тому назад!!

[feileacan]

Originally Posted by coolibrarian

Hey! I am not from the USSR. I am from the USA! But studied Russian много лет тому назад!!

Ah, ok, sorry. I misunderstood you.