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Re: I've just experienced a do daisym

Posted by simcha on December 9, 2004, at 0:05:05

In reply to Re: I've just experienced a do simcha, posted by daisym on December 8, 2004, at 23:35:38

Daisy,

I completely respect your perspective. BPD clients are very different from survivors of childhood sexual, physical, and emotional abuse, and neglect. These clients do need more phone time.

Currently I am a trainee I work under someone else's license. I have to consult with her and respect her wisdom in setting limits and boundaries. Right now she wants me to be conservative. So, I have to tow the party line in order to finish my traineeship.

Also, I will be an Intern for about 4-5 years. I will have a different supervisor then. They might have different limits and boundaries and a different clinical orientation.

When I get my own MFT license I will be free to explore boundaries and limits on my own. In your case, I would have spent at least ten minutes almost every day with you on the phone when you were having your existential crisis. This is crisis counseling and it comes with the fee you pay for the one hour per week session.

In my current situation I have asked my supervisor about having clients pay for more phone time if they need it. It would be at a reduced rate. The Agency and the Supervisor have to agree on this. At the moment they won't let me do this. They want me to experience the conservative approach.

As part of this I do have two clients who need to be seen twice per week and we are negociating the fee to be lowered per session to make it affordable to these clients. My supervisor is for this. She does not want me to get burned out as a trainee who works 30 hours a week at a Group home for pay, works 30 hours per week at a trainee center that pays me $50 per month, and goes to school full time spending 20-30 hours per week on class time and homework.

So, as an MFT Trainee, my availability must be more structured so that I can really be there for my clients. I don't want to burn out and become ineffective in the therapy room. My supervisor wants me to avoid this too. Currently I'm limited to six clients for this reason at this time. I do eight hours of therapy per week. Phone calls take up another hour or two. Don't even ask about the paperwork that goes with this, it's deadly....

So, my orientation is different from my current supervisor's. I see her point and I'll do it her way now in order to learn. She acknowledges that I will be doing things differently when I have my own practice. So, I will grow as a therapist. This is my first quarter as a trainee and I don't have ton's of experience with one on one therapy.

I have been a counselor for four years. This is a very different form of therapy and less taxing than psychotherapy. As a counselor, I could be more of a peer and do more self-disclosure. I could also do more behavior modeling and CBT techniques.

So, that is my history.

I respect your story and your experience and it sounds like you have a very good therapist. I hope to match his skills someday.

Respectfully Yours,
Simcha

> I don't want to come across as challenging, Simka, but I don't know if you have that willow thing down yet.
>
> I think if you've already set a time limit for things, 5 minutes, 10 minutes, etc. you've already limited your flexibility. I know the basic idea is to offer support over the phone and do therapy during sessions. But sometime clients need more than 5 minutes of support.
>
> I am a competent, well-educated 40-something woman who works in human services. When I finally started talking to my therapist about the abuse that happened in my childhood, I was shocked at how absolutely overwhelmed and suicidal I felt. I remember the first time I called after a session. I think it was a couple of hours later and I said something like, "I don't know what is happening to me. I can't stop crying and I hurt so bad I can't function." It wasn't an emergency - I wasn't planning on hurting myself - but I NEEDED to have someone normalize the pain for me and just be there. He said all the right things and let me cry on the phone until I was calm. It probably took 15 minutes. If he had cut me off after 5 minutes, I probably would not have continued on this immensely hard road trying to heal. Since then, we have lots of phone contact. Much of this includes loosely scheduled phone check ins (like "let's touch base Friday afternoon") if I'm going through a rough patch. I worry a lot that I'm that "pain in the a**" client that made all the rules necessary. My therapist tells me that he wants me to reach out to him as much as I need to. I believe he means this. If you've read any of my posts you will notice that I swing wildly about accepting this attachment and fighting it.
>
> I think I read in one of your other posts (forgive me if I'm wrong) that "most" people in therapy have boundary issues. I would argue that it is just as likely for you to have a client who won't want to bother you AT ALL as it is to have one bother you too much. That would have been me if my therapist wasn't so proactive in encouraging me to use him for support.
>
> By the way, I do pay for phone calls. We agreed that this would help me get past my reluctance of bothering him.
>
> Lastly, I think you will encounter clients who can't afford extra sessions, can't take the time off work, etc. etc. In these cases, longer phone calls might be just the answer.
>
> I should admit to being sensitive about this subject tonight. I'm trying to add a perspective, not lecture.
>


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URL: http://www.dr-bob.org/babble/psycho/20041203/msgs/426539.html