Psycho-Babble Psychology Thread 452491

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to gardengirl-- the perspective of a T

Posted by CareBear04 on February 3, 2005, at 14:09:34

hi gardengirl,
i've read a lot of your posts and have enjoyed hearing you talk from the perspective of a T in training. there are certain things i wouldn't feel comfortable asking my Ts, so i was wondering what your thoughts are.

1) when you stop seeing patients, especially because their insurance coverage runs out as opposed to termination or recovery, do you want to be updated as to their condition? i've read posts about Ts cutting all ties with former patients, and it seems irresponsible and scary to me. none of my pdocs (who have been my Ts) have done this. when i saw a pdoc at school, i ran out of sessions and was referred out to a private practice. then i took medical leave. with this person, i was in frequent email contact, and he seemed genuinely interested in my condition and would make suggestions and advocate for me on the school end. when i left my pdoc at home, whom i had seen for about four months, she referred me to a colleague near my school. she gave me a present when i left and would often call, especially in the beginning, to see how i was doing and because she was curious about what i was up to. when i left the new pdoc in late august, he also gave me a present and sent me back to the person at home. when i was doing very poorly in the fall, i called him, and we talked a few times. he suggested the hospital and helped me set priorities for which problems were the most urgent. i sent him a holiday card, and he wrote me back a really nice letter affirming that he believed in me and believed that i would find success wherever my heart leads me. with all these pdocs, i've never been emotionally attached. i never called the two men pdocs and only called the woman to leave messages if she asked me for an update, if i needed a script, or in mostly medical emergencies. is keeping in contact after termination dependent on how attached the patient is to the T? when you end with a patient, do you want to cut all ties, do you want to keep in contact but feel like you shouldn't, or do you make yourself available by email or phone? i'm just wondering what the typical protocol is and whether it differs between Ts of different generations and training. this is what i'm most curious about.

2) i have gotten the impression that you work at a university with college students. do you enjoy working with young patients more, or do you enjoy other age groups more, or are you impartial among age groups? are the problems of young adults much different from middle aged or older patients? my pdocs in private practice mostly fill their appointment books with middle aged professionals, mostly doctors and lawyers who come for analysis. the pdoc at school liked young people the best; i guess that's why he was at university counseling. in the hospital, though, it really bothered me that they preferred submissive and dependent elderly people whose quality and quantity of life was quickly detiorating. they didn't like me or want me on the unit because i'm young and ask too many questions and am very independent. it just seems to me that it is a worthwhile investment to meet a person where they're at instead of breaking them down first, and to try to help the young person back on her feet, to help her be able to live a long and fulfilling life. maybe this is a difference between inpatient and outpatient care? i've never had anything but damaging hospital stays, but i've had good outpatient Ts who have thrown the DSM out the door and have leveled with me and respected me. that's really important to me. i know that geriatrics and geriatric psychiatry are very important fields, especially as the population grows older. still, maybe because i've never been around grandparents or older people, i can't imagine people wanting to specialize in working with them. it seems to me like the problems are more dealing with helping the people resign themselves to retirement and less busyness and to come to terms with death. my impression is that geriatrics is more geared towards death, while child and adolescent or young adult care is about life. what is your impression and your preferences?

sorry for the long-windedness. if you've made it to the end of this post, i'm very impressed. i think you're so insightful and really appreciate your experience and thoughtfulness in your posts. if you can address these questions at all, i'd really appreciate it. and anyone else, feel free to jump in!!! thanks so much!!!

 

I'll respond, but I need a little time CareBear04

Posted by gardenergirl on February 3, 2005, at 22:27:56

In reply to to gardengirl-- the perspective of a T, posted by CareBear04 on February 3, 2005, at 14:09:34

didn't want you to think I was ignoring you. But I'll write more tomorrow evening. Gotta hit the hay tonight.

Take care,
gg

 

Re: to gardengirl-- the perspective of a T CareBear04

Posted by gardenergirl on February 4, 2005, at 8:10:58

In reply to to gardengirl-- the perspective of a T, posted by CareBear04 on February 3, 2005, at 14:09:34

Thanks for your kind words, carebear. I'll try to answer your questions as best I can.>
> 1) when you stop seeing patients, especially because their insurance coverage runs out as opposed to termination or recovery, do you want to be updated as to their condition?

I would love to be updated, because I always wonder how people are doing. There are several issues involved, though. First, if I stay in touch with a former client, it can difficult to not provide support or advice. Now as a human being, of course I would like to do that. But since I have had a therapeutic relationship with them, I really can't continue to do that after termination (for whatever reason it ended). First, there's liability. If I continue to stay in touch and there is an appearance of continuing to be therapeutic, well, I'm not licensed, and no one would be supervising me. Plus, if something I said or did was not appropriate, I'm not covered for liability. Those are the legal reasons. Ethically, it is not good to continue to have contact that may perpetuate the feeling of a therapeutic relationship. It can make it difficult for the former client to move on with being independent, or to attach to another provider if they are continuing therapy with someone else. One of my professors told us in a class that she deals with this by saying that although she would love to have an update occasionally if the former client wants to send one, she may not be able to respond. It IS hard, because most T's genuinely do care about their clients. I can't think of any at the moment I ever disliked. It's important to find something you like about all of them. Of course, some of my experiences with clients were more meaningful to me or more personally moving then others. It's sad for me to terminate, too. And it's a sacrifice. I've worked with clients who I feel I could become friends with in other circumstances. That's a sacrifice for me to give up that possibility upon beginning a therapeutic relationship. I think I'm at the conservative end of the spectrum with this, but I'm not overly rigid about it. I do have occasional email contact with one or two former clients. I find I really put a lot more thought into what I write back, though, to be careful not to sound like a T.

> i've read posts about Ts cutting all ties with former patients, and it seems irresponsible and scary to me.

I think there are lots of circumstances when this is appropriate. But of course you can't just leave the client hanging. You need to refer them to someone else first.

It sounds like you have had a different experience, and that it has been pretty good for you. I don't know if it is a training or generational difference, although of course students are influenced by the attitudes of those who train them. I think my school is careful about teaching what the ethical guidelines say about multiple relationships and contact after termination.

>is keeping in contact after termination dependent on how attached the patient is to the T?

This is a good question. I think if you have someone who is very attached, it would be important to think very carefully about how to terminate most effectively. On the one hand, an abrupt cutting of ties can be horribly traumatic, but if the client is really attached and it's not healthy for them to continue to be attached to someone who can no longer meet their needs, then it may be an important life lesson to work out with a new T. The loss, I mean. But at the same time, allowing occasional brief touching base may be helpful. But if it's helpful and therapeutic, have you really ended the therapeutic relationship? See how confusing it gets? :)

>when you end with a patient, do you want to cut all ties, do you want to keep in contact but feel like you shouldn't, or do you make yourself available by email or phone?

I can really only answer personally here. I am likely to want to hear from them someday down the road, but I feel like I shouldn't actually participate in keeping the relationship active. So I suppose I would be most comfortable with hearing from them after a period of time....at least several weeks. And I would probalby keep any replies fairly brief, although warm and caring.
>
> 2) i have gotten the impression that you work at a university with college students. do you enjoy working with young patients more, or do you enjoy other age groups more, or are you impartial among age groups?

This is actually kind of funny. I am specializing in geropsychology at school. I developed a love of working with older adults from working with them in rehab in nursinghomes. I never in a million years thought I would enjoy this. But older adults have a lot of wisdom and life to share with others. So I was convinced that I will want to work with older adults upon graduation. Makes sense, eh? Well last year before I started my training at my school's psych. services center, I was worried that I wouldn't like working with young adults. I had some false expectations that they might be shallow or something, at least compared to older adults. Boy was I wrong! I love it! I'm still working with college students. I can see continuing after graduation, but I'm not sure how I will use my specialized training in gero.

>are the problems of young adults much different from middle aged or older patients?

I suppose there are some differences. I see stuff related to being perfectionistic, there are school-related issues, relationship issues, and a lot of stuff that is at least indirectly related to forming an identity as an adult. You know, who am I and what do I believe in? But depression and anxiety and other stuff has a lot of overlap across age groups. So there are similarities.

>my pdocs in private practice mostly fill their appointment books with middle aged professionals, mostly doctors and lawyers who come for analysis. '

This might be because that's the group who can most afford analysis and maybe who might value it the most. Or even have heard of it.


>it just seems to me that it is a worthwhile investment to meet a person where they're at instead of breaking them down first, and to try to help the young person back on her feet, to help her be able to live a long and fulfilling life.

I absolutely agree with you. If you were on a unit with primarily older folks, it sounds liek maybe it wasn't the best place for you for inpatient. Are inpatient places limited where you are? Because my experience in a medium sized city is that most inpatient psych units are filled with young to middle aged folks. But then the hospital I am thinking of has a separate geropsych unit. It's too bad if you have few options.

I suppose that working wit older adults does seem like it is geared more towards death. But actually, folks are living longer and longer these days, and with more illness and disability. So yes, helping them reconstruct their lives when they lose important life roles such as employee, spouse, physically active person, etc. is a big part of working with them. Whereas younger folks may have a wider range of issues, but ultimately, it's always about improving quality and meaning in life, imo.


Hope this was helpful. You sound like a thoughtful person with insight. I'm sure that helps you in your therapy journey.

take care,
gg

 

Re: to gardengirl-- the perspective of a T gardenergirl

Posted by CareBear04 on February 4, 2005, at 13:53:34

In reply to Re: to gardengirl-- the perspective of a T CareBear04, posted by gardenergirl on February 4, 2005, at 8:10:58

thank you garden girl so so much for your reply! i know it was a lot of questions, but you answered them so articulately.

yes, my previous pdocs have usually not initiated contact with the exception of the woman dr who called occasionally when i transitioned back to school out of concern or curiosity. the first pdoc who saw me deteriorate from regular depressed to psychotically suicidal in the hospital seemed happy when i established email contact and always replied promptly. he seemed to like the communication. you raised a really interesting point, though, about liability, especially from the point of view of a non-licensed non-supervised student. i guess i've never had a T in training, so it hasn't occurred to me. but as far as getting advice from old pdocs, i feel lucky to get their thoughts. i don't usually follow a person's advice, anyway, unless it agrees with me personally, so it's just like surveying the people around me whom i trust. i guess i see it more like contacting mentors or friends. no matter what the consequences of their advice, i would never think to hold them responsible for giving me advice. i might think, "oooh, that was a bad suggestion," but as for accountability, i think that lies with the actual people who are face-to-face in charge of keeping you healthy and safe. it doesn't sound like you're too conservative at all. what you said makes a lot of sense. also, rethinking the generational differences in limits, i think it's probably less generational and more alligned with experience. my Ts were middle-aged with 10-20 years until their belts, and i'm sure by that time, they ease up on following rules to the letter and go more from their experience. if someone needs more followup and doesn't appear too reliant on the T, maybe an older T would feel ok with keeping some contact. the resident pdocs i've seen in the hospital, especially the R1s, are so uptight and can't make a move without an attending two feet away.

as for the hospitals, it differs. i've been in three psych units. maybe it differs also with the time of year. my first time was in my university's hospital. by the time i got there, there were at least a half dozen kids from my school and a handful of other young people. this was around first midterms. one 15 year old girl who had been there since december told me that, at that time, she was the only one under 60. my next time in a private hospital in uptown NYC, i was definitely in a geriatric setting, though it was a regular adult ward. this was mid september, right after school started. both places had plenty of old people getting ECT. the most recent stay, i started out with all others two or three times older than i am. with time, younger people came and went. this, too, was around midterms time. the latter two hospitals had psychology interns running groups and stuff. in the first hospital, there were no group therapies except for things like "creative writing," or the fun art and recreation ones ran by the occupational therapist. i hear many hospitals are cutting out psychologists and psychology interns? if that's true, i think it's a shame. interestingly, though i've been pelleted with handfuls of diagnoses in the hospital, i've never had any psychological testing since the first grade when they put me up a few grades.

anyway, thanks again for your response. you've been a huge help and a great source of insight! with much respect, cb

 

Re: to gardengirl-- the perspective of a T CareBear04

Posted by gardenergirl on February 4, 2005, at 21:23:49

In reply to Re: to gardengirl-- the perspective of a T gardenergirl, posted by CareBear04 on February 4, 2005, at 13:53:34

I think you might be right about experience level making it seem easier for Ts and pdocs to make decisions about boundaries. That makes a lot of sense.

And getting rid of psychologists in hospitals. Why, that's a horrid idea! Of course I'm biased. ;)

Glad to be of help.

gg

 

Re: to gardengirl-- the perspective of a T gardenergirl

Posted by messadivoce on February 5, 2005, at 12:43:30

In reply to Re: to gardengirl-- the perspective of a T CareBear04, posted by gardenergirl on February 4, 2005, at 8:10:58

Thank you, Gardenergirl, for your answers to CareBear's questions. It really helped me understand a lot more about why my former T is acting the way he is. I've been told something about ethics before, but to have it explained in such a human way really does help.

I think it's so great that you are here to offer your perspective...from a really unique vantage point. I can only imagine how much more compassion and understanding you must have for your clients.

(short story) Three months before I terminated with former T, I found "In Session" and read it cover to cover. I mentioned it to my T at the time and he didn't really seem interested--just skeptical. Right before I terminated he asked me about the book again. Eventually he read it and admitted to me that he loved it, and that "It's really cool to read something from the perspective of the client." To which I thought, you mean the majority of what you read ISN'T from the perspective of the client?? He also apologized for earlier engaging in what he called "professional snobbery" in regards to my book suggestion.

Anyway, I really appreciate your humility as you engage on this crazy therapy thing with us...
Voce

 

Re: to gardengirl-- the perspective of a T messadivoce

Posted by gardenergirl on February 7, 2005, at 22:15:26

In reply to Re: to gardengirl-- the perspective of a T gardenergirl, posted by messadivoce on February 5, 2005, at 12:43:30

Thanks for your kind words. I've enjoyed reading your posts, too.

And I'm embarrassed to admit I haven't taken the time to read "In Session" yet. I've got a stack of books and journals and loose articles on my bedside. Aack! So many words--so little time!

Take care,
gg

 

I'm shocked!!!!! lol gardenergirl

Posted by Dinah on February 8, 2005, at 8:16:11

In reply to Re: to gardengirl-- the perspective of a T messadivoce, posted by gardenergirl on February 7, 2005, at 22:15:26

My campaign to make it required reading for therapists sure hasn't gotten far yet. Perhaps I'll try my local universities. :)

 

(I'm teasing of course)

Posted by Dinah on February 8, 2005, at 8:17:12

In reply to I'm shocked!!!!! lol gardenergirl, posted by Dinah on February 8, 2005, at 8:16:11

Reading Babble is probably a reasonably good substitute.

 

Re: (I'm teasing of course) Dinah

Posted by gardenergirl on February 8, 2005, at 8:46:07

In reply to (I'm teasing of course), posted by Dinah on February 8, 2005, at 8:17:12

It is on my list. But my nightstand can't hold any more books, articles, or journals at the moment. :)

gg

 

Re: (I'm teasing of course) gardenergirl

Posted by fallsfall on February 8, 2005, at 11:13:31

In reply to Re: (I'm teasing of course) Dinah, posted by gardenergirl on February 8, 2005, at 8:46:07

So take the rest of them off and put "In Session" on your nightstand...

 

gardengirl, me too

Posted by CareBear04 on February 8, 2005, at 21:10:12

In reply to Re: (I'm teasing of course) gardenergirl, posted by fallsfall on February 8, 2005, at 11:13:31

hey-- you're not the only one. i ordered _in session_ over a year ago, but i haven't read it yet. i've read a lot of psychology-type books, but that one intimidates me for some reason. why knows? i'm sure that's not why for you-- you're just busy and have too much already to read-- but here's moral support one way or another!

 

Re: gardengirl, me too CareBear04

Posted by gardenergirl on February 9, 2005, at 11:11:23

In reply to gardengirl, me too, posted by CareBear04 on February 8, 2005, at 21:10:12

Awww, thanks. It is on my Amazon wish list. I had to start that to keep track of all the books I want to read someday. I had to stop ordering them for now. :)

gg


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