Psycho-Babble Psychology Thread 509915

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A question - possible trigger

Posted by daisym on June 9, 2005, at 0:22:21

I asked this question in Open tonight and got mixed responses.

I have a friend whose daughter tried to commit suicide a few months ago. The daughter is 18. I saw her yesterday and asked how things were. She said, "we don't like the new therapist." I asked what happened to the old one and she said that they were told that her daughter couldn't have her old therapist "back" because she'd made an attempt, it was the consequence of this. I know their health insurance is a self-contained HMO system, but I was really surprised by this.

So I asked about this in therapy today. My therapist was outraged and said he felt it bordered on malpractice. He said they must have this rule for liability reasons. Of course, then we had to talk about why I was asking...

But I'm curious. Has anyone else had experiences like this or know of this happening? It doesn't seem wise to me, but I guess I could see it as a therapist's defense against being manipulated by threats of suicide.

 

Re: A question - possible trigger daisym

Posted by alexandra_k on June 9, 2005, at 2:19:22

In reply to A question - possible trigger, posted by daisym on June 9, 2005, at 0:22:21

It might depend on the circumstances around the attempt.
Whether threats were made
The nature of the attempt
The persons views on the attempt after it happened.
Some clinicians won't work with people if they feel there is a risk.
For their own sanity I suppose.

If they can't handle it then better to find that sooner rather than later, I suppose.

If it was a 'consequence' thing then maybe it was to do with the circumstances. Especially if the person contracted not to do that and had the t's number to call 24/7 or agreed to call emergency services or whatever.

 

Re: A question - possible trigger daisym

Posted by littleone on June 9, 2005, at 16:01:47

In reply to A question - possible trigger, posted by daisym on June 9, 2005, at 0:22:21

I had the impression that it was common with DBT. Like it's part of the contract between T and client. I thought they used it as a tool to ensure the client calls the T rather than acts on the urges. I guess that to keep it effective, they need to follow through on it. Otherwise it is sending the message that "yes we have this rule, but if you break it, it doesn't really matter".

I haven't had any experience with that approach. That was just what I gathered from stuff I've read/heard.

 

I think it is fair enough for the T daisym

Posted by pinkeye on June 9, 2005, at 17:10:42

In reply to A question - possible trigger, posted by daisym on June 9, 2005, at 0:22:21

When a client attempts a suicide, the Ts mind would go through real hell.

It is incredibly incredibly taxing for the T to know that their client attempted to end their life. I guess that is the reason why they have this rule. Plus, it is really not fair for the client also to keep continuing with the same T, because the T would be shaken to the core with that client, and the client would not be getting adequate treatment. The T might feel very self defensive, manipulated, misunderstood, thing has gotten totally out of control feeling, possibly guilty etc. I think it would take everything out of a therapist when a client attempts a suicide or succeeds in it, however strong he/she might be.

 

Re: A question - possible trigger daisym

Posted by Tamar on June 9, 2005, at 18:30:54

In reply to A question - possible trigger, posted by daisym on June 9, 2005, at 0:22:21

I have heard of this. Sometimes I've heard of it in the context of suicide contracts. But I've also heard of it happening when the (usually inexperienced) therapist felt deskilled by the experience and didn't feel s/he could handle the consequences of continuing to work with the client - a bit like pinkeye was saying.

I agree that if it's a rule it's outrageous... but on the other hand, not all therapists are as experienced and incisive as yours.

I'm sorry, though, that they don't like the new therapist. Is there any way they can change and see one they like better?

 

Re: A question - possible trigger

Posted by alexandra_k on June 10, 2005, at 9:31:07

In reply to Re: A question - possible trigger daisym, posted by Tamar on June 9, 2005, at 18:30:54

I don't think termination is a consequence of an attempt in DBT. You are supposed to have some sort of access to contact your t in emergency situations. Not necessarily 24/7 but some kind of reasonable access that is worked out before hand.

If you are feeling like attempting or other forms of SI then you are supposed to contact your t or emergency services or whatever.

There is a 24 hour rule. Or maybe it is even 72 I can't quite remember.

If you SI or attempt you aren't supposed to contact your t for that ammount of time after the attempt. That is the consequence. Not termination. DBT is about treating / working with people who recurrently SI / attempt. That is part of the problem for them. To terminate them because of their problem isnt the solution. I haven't heard of termination as a consequence there - unless the client refuses to work on ceasing their attempts / SI. That would be grounds for termination.

 

Re: I think it is fair enough for the T pinkeye

Posted by Dinah on June 10, 2005, at 17:41:39

In reply to I think it is fair enough for the T daisym, posted by pinkeye on June 9, 2005, at 17:10:42

Ideally a therapist's training, skill, and personal strength (because they've spent timing sorting out there own stuff) would enable them to do what's best for the client.

My therapist has never said he'd quit seeing me if I attempted suicide. I think he'd be pretty angry though.


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