Hiring and Firing and Self-Advocacy
June 11, 2011
Times have changed.
The days of the family doctor house call, the one trustworthy person who would be with you for life, who knows you and your family like the back of his hand, to whom you could surrender your power because he actually really cared are long long over. It's taken our culture a long time to adjust to this change. For most of a century, we still adhere to the "doctor knows best" mentality, when we may never have seen the doctor before.
Just an example: In spite of their knowledge of the field of medicine, the doctor does not have very much experience of your unique body. With few exceptions such as denial or confusing your senses with mind-altering substances (such as caffeine), you know when something is really out of sync in your body, and if you don't you can learn to tune in and increase your self-awareness. You are with your body all the time and you have some of the best known diagnostic equipment for early detection if you get to know how to use it. The doctor may never have seen you before and his tools, while they may be technological marvels, are still creations of a young science. No matter which specialist you see throughout your life, you are what is consistent in your treatment. You bring yourself, your knowledge of yourself, what you learned from other health practitioners, and what you know about your own body to the table. You need to be a partner or even better an educated consumer of your health care.
The days of giving one's power over to an authority more knowledgeable and capable than oneself is over -- in medicine as well as mental health care. Psychology/psychiatry/insurance/mental health care have changed SO much in 25 years it's pretty scary. These changes definitely have their good and bad points, but I think having the attitude of being a consumer/client in your mental health care is also in one's own best interests. You are with your thoughts all day and night. You know when you need help, even if you can't always be motivated to get it. You can learn how to be more self-aware and how to pay attention to and act on the signals your mind and body give you when there's a problem.
You hire professionals as a resource in managing one's health. They are counselors, giving you information and options, outlining suggested treatment plans, and submitting them for your input and opinions and modifications. It's become very important to have a basic knowledge of what you need, what acceptable treatments are, what the side effects could be, etc. And it's up to you to ask whether the treatments this practitioner may describe would interfere with other treatments you're getting from another practitioner. This is what I mean by educated consumer.
I think it's unwise to dismiss one's own power in the health and healing process. The more you take charge, the better you will do.
I take it as a sign when a therapist has not caught up to modern times, when they treat you as a patient and forget that you are their client and you hold their access to getting paid. Even if you are on health insurance, and feel like you are not a "paying client", you really are. You are in charge: you can go or not go to appointments, you can change providers at will; you can cease treatment at any time. The only exception is if this you are under court-mandated treatment, however you still may have the power to request a different therapist or counselor even if you're under court-mandated treatment.
I recommend that everyone become empowered clients and take charge of treatment. Create an explicit but flexible treatment plan, goals, timelines, etc. with or without your therapist's assistance. The days of disempowering the mentally needy should be over and done with (I'm on the board of a local non-profit disability empowerment organization--does it show?). If your therapist is not equipped to handle these goals, then perhaps request that they get equipped for exactly what you need from them through training/reading/studying/etc. or ask if they can help you manage goals and direct you to resources that will allow you to achieve your goals -- like a deluxe case worker.
If your therapist has hit a wall, it's up to you to stop playing at being helpless and a victim, and get moving because life is finite. We don't know how long we have, but we only have so long.
A sure sign of a problem is when treatment has been taking too long. It's alarming when someone has been in treatment for over 10 years, especially if progress is slow or stalled, or if there are still significant problems with internal organization and communication. This, to me, is proof that the techniques being used are simply ineffective or even counter-productive. I already think the average of 6 years of treatment (in addition to an average of 6 years trying to diagnose multiples!) is crazy, and encourages learned-helplessness to the extreme. In other words, I think that slow progress encourages us to think we can't be helped, or convinces us that progress must take a long time. It encourages us to feel hopeless, discouraged, worn-out, exhausted, depressed.
I fear that some therapists really do not have the client's best wishes at-heart. Whether it's conscious or not, a client may be regarded as simply a recurring paycheck, a guaranteed consistent income. Expedient treatment and healing is no longer the real goal. With insurance mandating the lengths of sessions and their frequency, many counselors and therapists are not much better than a case worker. "So how have you been over the last two weeks?" There is little incentive to expand their knowledge base beyond what is required to remain licensed. No incentives to try new things, learn new techniques, read the latest research, etc. There is definitely no incentive to work harder than they have to to be insurance compliant and ensure their paycheck comes on-time.
Not to say they can't exist: I know there are gems -- people who work in the health systems and are really good people and really try, but after some number of years of frustration at the system they've been handed, they're very susceptible to burnout. Once you burn out, or while in the process, it's almost impossible to care anymore. You go through the motions, a zombie with no heart and no passion. (hence my book: http://liberatedlifecoaching.com/Books/SurrenderToPassion)
I had an adolescent psychiatrist from 1986 to around 1990. In 2001 I went back to get some assistance during a period of intense self-work. I had maybe a half-dozen sessions with him, about a half-hour each, at great energy expense for me (often a 3 hour round trip through intense traffic). The whole landscape of psychiatry changed in the meantime to a pill-dispenser mentality and I didn't even realize it at the time.
I went in as an empowered multiple; I had an agenda and didn't want to deal with developing a whole new therapeutic relationship with someone else. If I got the help I needed, I felt it was worth the long exhausting trip. The poor man was so far over his head. In retrospect I realize he always was; when I was younger he was outgunned by me and the complexity of my case and diagnosis, doubly so when I came back in 2001 empowered and self-advocating with an agenda.
After a few short visits, many of which I was late for due to immense traffic problems, I had to stop seeing him. I gave a half-hearted effort to finding a specialist in multiples, and then gave up. It's hard to imagine that I was in NYC and couldn't find an appropriate therapist on my insurance plan. It was frustrating. So I went right back to self-help work on my own with occasional help from friends in the budding online multiple community. Much of what I learned is available online through http://Kinhost.org, and right here in the bootcamp, and in my book-in-progress, United Front.
It's okay to want help, and it's okay to be frustrated when we can't find the right people to help us. Hang in there. What's not okay is to settle for substandard help, help that increases our own stress levels, or help that disempowers us in any way. Trust your own inner wisdom. Some of the help we need is right between our own ears. If you become self-aware enough, you can make sound decisions for other aspects of your care that you need, including choosing therapists, counselors or medical doctors.
Sometimes a relationship with a specific therapist is over, or you feel like you’re done with therapy.
How do you end an established long-term relationship? Or stop seeing a newer therapist, or transition between therapists?
It’s not always straightforward. There’s many ways possible, but here’s some ideas for 3 ways to end a relationship with a specific therapist, whether transitioning to a new therapist or just ending therapy.
Be sure to check in with internal folk and make sure they’re all ok with the plan — whether it’s cold turkey, wean, or scheduling a few discharge oriented appointments.
It’s up to y’all. They’re your consultant. Leaving on amicable terms is always nice in case you need them to help document anything in the future.
Y’all can also discuss it with your therapist. Note that you’re a steady paycheck for them — they may not be 100% on your side when it comes to ending/closing the therapeutic relationship. But often they have a waiting list and as comfie as they are with y’all and happy about the assured paycheck, these are not good enough reason for y’all to stay in the therapy beyond its usefulness to you. There’s likely clients lined up on a waiting list. So if/when y’all are ready (and no sooner!), taper off or end therapy so others can get on their schedule.
You stop booking appointments or you cold turkey by cancelling your next or ongoing appointment and not rescheduling depending on how your scheduling works.
This is the just walk away plan. If y’all have standing appointments y’all will have to cancel. It’s important to cancel so that you’re not on the hook for cancellation or no-show fees.
This may not be the best plan as even though y’all may want to, burning bridges can have consequences later especially if either you find someone in your system believes it was out of integrity or if you need to contact this therapist for paperwork or anything for benefits or documentation.
So use this method sparingly. However in cases of abuse, you may have to just stop and walk away. Protect yourselves.
Weaning Off Therapy
Y’all can wean off by spacing out appointments farther and see how it goes. Like weekly goes to every 2 weeks, then to every 3 or every month. Then eventually just quit making appointments or have a goodbye appointment (see discharge plan below).
“I’m feeling like I don’t need to see you as often. I would like to change to meeting every-other-week and see how that goes.”
The Planned Discharge
If you want a goodbye or a discharge plan, go for it and talk to the therapist about it. Usually there’s a set number of sessions to end the therapeutic relationship.
This time can be spent making sure you have external supports, housing and relationships are secure, financials (work or benefits) are secure, a plan for work or other supports/services if needed, etc.
This is also good for those who want or need closure.