Therapist cancelling appointment without notice

[Eggdad]

My 22yo dd missed last week's appointment with her therapist because she slept in. T left her a voice mail but dd never mustered up the courage to call him back. When she showed up for this week's appointment, she had prepared an apology for missing and not calling back and would have given him a check for the two weeks.

When she got there she found that another patient had an appointment in her time slot. T hadn't notified dd that her appointment was cancelled.  When she saw this she turned around and left without talking to T.

At this point, dd is angry and feels rejected. She started by saying "I never want me see this T again" but has since mellowed down a bit. I hope she can work it out because he's a really good T and I'm worn down just at the idea of going through the process of starting again with a new T.

My question for you all is: should we have expected T to cancel this week's appointment without  notice because dd didn't contact him after missing the previous one?

Our objective is to better understand the struggles our child faces and to learn the skills to improve our relationship and provide a supportive environment and also improve on our own emotional responses, attitudes and effectiveness as a family leaders

[lbjnltx]

Hi Eggdad

I can only speak from my own personal experience.

My d had a weekly standing appointment.  There was never a time when we did not call in advance if an appointment was going to be cancelled. I can say with near certainty that if we had not shown up or called our t would not cancel our next session.  If we did this twice he would most likely have someone from the office call to confirm our next appointment.

There should be information on display in the office or in your paperwork that defines the guidelines surrounding missed appointments.

Do you think he is using this as a teaching opportunity for your d?

lbj

[Turkish]

Can you ask the T yourself?

Also, did she oversleep due to an early morning appointment? If so, can you somehow work out a different schedule in future days to help with that? Or does it sounds like enabling?

[Eggdad]

Actually she overslept for her 2pm appointment . She was ashamed about this which explains in part why she couldn't get herself to call t. Calling anyone except for family and her bf is a major challenge for her.

Dd agreed to have me call t for a first contact. When I talked to him he said that:

- in his voice mail he had told d to contact him for his next appointment;

- it was up to her to contact him and by not calling back she puts up a boundary and he will not break it;

- I can convey to her that he will be glad to set up an appointment  and see her if she calls him.

So lbj, in a way he is using this as a teaching opportunity. However for the second point I disagree with his rhetoric. He is not "respecting her implicit boundary", he is establishing his own boundary, without having clearly communicated it.

Well I called dd (she lives half an hour away), relayed t's words and d cried that she will never be able to call him back. At this point I should have stuck with just validation,  but I insisted that I knew she could do it and she should call him back today to put this behind her. She blew up completely and started yelling at me. Then I did something I have never done before: told her I did not deserve to be yelled at and that I would now be hanging up the phone,  and I hung up. Dd called back 5 minutes later, crying, then hung up herself after two minutes.

She called back again almost two hours later, much calmer, and she said she that by insisting I was asking her to do something she didn't feel she was capable of, and this made her feel shame. I recognized that it wasn't my place to tell her when to call her t and apologized for pressuring her. So thing are now OK between us, but I'm still not sure she will be able to call her t. I'm afraid this teaching opportunity will end up in another broken therapy.

[lbjnltx]

Oh boy.

That is how it goes with pwBPD.  Something that we see as so simple to rectify and put behind us can take on a life of it's own.  It's tiresome to ALWAYS remember to use our skills with our kids Eggdad.  And it is good that continued communication, owning our part, and your love for your d got this resolved rather quickly.

If there is a "teaching moment" in your next communication with your d maybe you could remind her that communication, though difficult sometimes is all it will take to get back on track and keep moving forward.

I hope she will contact her t.  Maybe a baby step... .email?

[qcarolr]

Eggdad,

Then I did something I have never done before: told her I did not deserve to be yelled at and that I would now be hanging up the phone,  and I hung up. Dd called back 5 minutes later, crying, then hung up herself after two minutes.

This is a great step forward for you with boundaries. This was one of the first that I could keep consistently with my DD. It took her awhile to accept it. I just kept on saying 'talk to you when things calm down.' Then I hang up or leave the area - even driving away if she follows me around. This is a way to hold my DD accountable for her anger even when she does not have the skills to manage it yet.

Maybe the timing for the T's response is outside of a "teaching moment". Is this the first time your D has missed an appointment without a call to cancel or reschedule? If there is not an agreement with the expectations for your D, then that is a step to bring up to the T.

It is very frustrating as a parent to watch our BPD kids  mess up their therapy that is working. Could the 'success' be overwhelming your D? This often happens with my BPDDD28. Has your D learned any skills or tools to help her get past the vicious cycle of this behavior?

Is sleeping past an appointment a pattern with your D? It is a way that my D 'manages' her fears about therapy opening up her 'feeling box' and leaving her more distressed after the session than when she went in. It takes time for her to build enough trust to share the real issues in her life. She holds onto denial that there are any problems so often.

My D's current T, with D's written permission, allows me to communicate about D's appointments and living situation (which is very unstable). She does not share any info about the sessions with D as part of trust building and confidentiality. So I do call the T when D chooses not to attend. Her case at the county mental health center has been closed many times. Their policy is that if there is no attendance for 3 months, their case is closed. Then a new intact interview is needed to restart therapy.

I have learned, for my own sanity, to detach from the stress of 'making' D go to her appointments. She is an adult and is responsible for being ready to go. I provide her transportation. I remind her the night before. I text her 15 minutes before I leave home. Sometimes she texts back if she is not going. Sometimes I arrive and she tells me she is not feeling able to go. I persist knocking on the door until I see her directly - sometimes she sends a friend to talk to me. This is frustrating since I have rearranged my schedule for her benefit.

So I remind myself that I am choosing to support her in this. It is my choice to provide the transportation and reminders. Becoming angry and stressed damages my relationship with DD. I still experience intense frustration, and do get angry sometimes (try to not dump this on D). The most important part is for me to keep the connection open with her in an unconditional loving attitude. I can also set up my boundaries - she knows about these ahead of time.

Let us know how things go.

qcr

[Eggdad]

Stopped by her apartment today on my way back from work. She's having trouble keeping up with her classes and feeling more anxious than usual these past two weeks. It explains the context for missing her appointment with t and not calling back. She asked me to call her in two days at noon to remind her to call t. If she feels she needs me to be next to her to make the call she will say so. She hasn't figured yet if she will tell him off or schedule the next appointment... .Guess it depends on how the conversation goes.

qcr, I have also detached from getting involved with d's appointments, letting her handle everything except the bill. Right now I'm struggling with the dilemma of letting her handle it and learning at the risk of her terminating the therapy vs getting more involved at the risk of enabling her.

My instincts are yelling at me to call her t and explain all this, but I don't trust those instincts, they push me to enable her. My reason tells me to stick with calling her Thursday at noon. Yeah, that's what I'll do. Unless I change my mind... .sigh!

Next chapter Thursday pm. Thanks for your input.

[Sunfl0wer]

My instincts are yelling at me to call her t and explain all this, but I don't trust those instincts, they push me to enable her. My reason tells me to stick with calling her Thursday at noon. Yeah, that's what I'll do. Unless I change my mind... .sigh!

I'm not sure that you calling T would do any good.  It sounds like he wants to work with a pt who wants the therapy bad enough to ask for it. 

That may not be a bad thing.

[madmom]

I guess I will throw my two cents worth.  I can certainly understand your feelings of do I or don't I.  I myself am a control freak and enabler of my DwBPD, and am working on it.  In working with various professionals throughout the years I have come to understand that it is ok to ask for help when you need it, that is a healthy thing.  It sounds like your daughter needs a little extra support, and I would encourage you to call her, or stand by her as she makes the call, but not do it for her.  Here is one of the things my husband and I have agreed as a guideline for boundaries and have explained this to our daughter, who is currently doing fantastically well.  We will do anything we can to support and help you with good decisions about your health (BPD) and good choices, but we will do nothing to help you remain unhealthy or to support poor choices.  For us that means for example, yes we will pay for therapy---no question, we will attend therapy, we will take you and or participate in therapy with you if that is what is needed. We will not, did not, pay her rent for her when she foolishly gave all of her rent money away to "friend", who of course was going to pay her back and of course did not.  She had to figure that one out for herself, and she did and learned a good lesson from it.  I don't know if this helps, but know that I understand your struggle, you are not alone.  Best wishes that this will come to a successful conclusion for you and your loved one.

[qcarolr]

Stopped by her apartment today on my way back from work. She's having trouble keeping up with her classes and feeling more anxious than usual these past two weeks. It explains the context for missing her appointment with t and not calling back. She asked me to call her in two days at noon to remind her to call t. If she feels she needs me to be next to her to make the call she will say so. She hasn't figured yet if she will tell him off or schedule the next appointment... .Guess it depends on how the conversation goes.

This is such a good response from your D. She seems to know what she needs from you, and knows to ask for this. Whatever her choice, I hope she chooses to make the call.

qcr

[Eggdad]

Thank you qcarol, madmom, Sunfl0wer and lbj. Your unanimous advice to not get involved beyond   what dd specifically asks for and I am comfortable with has helped me stay strong and combat my natural fixer instincts.

One week later dd still hasn't called t but I'm confident that when she does, on her own time table, it will be to resume therapy. Meanwhile in the past week she has lost her cell phone, recovered it two days later when the person who found it called my cell (dad in her contact list), missed many of her current classes (east-asian studies) for high anxiety but has almost decided  to pursue her long time dream of following a college level jewelry program, which I believe will be a great fit for her, and two nights ago was woken up in the middle of the night because there was a small fire in her apartment that dd and bf handled but it still forced evacuation of the building and the arrival of firemen, with the ensuing questions, reports and stress. Also her mom, my wife, is doing chemo for metastatic cervical cancer. In the context, I find dd is doing remarkably well in making sound decisions in highly emotional times.

Our objective is to better understand the struggles our child faces and to learn the skills to improve our relationship and provide a supportive environment and also improve on our own emotional responses, attitudes and effectiveness as a family leaders

[lbjnltx]

Hello again Eggdad

All in all it sounds like your daughter is doing alright.  Good news.

Not good news about your wife.  When a major illness like this strikes it can really cause problems in coping and processing our fears.

Do you talk openly with your daughter about mom's illness?  Does mom talk about it with both of you?

[Eggdad]

Hi lbj,

Yes,  we all speak very openly about mom's illness. One thing BPD has taught us is the benefit of putting everything out in the open for all to see, and to become immune to "what will the neighbours/friends/family think, feel or say". Also to not expect miracles but make the most of today and keep realistic hope for a better tomorrow.

If anything, mom's illness has improved the relationship between her and dd. My wife still gets very emotional when recalling the years before dd's diag and moving out of our house two years ago. They were constantly at each other's throats while I spinned inneffectively trying to fix everything. Their relationship is slowly mending but mom still hold a lot of resentment, much of it toward me for enabling dd in our pre-diag days. But I digress .

This morning just as I was posting my previous reply,  dd called on her way to Japanese class where she had an exam. She was in distress, hyperventilating, saying she couldn't find her wallet  this morning (probably under a pile of clothes) and also couldn't find the backpack she wanted to use today and she would arrive late for her exam and why is everything going so wrong at the same time etc.  She talked to me on her way to class, once there the exam had already started and dd was in no state to attend class, much less take the exam, so she asked if she could redo it on Friday. Teacher said no unless she gets a medical note so dd walks back home, calling me again for emotional support along the way. She did not have a breakdown and I was able to validate her feelings without offering any kind of solution. NOT getting involved in soo much work!

[lbjnltx]

Oh goodness!

I'm glad to hear that your family is sticking together and not worrying about what anyone else thinks!  It's hard for any kind of shame to survive in that kind of environment.

I hope that you and your wife are able to let go of the past and make the most of today. We do the best we can with what we have to work with... .past and present.  I know differently and so I do differently.

I hope your d will call her t and ask to come in for a note... .and a session!

lbj

[thefixermom]

The therapist seems reasonable to me.  He requested a call to resume the sessions and I can appreciate that since he had reserved the time and was stood up.  Was he paid for this missed appointment? That might factor in, too.  But either way, it seems like a normal consequence to me. I'm also not thinking that it was good to step in and help DD resolve this and act as her secretary, being made responsible to remind her to call the therapist. That is a trap that I have fallen into numerous times myself.  Once I realized I was reinforcing in my DD a dependency and lack of consideration for others, I began to catch myself and detach from her missed obligations. Only then did she start to mature and take better care of herself. But even more importantly, I began to understand that I have my life to live, too, and quit putting myself or other family members, or my friends, or my hobbies, etc., on the back burner to be my daughter's keeper.  It's been a bumpy climb out, not without major testing, but she is respecting me more than she used to.