When to fire the therapist?

[tm006f]

I posted previously that my BPDh was arrested for the first time last week. 

It was a very traumatic experience for him and (I think/hope) a wake up call.

He has agreed to complete various therapies (start medication, see his current therapist twice a week instead of occasionally, go to anger management and go to couples therapy and maybe a support group as well).

I have been unhappy with his current therapist (psychologist) for a while, not only because it seems she missed his BPD and serious anxiety issues, but because she frequently flakes out on him, cancelling appointments at the last minute or allowing weeks to go by without an appointment, even though I would think you wouldn't do that when you have a patient who has serious issues.

When he was arrested, I texted his therapist and asked her to contact him right away.  The next day they were in touch and set up an appointment for the following day (a Saturday).  Supposedly we were going to meet for an hour (husband, me, and therapist) and then my husband was going to have a one-on-one session with her.

I had asked her to meet with us that same day, because I told her it was urgent and I wanted to discuss (at the very least) where our baby and I were going to sleep that night.  She texted to basically say, "can't you just discuss that with your husband?"  Thanks for nothing.

Anyways, Saturday night she texted me at midnight to say that she couldn't meet at 9 am and she would text me later with the "right" time.  I wrote her in the morning and asked her what the "right" time was.  She texted back to say 2 pm instead of 9 am.  I told her that really wasn't acceptable as we had another commitment in the afternoon.  I further said it seemed unprofessional to be changing the time like that when her client had just been arrested on domestic violence charges.  I said this is a crisis!  She then agreed to meet at 9 am after all.

We went to meet with her.  It went alright, although we came up with a loose plan for my husband and some ground rules for us cohabiting again, she did not put any agreement in writing.

Then, our family session ended and that was it.  No one-on-one session with my husband.

At the end of the session my husband started crying and apologized to his therapist for his behavior.  Then she hugged him.  It's clear he sees her as a mother figure.  I'm not used to therapists hugging their patients.  She has done this before, and also hugged me in the past when I have met with her.  At first it seemed friendly, but now I am questioning her professionalism (based on all the flakiness).

She did meet with my husband on Monday (yesterday).

My husband told me earlier today that he was meeting with her again tonight.  I said, I know he agreed to meet her twice a week, but two days in a row seemed soon, as I was thinking the second weekly session would be later.  He said he feels traumatized by his experience going to jail and needed to talk to the therapist more (he has been having crying spells and generally been really upset and obsessing about what happened in the jail).  I said of course it's fine for him to meet with his therapist as often as he wants.

When he came home, he told me the therapist cancelled on him.

Again... .really?

So, when do you fire the therapist?

She has a really good relationship built up with my husband, but if she continues to flake on him, it doesn't seem like a good relationship is going to overcome her lack of support.

When we met together, I told her directly that I was very unhappy with how often she has cancelled on him.  I asked her to identify a backup and questioned whether my husband should continue with her since he needs serious help and she is constantly flaking.  She promised she didn't have any other "trips" coming up so she didn't foresee the need to cancel any more sessions and she told my husband he could see another therapist, but that she would like to continue seeing him herself.

What do you think?

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[teapay]

I've learned to trust my instincts in regards to my W and her therapy/therapists.   It sounds like you have alot of concerns and that your instincts are ringing.

Would your H be willing to discontinue with that T?  My W has had Ts that I thought didnt really understand what was going on, seemed ignorant of the facts, missed dx, were played, wouldn't listen to my input. Of course, those were the ones my W loved and idolized the most.  She'd never want to terminate with them. Since I pay for it all, I could always terminate it if I wanted, but I've come to expect that the marriage might have little direct benefit from her therapy.  The marriage is a big concern of mine, but to her it is one leaf and a huge tree of other issues.  I don't know your situation.  As a spouse, unless your H is willing, you can be easily stonewalled, so you might need to think about boundaries here too.

Ideally, you want a T that you both have a good relationship with.  That can be hard to find.  How would your H feel about that and the search it might take?

[babyducks]

hi tm006f,

I guess my first question is what does your H think about all this?  Was this a couples therapist or his alone?   If he has established a rapport with his therapist and feels comfortable with her that could be a significant factor for him.

You raise some significant concerns about canceling appointments.   I can say from my experience it happens.   My T was also a first responder for a crisis center.   She would occasionally get called out short notice on emergencies.   What reason did she give for canceling?

It's not at all unusual for therapists to hesitate to give a diagnosis of BPD,  it's been discussed here for years.  There are insurance factors,   the diagnosis itself can be counter productive, and Axis II diagnoses can be comorbid.

teapay mentioned boundaries,  where do you think your boundaries should be around this topic?

'ducks

[Lucky Jim]

Hey tm, I have the same question as baby ducks: is the T a marriage counselor to both of you, or is she your H's therapist?  If the latter, then I might suggest that it's your H's call, not yours.  Of course it's frustrating when your spouse's T doesn't seem to get it, but you can't be totally sure of what his T is thinking, can you?  It sounds like you may want "to shoot the messenger", which is understandable, yet I wonder if some of that anger towards your H's therapist is more frustration about the message rather than an issue with the messenger.  Only you know for sure.

LuckyJim

[sweetheart]

Hi

It sounds from what you are saying that your h has a trusting, positive relationship with his T. Like the previous responses the decision to change T is his decision to make.

I also feel that given what has happened that if he is not actively seeking to change then it would be in both your interests that he stays with someone he knows and trusts, at least for the time being. What has happened cannot be fixed in the short term it will take a long time.

Do you have your own T, because you have been through a traumatic experience, and I understand your need to try and make sure everything is right. I can hear and understand your worry and frustration, remember though your h has set-up a lot of support. What support is there for you, what are your plans?

[tm006f]

This is my H's therapist.  We have gone to a few sessions together (at the therapist's suggestion) but she is my husband's therapist. 

I have my own therapist.

I know that I need to be careful about boundaries and it is important for my husband to feel comfortable with his therapist, but my concerns about her flaking out on appointments (I feel) are valid.

Unfortunately, I didn't start keeping track of her cancellations until the past couple of weeks.

However, I think that if your client gets arrested for domestic violence and you agree to meet that client and then text your client's wife at midnight the night before to say "oh, I messed up the time, need to reschedule" that just doesn't seem acceptable for me.  And then to agree at said meeting to see the client twice a week, and cancel the second appointment after that agreement is made.  Just seems not good to me.

She is not a crisis counselor.  My husband doesn't always want to tell me the therapist's reasons for cancelling, because he doesn't want me to judge her (his words).  The reasons he has given me for her cancellations or missing weeks include: she was sick, her husband's brother was sick, some other family member was ill, childcare issues, car accident.  I told her at our last group meeting that it seems like she has a lot going on and if she cannot handle a client with my husband's level of need, that maybe she needs to rethink whether she is the right therapist for him.  She left it up to my husband but told him she wanted to continue seeing him herself.

[babyducks]

I know that I need to be careful about boundaries and it is important for my husband to feel comfortable with his therapist, but my concerns about her flaking out on appointments (I feel) are valid.

I think you are right on all counts.   

In terms of boundaries.  I also read your other thread and understand he has agreed to do whatever you tell him in terms of treatment.   I think this is a mixed bag myself.    Right now your husband is motivated and compliant.   That doesn't seem likely to last.   Eventually he has to be responsible for his own mental health care.   In essence you want to thread a needle here, create an atmosphere that focuses on positive outcomes with out driving it.    You want to maintain your own boundaries.    You don't want to get caught in a triangle between you and your husband's therapist.     

'ducks

[sweetheart]

babyducks is right, for me this is a hot potato. Your h is in a remorseful place willing to do anything, my experience of this with my h is that it is not sustainable.

It is important that your h takes responsibility for his own T and other areas of treatment. Otherwise how will you be able to gauge his commitment to work on himself over the long term.

With such high stakes risk behaviour that your h was exhibiting prior to you phoning the police on him it is crucial that his actions convey his willingness to do the work needed. This means knowing when to get a new therapist if his old one continues to cancel appointments. This for you will be one of the ways you start to see that he is serious about addressing the problems he faces.

If he fails in his commitment to address his issues, or he leaves his T at your request and he doesn't like the new one and you have intervened to try and manage this process, i think it will be difficult for you to avoid being triangulated.

Discuss your concerns and issues around all of this with your T, they will help you navigate what is going on here for you. Your T will help you stay focused on you.