Ending the professional relationship.

[sparrowfarfrom home]

First time checking in since May 2015, when I went NC w my BPD sister. When I dont check in its bc my life as relates to BPD is people is PEACEFUL! My friends are supportive and loving .

I've  never shared that I am a healthcare provider with a private practice and have been in practice a long time. No staff.

The issue is BPD patients in my practice. I can now  tell during the first phone call what I'll be dealing with.  When I do, I have a few options:

1   Say im not taking new pts., but Living in an area where everyone knows everyone else,  I often cannot say that. I may accept someone they know the next day...

2   Legitimately tell them if I'm not able to help with that issue and give them a referral to someone who can.

3   Or take them, with my guard up. Usually, I just keep my boundaries tight and hope I fix the problem quickly.

It's a little known fact that patients can sue a dr for 'abandonment '.  We must make sure that the handing off of the pt to another provider is done properly and for ethical reasons. (Not bc the pt is driving the dr crazy.)

I have a person who has involved me in their drama, I should have been more aware, and I am looking for the right SUCCINCT  words to say that will be non accusatory, non personal, yet end the relationship.  I was on the pedestal and now have been knocked off. I can't give more details.

So, guys and gals, any ideas?  

[bekind]

As a therapist, do you have an estimated idea of how many sessions it might take?  If so, perhaps you can initiate therapy with new clients via a "contract" that can or cannot be be renewed after the stated amount of sessions?  Just a thought.

WRT the established patient you've mentioned, I will defer to those who have had more experience.

[sparrowfarfrom home]

I treat chronic health and pain  issues and often tell people that  I would like to see results in 6 weeks and we book 6 appts.  A contract per se is not used in my line of work , but I could reinforce strongly that if results were not gotten after 4 weeks  I could refer them.  I'll have to think about that, its a good idea. Thanks!

[unicorn2014]

First time checking in since May 2015, when I went NC w my BPD sister. When I dont check in its bc my life as relates to BPD is people is PEACEFUL! My friends are supportive and loving .

I've  never shared that I am a healthcare provider with a private practice and have been in practice a long time. No staff.

The issue is BPD patients in my practice. I can now  tell during the first phone call what I'll be dealing with.  When I do, I have a few options:

1   Say im not taking new pts., but Living in an area where everyone knows everyone else,  I often cannot say that. I may accept someone they know the next day...

2   Legitimately tell them if I'm not able to help with that issue and give them a referral to someone who can.

3   Or take them, with my guard up. Usually, I just keep my boundaries tight and hope I fix the problem quickly.

It's a little known fact that patients can sue a dr for 'abandonment '.  We must make sure that the handing off of the pt to another provider is done properly and for ethical reasons. (Not bc the pt is driving the dr crazy.)

I have a person who has involved me in their drama, I should have been more aware, and I am looking for the right SUCCINCT  words to say that will be non accusatory, non personal, yet end the relationship.  I was on the pedestal and now have been knocked off. I can't give more details.

So, guys and gals, any ideas? 

Are you familiar with the BIFF technique, brief informative friendly and firm?

[sparrowfarfrom home]

Unicorn,

no, I am not familiar... sounds Great. Where can I find more info? I have an appt with the pt today.

thanks

[unicorn2014]

www.biffresponse.com

There's a link to the website.

You also might find the high conflict institute helpful www.highconflictinstitute.com

[sparrowfarfrom home]

Thanks so much. This is a goldmine of information that I have never run across in my years of reading and learning about BPD.

[unicorn2014]

You're welcome, it covers not just BPD but all high conflict personalities. I'm glad you found it useful.

[Sunfl0wer]

Would it help to not allow yourself to get put on a pedestal?

Can you reframe the situation some for the client so you are not really ever lifted too high, so the crash is not huge?

[sparrowfarfrom home]

Sunflower, yes this is the key, but as ones like me who have been traumatized by BPD the lesson takes a long time to learn. Plus it can be so subtle.

I am 100 x  better than I was 10 yrs ago, but as we know, it's a dance we need to remember the steps to when we encounter it infrequently.

Turns out she came in today without angry reference to the issue. I was ready for anything, but I kept my boundaries tighter this time.

[unattached-sis]

I'm no expert, so I'm just tossing an idea out there.

Your pt has knocked you off of your pedestal. Why not play off of that? Let her know that you know longer feel that you are capable of being the help that she needs, and that she deserves the best counseling she can find. Then give her resources to find a new counselor or refer someone that you know can help.

[sparrowfarfrom home]

I've referred her to a specialist for some follow up treatment that I don't do. That may take her a few weeks. She has 2 more appts she can have with me according to her referral .

I will see how to proceed after that.