Aaarrgghh. Moving from improving to conflicted.

[toomanydogs]

Can you tell us more about your coach?  Degrees... .board certifications... .years of experience... .that kind of thing.

My "coach" used to be my therapist when she lived in this state. She has an MSW and a LISW. She has a little over 20 years experience in the state where I live. When she was here, she treated those with DID and personality disorders. A lot of clients who were suicidal and that sort of thing. Got compassion fatigue, so when she out of state, she held on to only two clients--I was one of them--and instead of continuing with being a social worker, she transitioned into coaching.
Because she started as my therapist--I was with her for four years in this state--I never checked what credentials she has now.
As I said, I've been in and out of therapy for nearly 45 years, and she and one other therapist, were so outstandingly matched to my personality and issues, I'd love to erect a statue. She makes me laugh. She challenges me when I'm getting caught up in the drama, and she pushes me to stay focused on myself.
[/quote]

So, I don't understand all the "details" of the issues with your hubby's P.  I'm going to suggest, for now, that we stick with principles (big picture stuff).  Being retired military... .I'm also a big fan of "structure" and "chain of command".

I don't think it wise that you ever be a "full fledged" member of your hubby's "team"  Why?  Because for you, it is personal... .even though it's obvious you have done an amazing job of "detaching" to fulfill a  "team" roll at certain times.   

Generally, I'd agree with you. However, the reason I established a team was that back in 2010, my H had a psychotic break. I thought he'd need 24/7 care. I got him to a recovery center near that was based in mindfulness as a tenet of treatment, and he got better. He was no longer running naked through the yard, screaming ethnic slurs at the neighbors, and peeing on the floor and in the yard.

When I got H back to the house (and we weren't living like "normal" husbands and wives), I asked representatives from a treatment facility that had as its number one tenet: mindfulness. The number two tenet was that a patient could only be as healthy as the household. (Systems based psychology). As a result, we, as much as possible, ran the household that way. We had monthly meetings, informal meetings, as well, to ensure that my H was not triangulating and to ensure that no one was getting burned out.

The P initially seemed to "buy into" that type of treatment. And it worked. I had support to maintain the house, and my H, in that environment, was able to get off a 20-year use of benzodiazepines (not easy); he quit smoking cigarettes; he was unable to triangulate; he was writing, and he was making music. To me, he was slowly getting better. He still had episodes but he was getting better.

I also thought and still believe that with the P, the T, the tech, and I, who have a 15-year background in teaching adults, that the team was ideal.
Yes, I have a personal RS with my H, but it's never been a typical marriage. For the past 7 years, my H has lived nearly exclusively in the guest house. He doesn't want to share my bed. He doesn't want to go out with me unless he suggests it.

In February, that all changed. And it changed when he called the tech a "c**t". I considered it an opportunity for him to learn to take responsibility for what he'd done. The P said the tech and I should learn to be called that, so it wouldn't bother us so much.

H has resumed smoking, and I strongly suspect he may be on drugs again.

An aside: When he called her an ethnic slur (she's Jewish) on Facebook and provided her name and address and phone number, she objected, and asked him to take it down.

"Members of my husbands team will have unfettered access to communicate with each other.  They will inform my husband and/or me as they, in their professional opinion, deem necessary."

Is that a value (principle) you could live with?

I could live with that principle where the T is concerned. With the P, no. I think she's lost her professional objectivity, and I consider her a danger to my H's well-being.
[/quote]

Perhaps the relationship with this P can't be mended.  Perhaps the process of mending the relationship with this P is a pathway to something better for you.  Only time will tell.

Understand that all of your team is involved with the "practice" of medicine.  Outcomes aren't assured. 

I know that. But I also know there is something off with the P right now. Instead of attempting to build my H's independence by encouraging him to write his father or write me or talk to me, she writes his father on his behalf, asking that my FIL provide my H more money. She writes me: "H has asked me contact you to stop treating him like a hostage." And she copies that text to FIL and T.

There's something wrong, and I completely get where you're coming from; however, in her case, she needs to be replaced.

Thanks! I'm off to start my day.

[/quote]

I'll hush for now... .kinda ran outta time and have to go.  I'll check in later.

FF

Cool. Talk later. Have a good day!
TMD

[formflier]

First of all... .I am totally jealous of the place you live.  We have been "off the farm" for... .goodness I guess it has been 4 years now.  We did dairy goats, horses, bees and several other critters.  Great place/lifestyle to raise a family.

I completely understand... .and miss... .the ability to spend time in the barn to work out stress, renew my mind, get a feeling of accomplishment... .etc etc.

Now... .on to the mental health team.

     

Please understand I'm not arguing with you and certainly not against you.  My perspective is as a person just taking a peek into the nuance of a chaotic situation.

My hope is in places where it doesn't appear that "i get it"... .that you can spend some time thinking through your point of view.  Perhaps it will "sharpen" your argument or objection or perhaps it will soften it.

1.  Use of the C word.  Horrible stuff.  My take is that the P is saying that your husband does "horrible stuff", including the use of the C word, and that chances of "making" him stop that are low (given where your husband is at now).  There is also a chance that your husband tried something "new and inflammatory" to get some kind of reaction/change.  It appears to me he got one.  

I'm also questioning how the "tech" allowed such personal information (address, facebook... .etc etc) to be known by the patient).   Remember... .I'm a structure and boundaries guy.  Honestly, I was not shocked at use of the C word (that's what they do)... .I was flabbergasted that a member of a mental health team would provide a patient personal information.  But... that's just me... .there very well could be good... .therapeutic reasons to do so... that are escaping me at the moment.

Again... horrible stuff... .I'm not at all saying given anyone a pass... .but I am suggesting that this is what a seriously disordered person does.  (look at other things that he has done from time to time)

AND... .that there can be improvement, but most improvement comes in a zig zag fashion.  3 forward 1 back 1 more back 1 forward, 4 forward 5 back... .(you get the picture).  The hope is that over years... .there is more back than forward.

   

Let's look at this another way.  What do you think would have been the appropriate thing for the P to do in the "c word situation"?  What do you think your hubby would have done in response, should the P have taken exactly the course of action that you wanted.

I'll address the rest of the post later.

I'm focusing on the "C word incident" because it appears to me that is the point of departure where you and the P really diverged... .instead of coming together around a treatment plan.

Do I have that right?  If not please point me to the "point of departure".  It does appear to me that "everything changed" around the C word incident, especially from the point of view of the "structure" of the team that was providing care.

   

FF

[babyducks]

So if the three points of the Karpman drama triangle are, victim, persecutor, rescuer, the way off the triangle or out of the triangle is to not accept any of these roles.

Stepping into the center of triangle means we change the role we play.

[babyducks]

and this is what happens when I try to post from my smart phone.   

So if the three points of the Karpman drama triangle are, victim, persecutor, rescuer, the way off the triangle or out of the triangle is to not accept any of these roles.

Stepping into the center of triangle means we change the role we play.

Let me try this again:

When you say:

Generally, I'd agree with you. However, the reason I established a team was that back in 2010, my H had a psychotic break. I thought he'd need 24/7 care

do you mean to suggest that the 24/7 care was a permanent condition?  I am wondering about the level of self determination that your H has regarding his mental health care.

I understand that family and household support is often crucial for sustained long term recovery.  I also get it is hard to do.   

You mentioned triangulation several times so I am assuming that you are familiar with the Karpman drama triangle.   There is some good stuff on this site about it. 
https://bpdfamily.com/content/karpman-drama-triangle

Like I tried to say before there are three points on the Karpman drama triangle.

The Persecutor - this is your fault,  you are not okay but I am so I am going to tell you what to do.

The Victim - I'm not okay and it's not my fault.   I'm blameless it's up to someone else to be responsible.

The Rescuer - You are not okay but I am nice and will fix this for you.

I am seeing a lot of Karpman Drama Triangles in the interactions you report in the mental health team.

I also thought and still believe that with the P, the T, the tech, and I, who have a 15-year background in teaching adults, that the team was ideal.

and your H agreed with this then?

When I read what happened with the tech and the C word, I see the drama triangle play out like this,   the tech starts on the triangle in the victim role,... she is justifiably upset... .however it is her job to 'fix' this,  H is the persecutor at the moment... .I lose the thread for a while but eventually you slip into the role of rescuer.   The tech quits but you hire her back in another role in the household.    Most of us here have over developed needs to rescue... .   I sure do.   Somehow or another the P is involved in the conversation,... .did your H self disclose?   Did the tech report the incident as abusive?   And the P ends up as Persecutor towards you and the tech and the rescuer towards your H.   That puts your husband in Victim role which he is probably more comfortable in.   but it also limits his ability to be responsible for his own actions.  where I get baffled is the man is 41 years old,  surely he has some level of understanding that using the C word is inappropriate.   

I considered it an opportunity for him to learn to take responsibility for what he'd done.

I'm struggling with this a little bit.   how did you envision this playing out?   and what role did you see yourself in here?

what I see in the mental health team is people moving around the triangle trying to get their voices heard and their needs met.

I am going to suggest that you try and get off this triangle.  at all costs.

there is a lot of literature about how to get off the triangle,... some people say move in to a more coaching, challenging, surviving/thriving role.   

other people say move out off the triangle to a more assertive, caring, vulnerable role.   

either way the answer is not to participate in the triangle as either a persecutor, victim or rescuer.

FWIW, I was never involved in my partners medication, getting it, tracking it,... .taking it... .all of that was up to her.   Frequently if there was a medication change she would tell me in case of side effects.   Sometimes I would offer reminders about diet, sleep and alcohol because she would honestly forget which interacted with what.     I never spoke to her psychiatrist, sent a text or an email.    That was her doctor and any communication went through her.    We had a 'map' agreed upon before of what I could and would do in the event of a psychotic break.   I can't take credit for the map idea, I heard that one on the internet.    Those boundaries afforded her the opportunity to recover in her own way at her own pace.   I am personally convinced that if those boundaries were not there we would have ended up in a situation much like you describe, with the various mental health providers at logger heads.

my two cents.

'ducks

[toomanydogs]

First of all... .I am totally jealous of the place you live.  We have been "off the farm" for... .goodness I guess it has been 4 years now.  We did dairy goats, horses, bees and several other critters.  Great place/lifestyle to raise a family.

I'm living out the fantasies I had as an 8 year old. Horses, however, are way more work than I'd realized, and goats, well, goats are just plain bad. I love them, but they are such opportunistic eaters that they all now look like African pygmy goats (think beer barrel) instead of Nigerian Dwarf (think deer.)

     

Please understand I'm not arguing with you and certainly not against you.  My perspective is as a person just taking a peek into the nuance of a chaotic situation.

My hope is in places where it doesn't appear that "i get it"... .that you can spend some time thinking through your point of view.  Perhaps it will "sharpen" your argument or objection or perhaps it will soften it.

1.  Use of the C word.  Horrible stuff.  My take is that the P is saying that your husband does "horrible stuff", including the use of the C word, and that chances of "making" him stop that are low (given where your husband is at now).  There is also a chance that your husband tried something "new and inflammatory" to get some kind of reaction/change.  It appears to me he got one.  

Her take is that bad behavior comes from a diseased mind. Fix the diseased mind, and the behavior improves. To me, this suggests she has too low an expectation on my H. I think he's capable of better behavior.

I'm also questioning how the "tech" allowed such personal information (address, facebook... .etc etc) to be known by the patient).  

No, it wasn't the tech whose information was put on FB; it was the psychiatrist's, and what I was getting at was, for me, there's a sense of hypocrisy, that I am supposed to get used to being called the c-word, but that she took offense at being called the K-word, and she objected to a few more things he'd written about her, and she asked him to take it down.

Again... horrible stuff... .I'm not at all saying given anyone a pass... .but I am suggesting that this is what a seriously disordered person does.  (look at other things that he has done from time to time)

I completely agree. Seriously disordered people behave pretty badly. I had wanted to come together as a team, so that my husband could 1) not feel ashamed of what he'd done, 2) take responsibility, and 3) apologize. I think she let him down therapeutically by not calling him out on his behavior. This is a man who has rarely had to face consequences for his behavior.

AND... .that there can be improvement, but most improvement comes in a zig zag fashion.  3 forward 1 back 1 more back 1 forward, 4 forward 5 back... .(you get the picture).  The hope is that over years... .there is more back than forward.

This is why I'm so distressed with P. We were moving forward. That movement forward had always zig zagged, but we have now moved backward so far that I don't think he'll regain the ground he's lost.

   

Let's look at this another way.  What do you think would have been the appropriate thing for the P to do in the "c word situation"?  What do you think your hubby would have done in response, should the P have taken exactly the course of action that you wanted.

I think she should have called my H out on his behavior. I think she should have let him know that it was inappropriate. I think his T should have asked my H how it could be handled. I think P should have used the behavior as an opportunity for my H to learn.

Please understand I have huge sympathy and empathy for my H. I also believe he is shame based, and I think instead of helping him get through the shame of what he'd done, she provided tacit approval for the behavior.

The P never liked the tech, always said the tech's job was cushy and that all she did was smoke cigarettes, exact phrasing of what my H had said about her.

When I pull back from all of this, I think I can fairly and accurately say that the P has crossed several boundaries and has lost her professional objectivity.

I'm focusing on the "C word incident" because it appears to me that is the point of departure where you and the P really diverged... .instead of coming together around a treatment plan.

Do I have that right?  If not please point me to the "point of departure".  It does appear to me that "everything changed" around the C word incident, especially from the point of view of the "structure" of the team that was providing care.

Yes, you have this right; however, I think there was tension before that. I am coming from a position that if meds could have made my H better, they'd have worked years and years ago, and that what we are now seeing is a personality disorder, and that there needs to be some level of consequence for his behavior.
She is coming from a medical POV--that if she fixes the diseased brain the behavior will lessen or disappear.
In December 2016, my H wrote the most beautiful post about being cigarette free, benzo free, and how he was going to now work on getting off the rest of the psychotropic drugs.
He was excited about the future, and he was fairly happy. He'd been on medical cannabis for 2 months at that time.
And then the c-word incident happened. Then he stopped working with his T, started working only with his P.
Then P increased his psychotropic drugs, then she gave him access to an entire month's supply, so he could go out of state--no plan where he was staying, no guarantee I'd even know where he was.
Now he's back on cigarettes, doesn't interact with me, attacked both me and his dad on FB.
Mostly I feel sad about my H and angry with the P.
[/quote]


   

FF

[/quote]

 Thanks for taking so much time with me. It helps when I'm asked to further explain why I think how I think. And our backgrounds are very different. I was always a hippie, an artist, a writer. Hierarchy doesn't fit with that kind of lifestyle. I was also a writing instructor, who liked horseshoe shaped classrooms, wanted students to call me by first name, if they were comfortable with that, and I wanted them to believe I was sincere when I told them I wanted to read what they wrote.

Thanks again for taking so much time and energy with me.
TMD

[formflier]

So... .I'm glad we understand each other better... .neither POV are right/wrong... .but they are different.

I'm talking to you, not your P, so (for now)... .I'm going to trust that the P was acting in accordance with her board certifications and training... .and her medical experience.

Also understand that when you have several disciplines working together... .toes will be stepped on and everyone needs to "give the benefit of the doubt".

I have personally been in treatment by a couple P's (meds to help me sleep due to PTSD... sleeping part is since resolved) and I've worked with Ps in a healthcare team when I was in the military.  Essentially when I was skipper of my shore commands I was "dual hatted" as the "clinic director".  So I had "administrative" authority over the medical team, but would never push any treatment options... but was very familiar.

So... .not sure how many Ps that you have been around... .but nothing you have said has raised any eyebrows on me.  I can certainly understand how you are frustrated.

I would also hope you understand that ultimately your hubby is responsible for his behavior... .your P is not.  As long as she is within her guidelines... .which, so far, it appears she is.

Please don't be shocked that a MD will treat an issue as a medical problem.

A psychologist will likely push "talk therapy".

A carpenter will likely use a hammer and nails... (I think you get the picture)

I would hope that if there is a future with the P that you could approach it like this.

"What are you seeing that leads you to believe my hubby managing his own meds is a good step?"

Also realize that an MD is at heart a scientist and will make a move and then collect data to inform the next move.  It very well may be that the P will use this as a "tried that and it didn't work" thing. 

We'll never know the outcome of a different course of action... .  If you want to press for a different course... .go in with metrics... stay away from feelings. 

The last x number of times we faced this we did y.  The outcome was consistent in z of those times with 1 time that was weird.

Mixing the world of a scientist and "feelings" can be hard... .do your best!

Hang in there.  I'll write more later.

FF

[toomanydogs]

Thanks, FF and thanks, Ducks!
  Based on what you have written to me, I've done a couple things:

  1) I realized I was inside the drama triangle: a) I was feeling victimized by P; b) I was perceived by H that whatever I did or said I was persecuting him. So... .
  2) I talked with my coach yesterday, who advised a few things, but basically she gave me a very good lead on The Empowerment Dynamic (TED), which is a book that suggests that "victims" begin looking at ways of becoming "creators." And persecutors can look at themselves as "challengers."
  3) Based on what she discussed, I'm ordering the book to get more info. However, immediately I focused the energy I had for P into how I could step out of feeling betrayed, et. al, and focus that energy on my own work.
  4) I cannot step out of how my H perceives me, so that leaves me with "playing nice" and being polite, keeping out of his illnesses completely. (An aside: I already messed up on that one when he mentioned how miserable he was in an email. I said, it sounds horrible and I was sorry. I should have said, "It sounds rough, but I know you'll be able to take care of it."

So that's where I am today. This forum is really helpful now that I'm on the right thread.

Write more later,
TMD

[formflier]

  I should have said, "It sounds rough, but I know you'll be able to take care of it."

I would hope you would minimize the "emotion" in email. 

"Thanks for sharing your thoughts.  I'm heading to  xyz coffee shop today at 1 if you want to chat... I'm up for listening."

Critical point.  You go enjoy a drink... hang out for a while... then go.  If it seems like he makes a reasonable reschedule attempt... .perhaps do that.  But don't "go round and round" to accommodate him.

Big picture:  You are living your life and being clear about "open doors" and "pathways" to relationship.  He gets decide to take advantage or not.  Not up to you to convince him or explain this.

FF

[babyducks]

First of all thanks for the game 2048.   I’ve enjoyed it.

As to

(An aside: I already messed up on that one when he mentioned how miserable he was in an email. I said, it sounds horrible and I was sorry. I should have said, "It sounds rough, but I know you'll be able to take care of it."

 I have a slightly different take on this than FF does.    I think it’s excellent that you recognized how your response could have reinforced his victimhood and a great insight that you could answer in more empowering ways.    You second thought was almost text book in how to reply in ways that can move other people off their points in the drama triangle.    I think you should give yourself a lot of credit,  in a very short people of time, during a period of emotional stress you are having some significant breakthroughs.

There are techniques and tips on how to frame a response in such a way to invite people to give up their position on the drama triangle.   I think this is a two thumbs up approach.     

I also see the invite out to coffee differently.   For what you’ve said he is still off his medication,   he is still self-medicating with nicotine and possibly something else.   and you haven’t mentioned that he has made any overtures towards contact…...       The likelihood that he is still ‘amped up’…. Is pretty good,… it does take people who are organized on the BPD/NPD level longer to return to emotional baseline.

Obviously one size does not fit all,... .each of us is a fully complex human with a myriad of different likes and dislikes.   You are the best judge of what is right for you.

In the example you gave above….how miserable he is…. if you went with your second thought the 'It sounds rough, but I know you'll be able to take care of it'... .Staying with that thought you could try….  do you want me to listen while you problem solve?    He might be still so dysregulated that he can’t process that yet…...   and it might take many repeats of a similar idea before he is receptive to it.

I have a friend who is an absolute wizard at active listening.   I wish I could do it the way she does.   She has this great ability to help me solve a problem I didn’t even realize I had.   Mostly she pays attention.   Serious attention and then paraphrases back the message she thought she heard.    It’s a skill I am working on.   You might try a little active listening... .

I'm glad you've found this forum helpful.   somebody was here for me on the day I showed up in crisis... .it's nice to be able to pay it forward.

'ducks

My two cents,