Unhealthy Relationship with Therapist

[hotncold]

So... .this is not really related to BPD but since it is something that runs in my family I thought people could have some insights here.
A family member has been dealing with severe psychological issues - mostly depression - now for 12 years. 12 years ago he found a therapist, and has been in treatment with her on a weekly basis... .maybe more, for that time period. He refuses to go far away from his home town to visit family, to go on vacation to do anything, because he says he cannot be far away from his therapist. He has a great deal of anxieties and rarely uses a computer, does not have a smart phone. He is very isolated. In the last year things have gotten worse and he has had to go on disability leave due to severe depression and probably suicidal thoughts. He now has a psychiatrist who maybe puts him on meds... .I don't have all the details. Does anyone familiar with the professional norms that dictate therapists find that a decade long relationship with a therapist where things are getting worse, rather than better, sounds unhealthy, to the point where the patient will refuse to put any significant geographical distance between themselves and their therapist? Obviously, family members are feeling helpless since family members are a source of the problem. But what happens when the relationship with a therapist appears to have become co-dependent to this degree? It seems incredibly toxic. Any thoughts?

[valet]

On the surface it seems that the therapy has not been effective if your family member feels like he can't function outside of the proximity of his therapist. It doesn't necessarily mean that the relationship between them is unhealthy, just that the therapy isn't working to the degree that you expect.

Remember, therapists are just people, and people make mistakes. Sometimes even professionals can have bad boundaries, get too involved, and enable their patients.

What about you hotncold? How does this make you feel?

[MeandThee29]

It's hard to say without knowing all of the particulars, but I know that the therapists/counsellors I've seen have always worked towards weaning down, although I'm not what one called "brittle" in the way that you describe. I've just needed some direction and polishing along the way.

Some will actually end therapy if progress isn't being made and recommend that they evaluate what they want and perhaps try someone else.

[Sunfl0wer]

Not sure I would assume causation or simply coorelation of the therapist and an apparent decline.  Lots of factors could be at play, even ones you are not at all aware of.

I am not sure how you can help this person from your position. Best that I know is that you can be a supportive person, encouraging and work on the dynamic between you two.

... .
I have been in therapy for over ten years with the same person.  (From 17yrs old to >27yrs) By default, that does not mean it was not effective.  It also does not mean it was a codependent relationship.  From the outside, I am sure there were times folks could think I was doing more poorly than times years ago.  There really is no way for folks to understand what was happening in those sessions and the dynamics, unless of course they spent some months learning, attending, etc.

If someone criticised (offered unsolicited opinions) my one relationship in my life that I trusted, then I would seriously question my trusting of the person questioning my T.  Taking a criticizing approach would not move me to be more independent at all and would make me frustrated with the person expressing doubt over my T choice.

I guess my point is,
... .be careful in your approach.
Know what is your responsibility vs this person’s.
Focus on what you can affect... .the relationship between you two.

[hotncold]

What about you hotncold? How does this make you feel?

I think at the end of the day, this family member had a really unhealthy co-dependent relationship with his mother. She was bathing him even when he was 15 or 16... .just not good stuff and so I am afraid that he has replaced the unhealthy relationship he had with his mother with his therapist which to me is almost worse because at least his mother wasn't charging him money for her "services"... .I am pretty much helpless to do anything about it since he lives in a different country and as I mentionned does not use a computer or have a smart phone... .he rarely answers his phone. Has never answered a single email I have ever sent him (he probably has to go to an internet café or something - do those even still exist?) to check messages. I hear the point about being criticized might make a person dig their heals in so I agree that it is a difficult situation. Some of your comments have been somewhat reassuring -- that it is not automatically a bad thing, but honestly, there's nothing I can do about it except advise his family members (his mother?) on what their options are... .but yeah. Having the unhealthy mother intervene with the unhealthy therapist... .well, that's a lost cause. It's something that pops up in my mind and the extended family (me included) are at a loss as we see someone who was once seemingly happy and enthusiastic and funny become a complete shell of who he once was... .isolated, alone. This person could easily find himself homeless and living on the streets. He is actually not very far away from that at this point. So it's sad and worrying.

[gotbushels]

I think at the end of the day, this family member had a really unhealthy co-dependent relationship with his mother. She was bathing him even when he was 15 or 16... .

Yes that example seems quite far from a typical relationship between a family member and his mother.

Having the unhealthy mother intervene with the unhealthy therapist... .well, that's a lost cause.

Yes, that makes sense. If there was someone I cared about and the only choice was to substitute one caregiver for another—and at that, unhealthy as you see them—that would seem quite bleak to me.

So it's sad and worrying.

It is saddening.

I am pretty much helpless to do anything about it

Do you feel some sense of obligation?

[hotncold]

Hi thanks for the response. I don't feel any obligation but I feel that I am probably the only one in our family who has stepped away, done the work and processed the unhealthy borderline -traityness of our family and therefore I feel as though I could actually help him in some way, if only to listen to what he has to say and give him advice based on my own experiences detaching from my unhealthy relationship with my mother (who is the sister of his mother - so there are quite a few similarities there). So I don't feel an obligation but I feel as though based on the work that I have done and my own detachment from it all I could maybe help him. And when someone is in such a bad state, it's hard to not want to help in some way. I once sent him a book via the post - it was a Tara Brach book... .I don't know if he ever read it. I know he told his mother about it who told my mother about it who told me about it... .so yeah. But every so often I wonder if there is more that can be done for him - not necessarily me but the family... .when we were kids my siblings and I did tease him every so often because he was too sensitive and was really easy to provoke and he would lost his sh-t and we would find it kinda funny... .so perhaps I am not high on the list of trustworthy people, although as adults our dynamics I think have only been respectful ones... .who knows... . 

[No-One]

He is very isolated. In the last year things have gotten worse and he has had to go on disability leave due to severe depression and probably suicidal thoughts. He now has a psychiatrist who maybe puts him on meds... .I don't have all the details.

Unfortunately, when you don't have all the details, you are left to speculate.  One speculation is that he might be someone who refused to try meds in the past, or perhaps meds were prescribed by a primary care doctor (who didn't have the expertise to prescribe the correct meds).

The involvement of a psychiatrist can be a good thing.  Mental health issues can be very complex.  A lot of things enter the mix.  The standard of care for the Country you live in can make a difference.  If insurance is involved, that can make a difference on the choice of therapists.  If you are paying out of pocket for a therapist, then cash is king.  There are lots of variables.

Perhaps, since he is now on disability, he is now forced to see a psychiatrist.  If he wants to continue to get monetary compensation via disability, he might be forced to jump thorough some new hoops.  Maybe that will prove to be a good thing. Although therapy alone can work for some people; in some situations, therapy alone can't work for everyone in every situation without finding the right med for that person (for some people this can be a trial and error situation). 

[hotncold]

Hi no one. Thanks for these insights. They are very helpful and yes there may be some potential positive in the latest developments. Since I only get the details from his mother and my mother who see everything with sh-t covered glasses I suppose I only get the most pessimistic view of what might be going on. I really appreciate everyone's insight into this and it helps to give a different perspective which is soo helpful for me to gain a more balanced perspective on this. He very well could have been someone resistant to meds... .He seems to be terrified of anything having to do with modernity. So while I have no idea if this is the case it does allow me the possibility to entertain a scenario that is not worst case. Thank you!

[gotbushels]

I see—thank you for sharing hotncold.

It's generous and good of you to want to share with him what you've learned. I know a little of what that feels like. Managing relations in the family and especially detachment as you described—I think these are very valuable.

I don't want to give an offhand skew to this, but something that's helped me is to recall that people have to be in a position to receive positive things. So while we're here doing the things we think are important to us with our own values, I think helping someone else is still to help a separate person.

Coming back to what you said before:

he lives in a different country

does not use a computer or have a smart phone... .

he rarely answers his phone.

Sometimes, from where we are, we can only do x number of things to reach out to someone.

I admire that you went out to purchase that book for him and send that to him. That's more than a phone call. Was that book True Refuge? 

[hotncold]

Hi Gotbushels,

You're very right. It does seem that my relative may not be open to receiving positive things at least as far as I can tell. The book I sent him was Radical acceptance... .i actually never read it but listened to probably more than 100 of her podcasts at some point and did some research and found that people who had been very severely depressed found this book to be really helpful, so I figured if this book was lying around his apartment he might pick it up one day... .Sometimes "doing" something is for our own benefit as much as it is for others. I felt happy about having done it and I still do. I felt like I was opening myself up a bit and being vulnerable doing it actually because "self help" and spirituality is mostly frowned upon in the family, so when he told his mom about it, who told my mom, I braced for some ridicule or criticism or disapproval, but it seems that the subject of the book got lost in the broken telephone and the "topic" of the book was never brought up with me... .