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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 26. This is the beginning of the thread.
Posted by TherapyGirl on November 9, 2011, at 16:56:16
I had therapy today. The whole Penn State thing was a huge topic of conversation (I have lots and lots of feelings and anger about that). But I also mentioned a situation with a family I am working with in my professional world. Mom has had mental illness for years and is clearly deteriorating. Adult son has an intellectual disability. Mom has said lots of "crazy" stuff on the phone to various staff in recent weeks such as that people think she's a terrorist and the house and phones are bugged, etc. Earlier this week she casually mentioned that her neighbors, who she says hate her, think she is having sex with her son.
I have been in various discussions with co-workers ever since deciding how best to handle this to get this family the help they need, whether or not she is molesting her son. It has never been a question in my mind of doing something, just a question of what to do. I mentioned my frustration with figuring out the best course to take and new T talked to me about it and then said, "And of course now I have to report it, so how do you want to handle this?" Obviously the LAST thing I want to do is go to my boss and tell her we have to call DSS because otherwise my therapist will rat us out. I have talked to my boss about the situation (not mentioning therapy), she seems unclear on the reporting laws and so now I have a call in to an attorney.
I'm worried that new T will take action if she doesn't hear from me soon enough, whenever that might be. I did tell her that boss had been out of the office and was not yet aware of the situation.
I'm worried about this family, pissed at T for putting me in this situation and mad at myself for not thinking of that ahead of time.
Thoughts? Ideas?
Posted by emmanuel98 on November 9, 2011, at 18:33:40
In reply to Need Advice *****Likely Trigger*****, posted by TherapyGirl on November 9, 2011, at 16:56:16
I find your T's response strange. Yes, she is a mandatory reporter, but she has no direct knowledge of or involvement in this particulary situation. Further, aren't there confidentiality issues here -- with you talking about a client. I think your T should let you handle this issue yourself. You and the agency you work with are presumably mandatory reporters as well, so it makes more sense for you and your agency to contact DSS if abuse is suspected.
Posted by sleepygirl2 on November 9, 2011, at 19:50:20
In reply to Re: Need Advice *****Likely Trigger*****, posted by emmanuel98 on November 9, 2011, at 18:33:40
I'm going to hazard a guess, and say that this person has been psychiatrically hospitalized before.
Is her psychiatrist aware? She has one right?
Some counties have crisis teams that go out to evaluate people when there are concerns.
I mean sure, you want to protect the son, but it sounds like psychosis is the most verifiable fact.
Posted by jane d on November 9, 2011, at 20:35:13
In reply to Need Advice *****Likely Trigger*****, posted by TherapyGirl on November 9, 2011, at 16:56:16
Is she also going to call homeland security? If not, why not? It sounds like she has just as much reason to believe that this woman is a terrorist as an abuser.
I also wonder if this is really something she needs to report at all. I took a quick look at the laws of my state and there's a lot of emphasis on "reasonable" suspicion. Each state is a bit different and in the end it's not really what the law says anyway but how it's interpreted locally. So you probably really do need that lawywer. Especially since your boss isn't clear on the rules. It's something that will come up again unfortunately.
You might call your therapist and tell her you're consulting a lawyer and would appreciate her holding off until afterwards. Would it upset you too much if you asked and she refused?
If my therapist did that to me I'd be angry but I think I'd be even more upset about her judgment being bad about it being reportable. I'm not sure I'd be comfortable continuing with someone whose view of reality was so different from mine. I'd also be upset if she didn't try to warn me before we got into mandated reporter territory which would be a bit unfair since I am aware of the issues.
I have no first hand experience but I do have relatives who are reporters and a disabled family member who these laws are theoretically meant to protect so I've sort of paid attention to these rules over the years.
I'm sure you know all this but keep in mind each state has it's own rules you can't rely on anecdotes from other places, interpretation and enforcement policies change rapidly so last years guidelines may not be useful, that reason has very little to do with how it's interpretated, and that your career can depend on getting it right. And that sometimes you will therefore have no choice but to do the wrong thing for your client. Which stinks.
Finally I'm very sorry you're dealing with this but I'm also greatful to you for posting about it. It's a good reminder to me to be careful what I say to my therapist. That trust needs to have limits.
Posted by Dinah on November 9, 2011, at 21:28:36
In reply to Need Advice *****Likely Trigger*****, posted by TherapyGirl on November 9, 2011, at 16:56:16
It sounds very odd to me as well. Did you use names? If not, who is she going to report? And is this actually reportable, by her?
I'd be very angry, and feel betrayed. As Jane said, she could at least point out that you were entering difficult territory. You need to have a certain level of trust to be able to talk openly with a therapist. Her involvement could have negative consequences for you. It seems she jumped into this without a lot of thought, or consultation with an attorney. If I were her, I think I'd consult an attorney before breaking confidentiality like this.
I might be being overly negative, but it's very very important for me to feel like I can trust my therapist. At the very least I need for him to be reluctant to take steps like that. At the VERY least.
Posted by sleepygirl2 on November 9, 2011, at 22:09:10
In reply to Need Advice *****Likely Trigger*****, posted by TherapyGirl on November 9, 2011, at 16:56:16
I apologize for my previous post. You probably know resources, and I can't really comment on how you could handle it, but she sounds like she's in a whole different reality, so teasing out what's what has got to make it difficult.
What I guess I can speak to is my reaction to what you said about your t. Icky boundary stuff, makes trust VERY difficult, with a lot of pressure on you.
sounds very uncomfortable
Posted by pegasus on November 10, 2011, at 9:09:55
In reply to Re: Need Advice *****Likely Trigger***** » TherapyGirl, posted by sleepygirl2 on November 9, 2011, at 22:09:10
I'm a mandatory reporter in my state, and I know that the laws require me to report child abuse, but not abuse of at-risk adults. I'm *urged* to report abuse of at-risk adults, but not required.
For child abuse, I have to report within 24 hours of receiving the information. And I have to report if I have reasonable cause to believe there may have been abuse, or if I have reasonable cause to believe that the abuse might occur in the future.
In order to report, though, I have to have identifying information about the possible abuser or victim. Did you tell her their names? Or enough information that she can easily know who they are?
If so, then in this situation, I would actually think that the mandatory reporting requirements have been met. So, this does sound like a mandatory reporting situation for your T, if your state requires reporting for at-risk adults.
Usually, if I am concerned that I'm getting into mandatory reporting territory with someone, I can stop them from giving me identifying information, at least. That's where I think your T should have warned you. That said, though, sometimes people just tell you things all at once, without you having a chance to warn or stop them. But if that's what you did, I would like to have seen your T be a bit more apologetic or gentle, or something with you around this. It sounds like she assumed you had the mandatory reporting requirement in mind while you were talking, which is not a good thing to assume. Mandatory reporting laws are tricky, and it's hard to keep them in mind when you're in the thick of a situation like this. Especially when you're talking to someone with whom you otherwise have very confidential discussions.
Hey, let us know how it goes with your boss and the reporting, and with your T.
And, wow, I agree with you about the Penn State thing. The part that gets me is the football fans standing behind the officials who didn't report what sounds like a really obvious and horrible instance of child sexual abuse. How can anyone say what they did is OK? All those poor boys who could have been spared . . . I can barely stand it. :(
- Peg
Posted by TherapyGirl on November 10, 2011, at 10:10:45
In reply to Re: Need Advice *****Likely Trigger*****, posted by emmanuel98 on November 9, 2011, at 18:33:40
Thanks, Emmanuel. That makes me feel less crazy for reacting the way I did.
Posted by TherapyGirl on November 10, 2011, at 10:11:37
In reply to Re: Need Advice *****Likely Trigger***** » emmanuel98, posted by sleepygirl2 on November 9, 2011, at 19:50:20
She probably has, but because our program is centered around the developmental disability that her son has we don't have that information for her. I'm trying to figure out a way to get it, though. Thanks for the idea.
Posted by TherapyGirl on November 10, 2011, at 10:13:22
In reply to Re: Need Advice *****Likely Trigger***** » TherapyGirl, posted by jane d on November 9, 2011, at 20:35:13
Thank you, Jane, for putting into words all the things I was feeling and thinking. I completely agree with you about the Homeland Security thing.
It seems our state has a reasonable suspicion thing, too. I'm still waiting to hear from the lawyer.
Posted by TherapyGirl on November 10, 2011, at 10:15:44
In reply to Re: Need Advice *****Likely Trigger*****, posted by Dinah on November 9, 2011, at 21:28:36
No, I don't think you're being overly negative Dinah. I'm right there with you on all levels.
I did NOT give names (not even first names) and I didn't tell her what county they live in. As one of my IRL friends said to me last night, let's imagine how that conversation would have gone:
T: I'm calling to report possible sexual abuse. I can't give you a name, address or even a county and I can't give you the name of my client who "reported" it due to confidentiality laws, but I can perhaps tell you that she works at ________. And by the way, the suspected abuser also believes that people think she is a terrorist.
Posted by TherapyGirl on November 10, 2011, at 10:16:21
In reply to Re: Need Advice *****Likely Trigger***** » TherapyGirl, posted by sleepygirl2 on November 9, 2011, at 22:09:10
No apology necessary -- I think both of your posts are wonderful!
Posted by TherapyGirl on November 10, 2011, at 10:17:28
In reply to Re: Need Advice *****Likely Trigger*****, posted by pegasus on November 10, 2011, at 9:09:55
That's just it, Peg -- she doesn't have any identifying information. Which makes me think she's bluffing and makes me furious. Especially since I would never NOT report suspected abuse and that was clear (or should have been) from our conversation yesterday as well as previous conversations on the subject.
Posted by TherapyGirl on November 10, 2011, at 10:19:03
In reply to Re: Need Advice *****Likely Trigger*****, posted by pegasus on November 10, 2011, at 9:09:55
I think I'm going to have to fire this T too. If this had happened deeper into our relationship or connection or whatever we might have been able to overcome it, but the strong arm technique NEVER works for me and especially not in this situation. I don't know what she was thinking, but I don't think I can get past it.
I miss my real T and I think I'm done with therapy at least for now. Maybe forever.
Posted by Dinah on November 10, 2011, at 10:35:55
In reply to Re: Need Advice *****Likely Trigger*****)Everyone, posted by TherapyGirl on November 10, 2011, at 10:19:03
I can understand why you feel that way. I'd likely feel that way too about a therapist early in our relationship. Not least because, as Jane says, her judgement appears to be poor. If she can't find a very good excuse for why she didn't really say what you think she said...
But I think that most therapists would find her position odd. If you find that you need therapy in your life, don't let this incident prejudice you.
(((TherapyGirl)))
I wish you could have kept your Real Therapist.
Posted by pegasus on November 10, 2011, at 11:36:34
In reply to Re: Need Advice *****Likely Trigger***** » jane d, posted by TherapyGirl on November 10, 2011, at 10:13:22
Well, but is there any mandatory reporting for suspected terrorist activity, from a legal standpoint? If not, then it's not really the same thing, even if it seems similar.
- Peg
Posted by pegasus on November 10, 2011, at 11:41:21
In reply to Re: Need Advice *****Likely Trigger***** » pegasus, posted by TherapyGirl on November 10, 2011, at 10:17:28
What!?!? Well, then, she has no requirement to report! She should know that. I can see why you're so upset. I agree that this makes it seem like she's trying to manipulate you, which is totally not OK.
Hey, but before you fire her, do you think it might be good to have a conversation with her about this? On the off chance that she has some defensible way of looking at this. Although . . . that seems hard to expect. But at least if you talked to her first, you'd have given that possibility a chance.
I'm so sorry about all of this. It sucks as a way to figure out your T isn't right for you. Not that there is a good way, but . . . I hope you know what I mean.
- P
Posted by TherapyGirl on November 10, 2011, at 13:35:12
In reply to Re: Need Advice *****Likely Trigger*****)Everyone, posted by TherapyGirl on November 10, 2011, at 10:19:03
My co-workers are going to visit the family next week to get more information (we really do not want to throw the son from the frying pan into the fire because of problems with institutionalization in this state if there is a way to make sure he's safe where he is). Still haven't heard back from the attorney.
I'm inclined at this point to get more information and just not email or call T like she ordered me to. I just can't imagine how she would report it. What do you all think?
Posted by pegasus on November 10, 2011, at 14:09:40
In reply to Re: Need Advice *****Likely Trigger*****)Everyone » TherapyGirl, posted by TherapyGirl on November 10, 2011, at 13:35:12
Sounds very reasonable to me.
Even if she did report it, I'm quite sure the police or social services would not do anything, because of the lack of identifying information. I've reported relatively vague situations, but at least with *some* identifying info, lots of times. And the most common response I get from the police is confusion. I've been asked, "What did you want us to do?" more than once. I'm quite sure they never did anything with most of those reports. For what it's worth.
I sure hope the son is OK. He sounds so very vulnerable.
- P
Posted by TherapyGirl on November 11, 2011, at 13:03:52
In reply to Re: Need Advice *****Likely Trigger*****)Everyone » TherapyGirl, posted by TherapyGirl on November 10, 2011, at 13:35:12
I decided last night to send T an email telling her we had taken action while not describing what the action was. Real or not, I started worrying that she would call Protective Services and/or the police and give them MY name. Below is the email exchange. I *hate* those non-apologies.
> Just wanted to let you know that action was taken today regarding what we discussed yesterday. I also feel I need to add that I'm pretty uncomfortable with the way that played out between the two of us. I'm not sure I can come back. For now, I'd like to cancel the appt. next Tuesday and then let you know after Thanksgiving what my final decision is.
************************************************Thank you for letting me know.
I am sorry that our discussion was uncomfortable for you. Should you decide not to continue to work together I only ask that we at least discuss your reactions. I will, of course, honor whatever you decide.
I look forward to hearing from you after the holiday.
Posted by Solstice on November 11, 2011, at 20:57:22
In reply to Re: Need Advice *****Likely Trigger*****)Everyone, posted by TherapyGirl on November 11, 2011, at 13:03:52
Maybe she doesn't know enough yet to know what she may, or may not, need to apologize for? Maybe she's hoping that you'll decide to at least give her a closing conversation, since that will give her an opportunity to repair it, and even if that doesn't work, at least she will learn from it for the future. Since she's asking for your feedback on what took place, I think it would be therapeutic for you to be heard on this - even if it doesn't work out for you to continue to see her. It would honor your effort in the therapy.
My own therapist would have responded similarly. I remember one time, I had been so pained by a breach in the relationship, that when I texted my therapist about it and my T called me, I couldn't answer the phone. T called again later, and I accidentally answered. So I didn't hang up, but I was in so much pain that I wasn't able to speak. T thought I was probably there, and really went out on a limb just talking to me. T must have talked 10 minutes or so without hearing me say a single word. My T eventually closed the call, without my having ever spoken a word. T just gave me repeated assurances that we could work it out together. Last thing T said was "I will be there for our appointment tomorrow, and I hope I will see you there." I showed up, and we worked it out. For me, the repair of the breach further cemented the therapeutic relationship.
Solstice
> I decided last night to send T an email telling her we had taken action while not describing what the action was. Real or not, I started worrying that she would call Protective Services and/or the police and give them MY name. Below is the email exchange. I *hate* those non-apologies.
>
> > Just wanted to let you know that action was taken today regarding what we discussed yesterday. I also feel I need to add that I'm pretty uncomfortable with the way that played out between the two of us. I'm not sure I can come back. For now, I'd like to cancel the appt. next Tuesday and then let you know after Thanksgiving what my final decision is.
> ************************************************
>
> Thank you for letting me know.
>
> I am sorry that our discussion was uncomfortable for you. Should you decide not to continue to work together I only ask that we at least discuss your reactions. I will, of course, honor whatever you decide.
>
> I look forward to hearing from you after the holiday.
>
>
>
>
Posted by Dinah on November 11, 2011, at 22:38:21
In reply to Re: Need Advice *****Likely Trigger*****)Everyone, posted by TherapyGirl on November 11, 2011, at 13:03:52
How long have you been seeing this one? Isn't it a different one than the first Not-My-Therapist you saw?
If there isn't a strong connection, I can understand wanting to just walk away. But I think I'd be interested in hearing her thinking. And even more interested in hearing who she was thinking of reporting it to, and how the conversation would go. As your friend pointed out, it was rather general.
I think I'd really like to know exactly how she thought this could be reported, why she felt as if she was legally compelled to report, and whether she was trying to pressure you into doing what she thought you should do, as opposed to talking to you about it and perhaps framing it as concern for you.
If she was pressuring me, I think I'd be even more angry than if she was making a legitimate threat to inform the authorities to talk to me - or would it have been your employer?
If you do feel more connection to her than I am assuming, it might be worthwhile to try to salvage it. Everyone screws up. Even your Real Therapist. If she offers enough in other ways, would it be possible to refuse to talk about certain issues with her because she's lost your trust in those areas? Of course, if her intent was to pressure you, the loss of trust might be wider than simply work issues.
Posted by Solstice on November 11, 2011, at 22:56:41
In reply to Re: Need Advice *****Likely Trigger*****)Everyone » TherapyGirl, posted by Dinah on November 11, 2011, at 22:38:21
As always, Dinah, you've brought up a lot of really good points. Therapeutic relationships are complex, for sure.
Solstice
Posted by Dinah on November 12, 2011, at 15:23:09
In reply to Re: Need Advice *****Likely Trigger*****)Everyone » Dinah, posted by Solstice on November 11, 2011, at 22:56:41
I talked to my therapist about this in the last few minutes of my session yesterday. It brought up a good, if brief, discussion of the legal portion of his practice - not only mandatory reporting but CYA questions. I think it's an area that will always lead to tension between us - that's inevitable. It's good to have discussions about it from time to time. I think we've got an understanding at the moment, and that he'll at least be aware of what I'm thinking and assuming should the topics arise again.
He doesn't think that, as I described it of course, he would see it as something he would feel compelled to report. And that if he felt strongly about what I should do, he would talk to me about it rather than pressure me by threatening to tell himself. Perhaps framing it in terms of being worried of the consequences for me in not reporting, because he's my therapist and not my supervisor. Of course, I think he was careful about what he said because he knew it would have an impact on our relationship.
I wonder in all of this, if this therapist gave any thought as to the therapeutic aspects of the discussion.
So... I suppose any thoughts I have on the topic are influenced by that discussion.
Posted by TherapyGirl on November 12, 2011, at 20:07:37
In reply to Re: Need Advice *****Likely Trigger*****)Everyone » TherapyGirl, posted by Solstice on November 11, 2011, at 20:57:22
Thank you so much for this, Solstice. I had similar experiences with my real T, who retired almost 2 years ago. This just seems so early in this relationship that it worries me. I'll try to keep an open mind, though.
Thank you!
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