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tomatenoir
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Default May 08, 2019 at 03:13 PM
  #21
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Originally Posted by guilloche View Post
In theory, yup, they're supposed to give you referrals. In practice, ehhhh... it doesn't always work out that way. And sometimes, they don't really give you *good* referrals.

The stuff you're worrying about would be GREAT stuff to talk to your T about, there's a lot there to work on!

If it helps, a T that I saw a couple years ago (one who actually thought about the "have you ever terminated anyone?" question when I asked and gave a really good answer) - told me that if we got to the point that he thought I was wasting my time and not getting anything out of therapy, he'd absolutely tell me. And, if I said that I wanted to continue, he'd be fine with that. That felt fair, and I believed him.

For the record, when I asked if he ever terminated anyone, he actually thought for a second and then told me there was one client with an active drug addiction. She didn't want to work on her addiction, AND she only wanted to come to therapy once every 6-8 weeks or so! So, he told her that he couldn't really be helpful under those circumstances. Totally fair, in my mind, and not related to any of my stuff - so a little reassuring!

RE: my terminations:

- My first T. I saw him for a year. I was totally freaked out by therapy in general, a friend had pushed me to go, I had a trauma history and was easily freaked out. I ended up bringing up dissociation, which he *didn't believe in*. He finally sent me out for a consult, I was diagnosed with a dissociative disorder, and he told me that it was basically outside of his scope of practice.

He didn't give me referrals, but the T that we consulted with did.

I had left (and come back to him) previously, and he DID give me referrals then... one of which was...

- First T's wife! I saw her for 3-4 sessions, and then she told me that she couldn't help me. She actually said, and I remember very distinctly, "You need immediate support and I'm going to be going on vacation for a couple weeks, so... I can't see you any more." I wasn't suicidal, and I thought she *was* seeing me - I didn't realize that we were in a trial period. No referrals either... (I still feel a little bitter over the whole thing). I ended up bouncing back to the first T!

- My last T. Technically, it wasn't a termination. It was the threat of termination though, so I quit on the spot (I'm usually not so dramatic, I swear!) She said that I needed to set specific goals with a timeline, and if I didn't accomplish those goals, she'd refer me out. (But I also found out she was still feeling afraid that I was judging her, so there was apparently some weirdness that I thought had passed.)

I couldn't get my head around the idea of "stop being depressed in 3 months, or you're getting kicked out" - so I quit on the spot. It was actually kind of horrible. She emailed and offered to help me find a new therapist, but honestly, at that point I didn't want anything more to do with her, so I didn't reply.

Soooooooo.... I don't know if that's helpful. I think it happens. I feel *much* less trusting at this point then I did before, and honestly, anyone who tells me, "Why no, of course I'd never terminate you!" - I just think is just saying what they need to gain your trust. I'd rather someone be upfront and say, "Yeah, look... under these circumstances, I'd probably have to stop working with you."
I enjoyed reading your post. I don't intend to go back to therapy, but if I ever do, making sure a therapist can disclose when they have or would have a negative reaction to something is pretty up there.

I think it's why I like LT's therapist so much.
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Default May 08, 2019 at 07:05 PM
  #22
Saying no terminations could be a largely semantic distinction... the therapist might still have pushed a boatload of people out the door by various means, such as making authoritarian pronouncements about improper fit or modality, leaving the client feeling they have no choice in the matter. In other words, could be many de facto terminations.

Also I dont accept the premise that unilateral/dictatorial terminations necessarily result from challenging cases. Therapists can drop-kick clients for any reason. Could be entirely self-serving.
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Default May 08, 2019 at 08:10 PM
  #23
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Originally Posted by ArtleyWilkins View Post

I don't consider referring to a better equipped therapist a termination; that's a responsible move if a therapist feels they cannot help their client. Yes, the client may feel "terminated," but sometimes those kinds of changes have to happen.
A therapist can only know if therapy is helping or not by asking the client. If the therapist decides for the client, then that is pure crazy (unless the client has serious impairments).

Also, forced terminations have the potential to do more damage than anything else.

The most dangerous element in such situation is the the delusional therapist who believes that he/she knows what is best for others.
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Default May 08, 2019 at 11:23 PM
  #24
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Originally Posted by BudFox View Post
A therapist can only know if therapy is helping or not by asking the client. If the therapist decides for the client, then that is pure crazy (unless the client has serious impairments).

Also, forced terminations have the potential to do more damage than anything else.

The most dangerous element in such situation is the the delusional therapist who believes that he/she knows what is best for others.
I've never had a therapist decide anything for me. We had discussions about possibilities. Second opinions were pursued if and when I decided I wanted to do that. I've truly never had a therapist force any sort of decision on me, even when I was seriously impaired.
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Default May 09, 2019 at 12:23 AM
  #25
I didn't realize it was quite that rare. I mean, I didn't think it was common, but ...
I guess I have some questions for my T
I wonder if I was the first/only one he ever terminated...
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Default May 09, 2019 at 01:10 AM
  #26
I'm not surprised. The therapist unilaterally ending therapy should be rare. Other than unusual exceptions, it should be up to the client to decide whether things are beneficial and whether to continue.
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Default May 09, 2019 at 07:13 AM
  #27
I highly agree with the semantics argument and with Budfox that there are many ways to get rid of problem clients that aren’t formal terminations. I’m guessing most experienced therapists know how to do this, though the % of time this is done... I couldn’t foster a guess. I strongly suspect this happened in my case though “I” technically quit. In many ways I think this makes sense because it leaves the client feeling at least partially in control.

I think the majority of therapies end in really normal ways - either the client feels good enough to move on, or things fizzle out. Termination isn’t anything I’d spend a lot of time worrying about as a new therapy client. That said, I think it’s important to remember that therapy isn’t “forever and ever” and life happens, therapists retire etc.

Would I believe a therapist who said they never formally terminated a client? I think so. Even with the ethical responsibility to refer out, ultimately it’s the client’s choice. Most therapists would probably stick with a client who would never see another therapist rather than let the client go without a therapist.
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Default May 09, 2019 at 09:32 AM
  #28
I asked my therapist about this ages ago. He said there was only one person he had to let go over 30+ years.

Credentials do matter, so I disagree with those who assert that it does not. MD therapists (psychiatrists) often see more complex clients than other therapists, such as those with chronic psychosis.

I agree with those who think therapists may let a client go in more subtle ways. Those who are not up to the task of terminating a client could do things to drive the client away or try to convince the client to quit. Rather than the norm, I believe this would likely only occur with those who are unprofessional/ incompetent.
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Default May 09, 2019 at 09:37 AM
  #29
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Originally Posted by CartDown View Post
Don't therapists have to refer you to another therapist after termination?

It was comforting to hear he is not big on termination, but if things get stale, like if he believes I'm wasting my time, I'm afraid he won't tell me and it will be up to me to figure it out. And if I'm too slow to connect the dots, he may end up resenting me. I'm sure that sounds a bit ridiculous. I already feel like a fraud in therapy sometimes, so it stresses me out a bit.
Knowing he rarely lets anyone go, hopefully you have less to worry about now. You aren't the only one who needs reassurance about this as many who write here talk about abandonment fears.
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Default May 09, 2019 at 09:38 AM
  #30
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Originally Posted by PurpleMirrors3 View Post

Most therapists would probably stick with a client who would never see another therapist rather than let the client go without a therapist.
I don't think that it is a matter of a therapist sticking with anything. The therapist has no stake in it.
I also think this is a super bad plan in general- no therapy is not worse than bad therapy. Quite the opposite in my opinion.

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Default May 09, 2019 at 09:53 AM
  #31
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Originally Posted by octoberful View Post
I asked my therapist about this ages ago. He said there was only one person he had to let go over 30+ years.

Credentials do matter, so I disagree with those who assert that it does not. MD therapists (psychiatrists) often see more complex clients than other therapists, such as those with chronic psychosis.

I agree with those who think therapists may let a client go in more subtle ways. Those who are not up to the task of terminating a client could do things to drive the client away or try to convince the client to quit. Rather than the norm, I believe this would likely only occur with those who are unprofessional/ incompetent.

I said something similar to your last paragraph to my T, when he claimed that the client holds all the power in the relationship, because they can terminate at any time, while he ethically can't do so. I said that he could do things to make clients leave without terminating them. Like for me, he knows email is important to me. So he could choose to take that away (he said he never would) or otherwise not meet my needs. He could shame me. Insist on a particular psychological technique that I feel doesn't work for me. Etc.
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Default May 09, 2019 at 11:56 AM
  #32
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I don't think that it is a matter of a therapist sticking with anything. The therapist has no stake in it.
I also think this is a super bad plan in general- no therapy is not worse than bad therapy. Quite the opposite in my opinion.
I suppose I was speaking on behalf of how a therapist might feel.

I do agree with you especially on the second point. I am immeasurably better with no therapy.
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Default May 09, 2019 at 12:49 PM
  #33
Doesn't that seem cruel?

Idk maybe it's naive, but I'd like to take my T at his word that he really thought terminating was in my best interests, even if it was ****ing stupid, and that it was difficult to do and he didn't want to but felt that he should.
He left the door open for if I finished DBT, but I kind of convinced myself that he was only saying that to try to make me feel less abandoned.
(Though he's the one who initiated us working together again so I guess maybe he did mean it)

ineffective therapy to get a client to quit seems super unethical. You're letting them pay you and using their time to provide what you know to be not what they need.
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Default May 09, 2019 at 04:22 PM
  #34
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Originally Posted by LabRat27 View Post
Doesn't that seem cruel?

Idk maybe it's naive, but I'd like to take my T at his word that he really thought terminating was in my best interests, even if it was ****ing stupid, and that it was difficult to do and he didn't want to but felt that he should.
He left the door open for if I finished DBT, but I kind of convinced myself that he was only saying that to try to make me feel less abandoned.
(Though he's the one who initiated us working together again so I guess maybe he did mean it)

ineffective therapy to get a client to quit seems super unethical. You're letting them pay you and using their time to provide what you know to be not what they need.
i agree its unethical but I can see situations occurring among those who at least try to practice ethically.

Like losing empathy, indifference. Telling clients they dont have the skills when in reality its their countertransference such as feeling helpless or their needs not getting met, like a need to save someone.

Their inability to keep their own stuff out of the therapy, where they are afraid to terminate. Afraid of client anger or suicide attempt. Even those who truly don't want to hurt someone.

There's no doubt in my mind this stuff does not happen infrequently.
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