Therapist May Be Cognitively Impaired Due To An Accident

[redstone]

My therapist had an accident last fall and subsequently found he had kidney issues and other ailments. I have been waiting eight months for him to return to his practice. In this time he has exhibited cognitive changes. He has done nothing inappropriate but took to a too familiar way of communicating with me. He texted me, all thumbs to "check in." His emails were incoherent. He couldn't remember previous conversations. He thought it would be OK to have a phone session while he walked his dog, stuff like that. He'd also have unrealistic ideas about when he could get back to work. He thought that two weeks would be enough time to recover from kidney surgery and urged me to "be patient."

He also discouraged me from quitting him and finding another therapist. I didn't/don't want to change either. He had been an excellent therapist. I am alive, high functioning, in my body, aware of the internal system, no self harm now at all and doing well because of our long (13 years) work together, including sand tray work, EMDR , CBT and plain empathy and wisdom. In fact, just before his accident and the onset of his ailments, I was getting really close to not only remembering the beginning of the incest (I was about three) but being able to understand my life-long responses to it. .

Still, when his communications made me uncomfortable, I was able to be clear about my boundaries and request official time off. I set up body work and other support for myself. I did well, considering, but I know I am not done with therapy yet. Now he says he is ready to see patients again in two weeks.

The issue is that from the perspective of my trauma history, his behavior has been triggering and I am not sure of my own responses. Is this me accepting abuse because I don't want to lose my daddy? Is it me being intolerant and and not being open to the fact that he may be better and well capable of continuing our therapeutic work? Will I be able to trust him, when I have those odd remarks and "off" interactions in my head?
Whom can I trust?

Maybe I am not asking myself the right questions.
Any insights are welcome here.
Thank you.

 

[EveHarrington]

If you were meeting him for the first time would you accept this level of unprofessionalism and forgetfulness?

Don't lose sight of the fact that you're paying him to provide therapy to you. If he is no longer able to give you what you need then you're well within your rights to move on. It's not personal---

 

[redstone]

No, quite right. It is sad though, to see him diminished, though that is not my problem to resolve. I think I have also n=been unrealistic until now that this might be the end of our relationship.

 

[GardenGirl0214]

Yikes! I'd definitely have some concerns! Maybe you could go to your next session and see how it goes? I only suggest that due to your long history together. But, honestly, if you feel you will be triggered, then it may be time to look for another therapist. You don't want to risk undoing all the progress you have made thus far by staying with him! Good luck, and please keep us posted.

 

[Justmehere]

It's hard to let go of a therapist even in the best of circumstances. You have done very good work with him. Moving on to a new therapist would not diminish that work at all. It could be a chance to graduate into even deeper work and work on things in some new ways that your old therapist wasn't ever able to do.

Staying with him when he isn't as professional and cognitively there for as you need - this could be a bit of a setback though.

Have you told him about the changes you have noticed? Have you talked to him about how it affects your trust in him?

It seems like it is time to consult with another therapist about transfer of care to them.

 

[joeylittle]

Is he with a group or is he in independent practice? If he's with a group, it would not be inappropriate for you to request some supervision or evaluation from a colleague.

You also might contact his regulatory board, to get some help there.

If you want to keep working with him, it sounds like he will need more time to rehab. But it also sounds like he may have lost perspective on his own abilities and boundaries.

It's not really appropriate for him to even ask you to wait for him to get through recovery, frankly. Ethically, he should only explain his situation and ask you what you would like to do - including being referred out of his practice.

I'm sorry - it sounds like a tricky situation. I applaud your tackling it head-on.

 

[Whyteferret]

The hard thing about cognitive impairment is sometimes you don't know that you are- or how much.

It's also tough to step away from a career.

You have to take care of yourself and keep getting the help you need. Even though it may be tough to move on from him.

 

[redstone]

Is he with a group or is he in independent practice? If he's with a group, it would not be inappro...

Joeylittle - Re getting an evaluation from a colleague.

That was my first impulse, to get a "reality" check from outside myself. My T shares a practice with his wife, whom I have met a few times and have had good conversations with when, for example, he forgot to cancel my appointment and I drove down to see him and she came to the door.

I actually asked him to check with her before he communicated with me - this was when he was writing indecipherable text messages. On our last call, not therapy but making an appointment, I told him I wanted to check with her re his readiness to begin his practice again. His response worried me - he said, with what I heard as contempt, " My WIFE, you want to talk to me WIFE? There are many other people better qualified than she is to say how I'm doing." I was firm and clear and said, no I am not talking to your wife, I am talking to your colleague. He calmed down but it left me feeling confused. What's with the contempt for his wife? Am I projecting? It is true that my father used to tell me in graphic terms what he did to my mother in bed the night before . . . but that is not the current situation. I know mt therapist is not my abusive father, but , really, why do I have to hear that tone in his voice?

Anyway, I waited a week until I was clear that his anger should not deter me and I called his wife, left a message. That was three days ago and I haven't heard back.

I have made an appointment next week with my psychiatrist to talk about this but he does not know me as my therapist does. And I still have the appointment with my therapist for the week after next.

I feel fear and ambivalence when I think about seeing him. I feel all the old feelings of being at fault for the break, if only I could be chilled out and easy going etc.

It is triggering. I think I can learn from what triggers me, but I am not entirely confident that I will make the right choice.
Thanks for listening.

 

[redstone]

The hard thing about cognitive impairment is sometimes you don't know that you are- or how much.

I...

I know, this is terrible for him. And / but, though I care about him and am deeply grateful, hewill have to work it out for himself.

 

[joeylittle]

My WIFE, you want to talk to me WIFE? There are many other people better qualified than she is to say how I'm doing." I was firm and clear and said, no I am not talking to your wife, I am talking to your colleague. He calmed down but it left me feeling confused. What's with the contempt for his wife?

If I had to guess, I'd guess that he knows he should not be returning to work. I think that if she doesn't call you back in a week, you could give her one more call, but honestly - my instinct is that either way, the result is going to be the same: he's not able to be working right now, and you are going to need to find another therapist for talk-work.

The issue is that from the perspective of my trauma history, his behavior has been triggering and I am not sure of my own responses. Is this me accepting abuse because I don't want to lose my daddy? Is it me being intolerant and and not being open to the fact that he may be better and well capable of continuing our therapeutic work?

It's really, really sad and I know that if I were in your position, I'd be pretty wrung out about it. I don't think this is actually to do with triggers, I think your therapist can't be your therapist anymore through no real fault of their own or of yours. Life has intervened, and things need to go a different way. You worked with this person for 13 years - that's a substantial amount of time. It's hard to decide when to leave therapy even under the best of circumstances, and this was not that.

As an outside reader - no, you're not being intolerant, you're being very appropriate and realistic. You know he's not ready to be working, and you know he's not OK. The client can't ever be in the position of doctoring their therapist. Your therapist might know what is going on with himself, or might not - either way, he's probably feeling overwhelmed and grasping at life as he knew it. As much as you care about the relationship, it's still not appropriate for you to be there for him in this way.

Ask your psych for referrals, and you can also run the situation by your psych for their opinion. Does your psychiatrist also do therapy? Some do, and ours might be willing to take you on for a limited term, perhaps 6 months or until you have found a good permanent solution - or, at least, to process the abrupt discontinuation of work with your original therapist. There will be some talking it out to do, concerning that.

Thinking of you. What a tough situation.

 

[redstone]

If I had to guess, I'd guess that he knows he should not be returning to work. I think that if she...

I do believe you are right on the money. Thank you for the insights. It is not really about me at all.
Ouff, letting gi is hard, but I have the feeling I will find I am plenty stable and strong enough in myself to do it.

 

[Whyteferret]

I do believe you are right on the money. Thank you for the insights. It is not really about me at all....

@redstone
Not always. I tried to return to work for three after my brain injury. I had a supportive supervisor who had me mostly doing administrative duties that I could take at my own pace. my contact with clients was limited and I still couldn't handle it. My PTSD from a totally different issue was got worse. Add in the "normal" anxiety and depression common to brain injury... My supervisor was right.
Between the straight out problems cause by the injury and PTSD...Damn
It took years before I really recognized that I wasn't able to practice anymore: that the Best thing for my clients and me. I retired with disability pay.

I'd go back to clinical practice if I could.

Part of having cognitive issues is that you don't always know you do or how bad it is.
Like PTSD. Sometimes we don't know either (or want to accept)