Considering Quitting With Current Therapist

[Deleted member 40384]

I've been having some recent issues with my current T, and I'm trying to decide if continuing to see him is more helpful than harmful. I've been seeing him for five years, and I've become really attached to him, possibly to an unhealthy degree. But I've been trying to accept the attachment issues instead of push them away, with the hope that they would resolve eventually.

I had a near-suicide attempt two months ago. At the time, my T talked me down on the phone, and the next day at our session I was asked to bring in the rope I had used, which I did. We didn't establish a safety plan. Last week, I was experiencing suicidal urges and intentions again, and I worked up the courage to text my T about it. Right after, I went for a walk with my partner to try to distract myself and forgot my phone at home. Toward the end of our walk, my partner saw that T had called him, so he called back. T had tried to call me, got worried, and called the police for a wellness check. He said they came by, but no one was home. T said he would definitely call me in the evening to set up a safety plan, and got my word that I was okay until the evening.
The evening rolled by and T didn't call. I had been dissociating the entire day, and for me, when dissociation is accompanied by suicidal urges, it can be a crisis situation. I texted T to tell him what was going on, but he didn't call. Thankfully I managed to get through the evening safely.
The next day, I got a voicemail from T, not mentioning anything about the evening prior, but demanding that I bring in a written-out safety plan to my session later that week. There was no warmth in his tone, and he did not say anything about how I could plan to keep myself safe in the days leading up to my appointment. I texted him back in response to the message, expressing that I was hurt and confused as to why he hadn't followed through on our agenda to talk about a safety plan as soon as possible. I texted that his message came across as punitive, that it hurt me, and that I felt incapacitated to call 911 myself. At this point my suicidal urges were high, even higher than before. T didn't respond. I forced myself to stay in bed as to ride out the suicidal urges.
My partner was home the next day so I felt confident that I wouldn't hurt myself.

T and I talked on the phone a couple days later, and he said he didn't call me on Monday because "the weather was crazy" (? it wasn't?) and that he couldn't be there for me 24/7. I have never asked or expected him to be there for me 24/7? I just expected him to follow through with what he said he would do in a crisis situation to ensure my safety. He said that my texts from Tuesday "seemed angry" and that "lowered his motivation to help". Isn't that unethical? I can understand in "normal life" that it's a natural reaction to not want to help someone when they're perceived in a negative light, but isn't he a professional who as a responsibility to provide a basic standard of care, especially in a crisis situation? I don't think I came across as angry, but even if I did come across that way, how is it ever OK to decide not to help someone when they are in danger?

My partner was really upset by what happened, and he's going into my next session with T the day after tomorrow. My partner is good at being diplomatic and being assertive without being aggressive, and we thought it would be a good idea to have him there so that T can't use my PTSD abandonment issues as a way to get me to apologize and deflect his shortcoming. He often sits there passively, and when my emotions are high I have trouble structuring the session. T does "extra" things for me that he doesn't do for other clients, although he has a history of being unreliable; and he subtly brings up these "extras" as a guilt-trip when something does go wrong in the relationship. If I wasn't so dependent on the relationship, I would stop seeing T. I want to at least go in to the next session and properly talk out what happened. I'm definitely bringing in a draft for a safety plan as well.

Am I justified in thinking that what he did (or failed to do) is unacceptable and unethical? How do I respond if T blames me? And if I do decide to stop seeing him, how can I get through the pain of losing such an important relationship?

 

[Deleted member 39333]

I am not sure what you mean by "extra things" but if you think or know that he does "extra things for you that he doesn't do for other clients" then presumably that is because that is what he told you. I think that sounds sketchy. If he is doing "extra" things for you, he shouldn't be telling you that he is doing things for you that he doesn't do for other people, still less using them as ammunition for guilt. To me, it sounds like one of the primary elements of grooming someone. I would feel very uneasy and unsafe about this if I were in your shoes.

 

[Deleted member 40384]

I am not sure what you mean by "extra things" but if you think or know that he does "extra things for yo...

Thanks for your reply. To clarify, I know that he does extra things for me because he has said that such things are "new territory" for him. As an example, he goes on outings with me outside of session time as a form of exposure therapy.

 

[Suzetig]

n? I don't think I came across as angry, but even if I did come across that way, how is it ever OK to decide not to help someone when they are in danger?

I don't think it's ok not to help someone in danger but the reality is he can't be there 24/7. For you to text him "in crisis" and then go out and leave your phone (meaning you weren't contactable) would have scared the life out of him, I imagine. That's not yours to worry about in terms of his wellbeing but it's reasonable for him to think about how available he can be if you're in crisis and to agree a safety plan, if that's how he works with suicide.

Yes he should have kept his commitment to phone you and him not doing so could be a form of payback - which is not ok. That, coupled with you seeming to get his attention by acting out when you're in crisis makes me think the relationship is too enmeshed - you need to clarify boundaries between you and work within them which means no "special" treatment from him and a clear crisis plan for you that doesn't involve him.

I'm not sure about why you're taking your partner into your next session, the issue seems to be between you and your therapist, taking your partner with you seems to me you'd be opening a whole different dynamic.

 

[Deleted member 40384]

I don't think it's ok not to help someone in danger but the reality is he can't be there 24/7. For you...

I know he can't be there 24/7, and I don't expect him to. That's not what I was asking of him. The first time I texted him, I was expressing my concern about the intensity of my suicidal urges. At the time I didn't feel I was in danger because my partner was with me, and I should have mentioned that to T. I regret not saying that, and I feel bad that I caused him worry. If I could go back in time, I would have done that differently.
I don't really understand what you mean by "acting out". Do you know what I should have done in that situation?

I'm taking my partner in because he knows what happened, and he is better at keeping objectivity in hearing both sides of the experience. T has mentioned wanting to meet with all of us in the past as well.

 

[Suzetig]

By acting out I mean contacting your T in crisis when you know you're able to keep yourself safe - i.e. You knew your partner was there, knew to take yourself off to bed and ride out your urges etc. Most people will respond to someone saying they are suicidal - but when you texted your T you had strategies to keep safe and didn't tell him. It might be worth thinking about what kind of response you expected from him when you contact with stuff around suicide because it may feel to him like you're trying to elicit contact by saying you're unable to keep yourself physically safe when in fact you do have strategies in place.

Honestly, if I'm in an actual crisis I wouldn't be contacting my T, I'd be using emergency services - if it's not bad enough to need emergency care, it's not bad enough to contact my T and if it is bad enough to need emergency help, my T isn't the right person.

It sounds like you're trying to get something from your T - maybe think about what it is and how you might articulate that?

As far as your partner goes, you and your T know what happened - your partner can't possibly be objective when in a relationship with you especially if he's concerned for your safety. If your T (and you) feel it would be worth all of you meeting, better to do that on a planned basis, with a clear agenda after you've resolved this current rupture.

 

[Deleted member 40384]

By acting out I mean contacting your T in crisis when you know you're able to keep yourself safe - i.e....

I do have strategies that he knows I use, but these strategies have the potential to fail. I didn't know for a fact that I could ensure my safety - if I knew that, I wouldn't have needed to contact him. I was using my strategies and hoping for the best. In that case, they worked in lowering my urges. To clarify, my partner was leaving for work after our walk together and I was hoping to establish a safety plan with T for times when I would be alone. I should have said in my message that I was going for a walk and that my partner was with me for another couple hours.
I think that what I was trying to get from my T was to touch base about what steps to take if my coping strategies weren't working. I don't feel comfortable calling emergency services for myself. That is part of the safety plan I have drafted and want to work out. I would feel comfortable asking T or my partner to call emergency services for me. I feel like it seems like I was attention-seeking? I don't believe that was the case, or what motivated me to ask for help. I wouldn't have wanted to put that stress on anyone or myself for the primary sake of acting out. I'm feeling pretty bad about myself.

 

[Suzetig]

I think you're seeing acting out as a bad thing when I don't mean it that way - what I mean by acting out is that you're trying to express needs through behaviour rather than being able to articulate what they are and openly ask for what you want. I also attention is a valid need so I don't think attention seeming is a bad thing in and of itself - we all need people to pay attention to our pain and it sounds like he's been important to you for a long time now. That's not me saying you were attention seeking, you may have no idea what you need right now, just to say it's ok to need and seek attention.

For you to have a plan where your T calls emergency service for you does mean him needing to be pretty available to you because neither you or he can predict when you might need emergency help - the very nature of crisis being that it's unexpected. theres nothing wrong with wanting him to be available to you in an emergency but he may just not be able to do that for you and your safety plan needs to work independently of his availability.

 

[Deleted member 38644]

This website does a better job than therapists. I'm totally afraid of trusting because certain therapists of different kind will be there until a certain point and it shouldn't be like that. You have to be careful what you say and etc. How can they expect people to trust them when this is so common? I'm very sorry this happened. I recommend Google to research more therapist but to read Google reviews about them.

 

[joeylittle]

@sasha t - do you mind if I ask, what is your diagnosis? Are you co-morbid to something (along with PTSD)?

My take on the situation: T realized they were past their own comfort zone in terms of safety, the day you didn't have the phone. That's why the rules changed immediately following, and it's why your T withdrew crisis support.

That's not unethical, at all.

I think they did it a bit sloppily - saying they would call later, then realizing they needed to change approach (and not calling), that was sloppy. But understandable in the situation, to me.

I texted him back in response to the message, expressing that I was hurt and confused as to why he hadn't followed through on our agenda to talk about a safety plan as soon as possible.

Just a note for the future: don't engage in conversation over text with your T. It's almost always a bad idea. This topic you raised is a conversation, and better held for a situation where you can speak.

T and I talked on the phone a couple days later, and he said he didn't call me on Monday because "the weather was crazy" (? it wasn't?) and that he couldn't be there for me 24/7. I have never asked or expected him to be there for me 24/7?

Weather... who knows. Can't be there for you 24/7 - yes, you're right, you never asked that. But:

just expected him to follow through with what he said he would do in a crisis situation to ensure my safety.

"Ensuring safety in a crisis situation" requires 24/7 availability.

So although you never thought you were requiring that level of responsiveness - you were, inadvertently, by placing this burden of care on him.

I doubt that he understood the extent of what he was volunteering for in re: crisis support, until the day he called in the check

isn't he a professional who as a responsibility to provide a basic standard of care, especially in a crisis situation? I don't think I came across as angry, but even if I did come across that way, how is it ever OK to decide not to help someone when they are in danger?

Depends on your definition of 'help'.

The basic standard of care in a crisis does not require contact. It requires safety. If that means, hospitalization, then that's what it means.

Clearly that was not the way you and he were operating. But he is now redefining the terms in light of the most recent incident. This is also not uncommon.

With certain diagnoses, in certain treatment protocols, responding to suicidal threats with anything other than calling the police (to being the client in) is strongly discouraged.

does "extra" things for me that he doesn't do for other clients, although he has a history of being unreliable; and he subtly brings up these "extras" as a Guilt-trip when something does go wrong in the relationship.

'Outside his comfort zone' is a little different than extras, I think...but what's important is: have you ever told him that you perceive this?

Am I justified in thinking that what he did (or failed to do) is unacceptable and unethical?

Bottom line - no, not justified. Your feelings are valid, they are real. But I would say he and you are now in an adjustment of terms. Like I said, he's not doing it perfectly - but that is not necessarily ever guaranteed. He's doing it fairly well.

It will be important for you to unpack the text you sent before your walk, why you did not tell your T it wasn't a crisis/why they thought it was, and whether or not you expressed your regret/apology at the time, and if not, why.

 

[Deleted member 40384]

@sasha t - do you mind if I ask, what is your diagnosis? Are you co-morbid to so...

I'm not sure if he was changing the terms. I could ask about that in our next session. But in the event that he was, wouldn't he let me know of that? Or, wouldn't it have been better for him to follow through with calling me to at least set up a plan until we could discuss his changed terms in our next session? I understand he was in a tough position, but his reasons for not helping me were the weather, and that he thought I was angry with him - I'm not sure if those were the real reasons?
I apologized for not having my phone and for not being more detailed in my message, when he called my partner's phone that same morning. He wanted to follow up with me that evening. If he changed his mind, I would have appreciated that he tell me that. Maybe that was unreasonable?
My diagnoses are MDD, PTSD, and social phobia.

 

[Muted]

I get this struggle and you're not alone in how you feel.

A long time ago I screwed up by sending my t. a text that understandably freaked her out about my safety and I was fighting with my SO and didn't respond right away when she texted me back. This put her in an extremely difficult situation, which I didn't get at the time but did after. Now she keeps me at a distance and I have no way to contact her outside of her office hours no matter what happens. In essence, I get I f*cked up, but it sucks to be punished for the rest of my life for it. I've never had this issue with any other t and am pretty horrified that I did this and permanently lost her trust, but I can't change the past and obviously I am too needy and I don't really blame her for not wanting me to contact her outside of her business hours.

I hope you can find the support you need. We're all here for you.

G