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Is this routine? Do psychiatrists always insist on bringing in and talking to another family member during sessions with you?

Thread starter #1
I just canceled all appts with a psychiatrist assigned to me after having called a suicide hotline. Yes I was in deep despair at the time and suicidal...very desperate for help. They arranged care with the psych doc, a clinical social worker trained in trauma, and a case manager.

Now here is my question: Having never had ongoing sessions with a psychiatrist before I’m not familiar with their protocols. Do psychiatrists always insist on bringing in and talking to another family member during sessions with you? Mine did and I felt betrayed. They exchanged phone numbers and agreed they would keep in touch. And my hubby was included under the supervision of the same case manager as I. Is this normal? I feel constrained...watched and trapped. It feels like there is no safe place when talking to the doc. So in self defense I stopped all further appts with him.
 
#2
I don't think it is necessarily protocol that another person would be involved. However, if the doctor really feels that you are a threat to yourself, it is certainly understandable from the standpoint that the doc wants to ensure that you are safe at home.

On the other hand, if you don't feel safe having your husband involved, as long as you aren't under his care legally, I can't see why you wouldn't be able to tell the psychiatrist that you need to be seen on your own.

I hope you feel better soon.
 
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#3
@Still Standing I have been under the care of two psychiatrists in outpatient settings, two different psychiatrists in inpatient settings and have just been assigned a new PA in outpatient and have never once had anyone else brought in to my sessions nor insist on speaking to any member of my family. Even when I voluntarily committed due to SI, they spoke to no one other than my T which I authorized. You need to advocate for yourself. If you are in the US you do not have to permit the P-doc to speak to anyone even other members of your care team about you. Unless you have been made a ward of your husband or someone else has been given legal guardianship over you NO ONE and I mean NO ONE has the authority to bring someone else into your sessions or discuss you with someone else.
 
Thread starter #4
Thank you, RussellSue and FauzLiz for your responses. You have helped me understand this situation much better.

If I am put in a position of having to speak to this psychiatrist, in the future, I now know I can tell him he does not have permission to talk to anyone about my care when it comes to hubby. Though hubby takes wonderful care of me during times of physical (post surgical) needs, he is silent on my emotional ones. I learned years ago to not involve him in my times of deep depressions and suicidal ideations until the bouts were well over. So knowing he has been pulled into this bout makes me pull more into that cover-up mode of looking and saying, “I’m fine” when it really isn’t. If I were to show my distress he would simply listen and then turn back to whatever he was doing. End of conversation. Been here and done it like this too many times already. As a result I don’t trust him with my deeper self. Now I feel forced into including him into an area of my life he does not participate in otherwise.

I’ve gone through these dark periods so many times on my own that I know this one will get better without oversight of a family member. I think I can say all this to the psych doc if needed, now. Thanks.
 
#5
As a result I don’t trust him with my deeper self.
That has to be very hard especially while dealing with heavy emotional turmoil. It's certainly understandable that you would not want him pulled into your mental health business when it sounds as though he has not been there when you needed him in the past.

Doctors who have their own agendas are also difficult to manage while having a mental health crisis. You certainly are not the first person to feel forced into doing something you were not comfortable with by a psychiatrist. Hopefully while you are less in crisis you will have a chance to try and make your needs known.

Though, frankly it sounds as though some couples counseling might be very helpful. It has to be hard to feel emotionally abandoned all the time. It doesn't sound like your husband is aware of the effect this has on you.

I hope things get better soon.
 
#6
It varies from one situation to the next.

With people who are suicidal, oftentimes they're best off staying at home in the community, and safety issues (depending on the person) may mean that's only possible if they know that someone competent is aware of the issues and willing to take some degree of responsibility for keeping an eye out for the person at risk. Failing the availability of such a person, the pdoc needs to weigh up wether hospital is necessary to keep the person safe (voluntarily or involuntarily).

The situation is made even harder if there isn't a long-standing relationship between the patient and the pdoc, and they don't have personal experience of how your own depressive episodes play out.

Certainly I've only stayed out of hospital on a number of occasions on the basis that my pdoc was able to contact someone close to me, and get some reassurance that they knew what was going on and would touch base with me.

Ultimately, I now have an understanding with my pdoc that there isn't anyone in the community who can fill that role for me, and who they can contact if they're concerned about me. The downside of that is that without that person? The threshold for me needing to be hospitalised is lower than it would be if there was someone in the community they could monitor my situation with.
 
#7
Failing the availability of such a person, the pdoc needs to weigh up wether hospital is necessary to keep the person safe (voluntarily or involuntarily).
This.

The only time I’ve ever known a doctor to insist on a 3rd party (Outside of themselves and the patient), is when the other choice is inpatient.

Similar to not being allowed to book a surgery without someone willing to drive them to/from, or a closer parallel? To STAY with them for x number of days, postOp. (Since most insurance companies won’t pay for surgical patients to be monitored by medical staff anymore <rolleyes>, unless there’s a medical emergency/complication in addition to having just had surgery and being drugged senseless; either or both rendering them incapable of caring for themselves.). The person who will be providing aftercare has to be read in on private patient information, in order to provide care. Without a caregiver arranged, personal or professional, the patient isn’t allowed to book the surgery.

So, nope. Not standard practice to insist on a friend/family member being present for MOST psych appointments, but often standard practice & a deciding factor when doing an suicide-admit evaluation.
 
Thread starter #8
Hmmm, interesting, Sideways and Friday.

This psych doc had only talked with me twice before. However, he assured me on the first two sessions that he had no intentions of placing me in the hospital. It was on the third session that I had to include hubby. And there they talked together about me but I was not included in their conversation until the end when the doc asked if I minded hubby staying for the remainder of the time while he and I talked. I told him I did not want to talk in front of hubby. I felt minimize, betrayed, and trapped. The whole thing did not feel right or safe. Before closing the appt., The doc asked if I would promise to call him or talk to hubby if I needed
help. I was so angry that I told him, “No!” He said, “Ok” and closed the video session. No way was I going to promise anything at that point.

So to give myself an option for safe dialogue and a way to find support, I decided to come back to this forum since I’d been gone for awhile.

As expected, you all have been helpful and informative with all that you all have shared. Thank you.👍🏻
 

joeylittle

Administrator
#9
They arranged care with the psych doc, a clinical social worker trained in trauma, and a case manager.
You could try asking the case manager about your privacy rights. Somewhere along the way, you lost your right to say who can or cannot be privy to your care. Navigating this stuff is always stressful, but if you're in a good enough headspace to contact the case manager and ask them to explain it all to you, they should be able to.

My advice would be to simply start from asking them to go over what you've signed, and who you've given permissions to. If you're comfortable, you can then give them the example of what happens with your husband and the psychiatrist.

The easiest rule of thumb to remember (this applies to the US, I'm not sure about other countries) is that anyone can tell your psych providers (therapists and doctors) anything they are concerned about, or that they've observed about you, or anything they think the doctor should know.

The care provider is not allowed to discuss you with them in any way (they can only listen and give neutral responses), unless you've signed a release for co-ordination of care.

But, when emergency hospitalization/emergency care is involved, there can be a temporary suspension of privacy. You may have signed forms relating to that, and not been aware. So a case worker can be really helpful in guiding you through all that....it's exactly what they are there for, really.
 
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Thread starter #10
Thanks, joeylittle. What you shared also helps a lot. Since everything is being handled via the internet and telehealth, I only remember signing a consent form “ to treat” once, online. No other paperwork was signed that I recall but, considering my head was in the darkest regions of The Black Hole at the time, I could have signed other things with no recall of doing such.

Talking to the case manager is a great suggestion. I didn’t know what her role was and had decided to ignore her phone calls but now I will talk with her and ask questions. And I will make an active list of questions written down so I don’t blank out over them. You all have given such good advice and shared insights. I am very grateful for it all. Thanks!
 
#11
I've been asked to come in and talk with my brothers psychiatrists over the years but it has ALWAYS been with his consent. Usually they want to verify information about his childhood to separate his fact from fiction because he gets really delusional when he's in a mood.

Sometimes I meet with them separately, sometimes when he's there. It really just depends on if he is delusional or suicidal. and even then it is always his choice if I am in the room or not.

As for the papers you signed? You can rescind them at any time if you are here in the states. Just because you signed them once doesn't mean you can't change your mind
 
Thread starter #12
I investigated through all my records and found that I have actually signed 6-7 documents (so much for being clear-headed about how many I signed🥴) with only one being a Hippa form and another concerning treatment agreement. None of the forms discuss me giving over the right to talk to someone outside of my permission, if I signed the form. It is just not mentioned. So, you are all correct in that I should have been asked if I wanted hubby included in my care. This certainly gives me confidence that I can address the issue with my caregivers. 👍🏻
 
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