Posted by gardenergirl on February 4, 2005, at 8:10:58
In reply to to gardengirl-- the perspective of a T, posted by CareBear04 on February 3, 2005, at 14:09:34
Thanks for your kind words, carebear. I'll try to answer your questions as best I can.>
> 1) when you stop seeing patients, especially because their insurance coverage runs out as opposed to termination or recovery, do you want to be updated as to their condition?I would love to be updated, because I always wonder how people are doing. There are several issues involved, though. First, if I stay in touch with a former client, it can difficult to not provide support or advice. Now as a human being, of course I would like to do that. But since I have had a therapeutic relationship with them, I really can't continue to do that after termination (for whatever reason it ended). First, there's liability. If I continue to stay in touch and there is an appearance of continuing to be therapeutic, well, I'm not licensed, and no one would be supervising me. Plus, if something I said or did was not appropriate, I'm not covered for liability. Those are the legal reasons. Ethically, it is not good to continue to have contact that may perpetuate the feeling of a therapeutic relationship. It can make it difficult for the former client to move on with being independent, or to attach to another provider if they are continuing therapy with someone else. One of my professors told us in a class that she deals with this by saying that although she would love to have an update occasionally if the former client wants to send one, she may not be able to respond. It IS hard, because most T's genuinely do care about their clients. I can't think of any at the moment I ever disliked. It's important to find something you like about all of them. Of course, some of my experiences with clients were more meaningful to me or more personally moving then others. It's sad for me to terminate, too. And it's a sacrifice. I've worked with clients who I feel I could become friends with in other circumstances. That's a sacrifice for me to give up that possibility upon beginning a therapeutic relationship. I think I'm at the conservative end of the spectrum with this, but I'm not overly rigid about it. I do have occasional email contact with one or two former clients. I find I really put a lot more thought into what I write back, though, to be careful not to sound like a T.
> i've read posts about Ts cutting all ties with former patients, and it seems irresponsible and scary to me.
I think there are lots of circumstances when this is appropriate. But of course you can't just leave the client hanging. You need to refer them to someone else first.
It sounds like you have had a different experience, and that it has been pretty good for you. I don't know if it is a training or generational difference, although of course students are influenced by the attitudes of those who train them. I think my school is careful about teaching what the ethical guidelines say about multiple relationships and contact after termination.
>is keeping in contact after termination dependent on how attached the patient is to the T?
This is a good question. I think if you have someone who is very attached, it would be important to think very carefully about how to terminate most effectively. On the one hand, an abrupt cutting of ties can be horribly traumatic, but if the client is really attached and it's not healthy for them to continue to be attached to someone who can no longer meet their needs, then it may be an important life lesson to work out with a new T. The loss, I mean. But at the same time, allowing occasional brief touching base may be helpful. But if it's helpful and therapeutic, have you really ended the therapeutic relationship? See how confusing it gets? :)
>when you end with a patient, do you want to cut all ties, do you want to keep in contact but feel like you shouldn't, or do you make yourself available by email or phone?
I can really only answer personally here. I am likely to want to hear from them someday down the road, but I feel like I shouldn't actually participate in keeping the relationship active. So I suppose I would be most comfortable with hearing from them after a period of time....at least several weeks. And I would probalby keep any replies fairly brief, although warm and caring.
>
> 2) i have gotten the impression that you work at a university with college students. do you enjoy working with young patients more, or do you enjoy other age groups more, or are you impartial among age groups?This is actually kind of funny. I am specializing in geropsychology at school. I developed a love of working with older adults from working with them in rehab in nursinghomes. I never in a million years thought I would enjoy this. But older adults have a lot of wisdom and life to share with others. So I was convinced that I will want to work with older adults upon graduation. Makes sense, eh? Well last year before I started my training at my school's psych. services center, I was worried that I wouldn't like working with young adults. I had some false expectations that they might be shallow or something, at least compared to older adults. Boy was I wrong! I love it! I'm still working with college students. I can see continuing after graduation, but I'm not sure how I will use my specialized training in gero.
>are the problems of young adults much different from middle aged or older patients?
I suppose there are some differences. I see stuff related to being perfectionistic, there are school-related issues, relationship issues, and a lot of stuff that is at least indirectly related to forming an identity as an adult. You know, who am I and what do I believe in? But depression and anxiety and other stuff has a lot of overlap across age groups. So there are similarities.
>my pdocs in private practice mostly fill their appointment books with middle aged professionals, mostly doctors and lawyers who come for analysis. '
This might be because that's the group who can most afford analysis and maybe who might value it the most. Or even have heard of it.
>it just seems to me that it is a worthwhile investment to meet a person where they're at instead of breaking them down first, and to try to help the young person back on her feet, to help her be able to live a long and fulfilling life.I absolutely agree with you. If you were on a unit with primarily older folks, it sounds liek maybe it wasn't the best place for you for inpatient. Are inpatient places limited where you are? Because my experience in a medium sized city is that most inpatient psych units are filled with young to middle aged folks. But then the hospital I am thinking of has a separate geropsych unit. It's too bad if you have few options.
I suppose that working wit older adults does seem like it is geared more towards death. But actually, folks are living longer and longer these days, and with more illness and disability. So yes, helping them reconstruct their lives when they lose important life roles such as employee, spouse, physically active person, etc. is a big part of working with them. Whereas younger folks may have a wider range of issues, but ultimately, it's always about improving quality and meaning in life, imo.
Hope this was helpful. You sound like a thoughtful person with insight. I'm sure that helps you in your therapy journey.take care,
gg
poster:gardenergirl
thread:452491
URL: http://www.dr-bob.org/babble/psycho/20050129/msgs/453007.html