Aa
patient rights
Hi
I was wondering about your views on a patient's right to adequate treatment.
I was wondering about your views on a patient's right to adequate treatment.
Thank you. That means a lot to me.
No, the service is still not enlightened as to how best treat me. It has been said that the psychologists arrogance will preclude them from changing their methods. And also that they are taking a stand because a previous psychologist labeled me as untreatable.
I feel angry because six months after my previous T left I still have no support. And I am upset by the lack of respect they show my GP (who has taken sole responsibility of my care).
My goal had been to write to the Director of Mental Health here but I become fragmented each time. I feel re-victimized/ re-traumatized.
I believe I need more therapy but find addressing the issue difficult as that leaves me vulnerable and open to attack by the service and others.
I know I need to take a stand, not just for myself, but for others as well.
I'm frightened but I'm going to follow through this time.
J
No, the service is still not enlightened as to how best treat me. It has been said that the psychologists arrogance will preclude them from changing their methods. And also that they are taking a stand because a previous psychologist labeled me as untreatable.
I feel angry because six months after my previous T left I still have no support. And I am upset by the lack of respect they show my GP (who has taken sole responsibility of my care).
My goal had been to write to the Director of Mental Health here but I become fragmented each time. I feel re-victimized/ re-traumatized.
I believe I need more therapy but find addressing the issue difficult as that leaves me vulnerable and open to attack by the service and others.
I know I need to take a stand, not just for myself, but for others as well.
I'm frightened but I'm going to follow through this time.
J
MEDICAL PROFESSIONAL
jaquta, yes, you have the right and the need for psychoanalytic treatment, and I hope that the agencies involved are enlightened by the report of the wonderful therapist who was able to provide that.
Sorry this is disjointed. I didn't have time to complete this earlier and I can't seem to formulate the question in my mind.
I believe people do have a right to adequate treatment. Intellectually I believe I do, emotionally I don't know (I'm torn between yes and no. Yes, I deserve (need) treatment, no I don't, I'm useless and worthless).
I'm stuck. Maybe an example will help.
Excerpt from letter from T (not my last one).
As you are aware, J [using my user ID here] has be re-referred to our service, with a specific request for psychotherapy. Given the complexity of her case, as well as the history of dissatisfaction with treatment and the continued disagreement within the treatment team as to what her treatment should comprise of, I want to request the following be considered:
Background: ...
History: ... [It says I showed significant improvement in my ability to empathize with other people, etc, etc. It also says I continued to access care by using behavioral patterns that relied strongly on threats of harm to self or others and became hostile and often abusive whenever I felt my needs were not met. This behavior and the management thereof frequently resulted in disagreement in the team which probably again contributed to my feeling's of fragmentation and anger. Although I showed important improvement, my behavior essentially remained unconstructive and resulted in strong dissatisfaction from me and feelings of helplessness in the team].
Problem statement:
After disengaging from the service approximately eight months ago, J has now again been referred to our service by her GP, with whom she has frequent contact.
As described above, it has been shown that in spite of the high utilization of service resources her pervasively unsatisfying engagement with us remains. In this, seemingly only supporting her apparent rigid belief that she is ultimately dependent on others who will prove themselves to be frustrating and unwilling in providing her the support she feels she needs. Her active participation in frustrating our attempts to provide "good enough" care is apparent. Given the relatively large amount of service resources usually utilized in J's care, the increased risk for clinicians involved in her care, and our repeated failure in maintaining a treatment framework that undermines her psychopathology as opposed to supporting it, external consultation should be considered.
Recommendation:
1. A second opinion by an independent clinician who has expert knowledge in the treatment of severe personality pathology should be sought, specifically gauging opinion with regard to:
a) The suitability of our service as primary care provider.
b) Suggested treatment frameworks.
2. Should care remain within our team and service, the provision of time limited team supervision in implementing suggested treatment frameworks.
At the time I was having one 50 minute therapy session per week.
This is from my more recent T (who left at the end of last year).
...
My aim from the start was to create a solid therapeutic alliance with J. A starting point for this was that she be involved only with me. ... It was vital that the therapeutic frame be contained and that no opportunities for splitting be created.
I initially saw J for two sessions a week but then added in a third session weekly. This was difficult for J but she settled down into this structure and came to feel safe and contained. It was within this structure that the therapeutic work could begin and she was finally able to talk about a range of traumatic issues. My departure is far too soon in this process for J but in the year that she has been with me she has experienced acceptance within a therapeutic relationship. For someone so traumatized by her past experiences in the service this has been vital for J. That is, she can, and should, never again be labeled as an untreatable patient.
My approach with J was psychoanalytic which means that the deficiencies in the self, emanating from her earliest childhood, were addressed in an experiential way. That is, it was through my experience of her that she came to understand herself. individuals who have to heal at this level employ the defense mechanism of splitting and projection. Clinicians who are not experienced or trained to deal with the consequences of these will find it difficult to treat such a patient. Unfortunately in such cases it is more often the patient who is labeled as untreatable rather than the clinician as insufficiently skilled. The techniques that I used to carry out J's treatment are part of an extensive doctoral training and cannot be summarized here. Be it said, however that for someone whose trauma is placed at such an early stage of development, it is inconceivable that clinicians use methods such as CBT and DBT. These models address the area of skills and until the earliest foundation in the self has been supported and corrected, these methods merely become an impingement to the self. ... At any rate, without a solid therapeutic alliance no method can work.
As this year with me has proven, J is a very treatable patient and is the most willing of participants when she feels understood. It is up to the clinician to find the healthy aspect of the client to facilitate growth. Should there ever come a time that J is uncontained, I would urge the system to look at the method rather than to blame J as has been done in the past. J has lost enough years in her life and I feel has the potential to develop into a functioning adult who could find work and a relationship. Her year in therapy with me has been challenging for her but she has taken this on board and weathered the storm.
Two months ago I requested that alternative arrangements be made for J for ongoing treatment, including the possibility that she be seen in another service. This request has been blocked at management level. The option for her to see a psychologist from our child service has not come to fruition because of the shortage of psychologists at [the hospital]. My replacement has not come on board at this point, ... Please can I recommend that you liaise with [HoD] on J's behalf so that she can be spared from the bureaucratic process.
It has been a pleasure working with J and I am extremely sad that I will not be witness to her ongoing growth.
Do I have a right to ask for, and receive, the psychoanalytic psychotherapy that has been beneficial for me? Or must I accept the status quo, regardless of how damaging it is?
Sorry for the long-winded post.
I start radiotherapy tomorrow. This other service will provide interim support for the duration of the treatment.
J
I believe people do have a right to adequate treatment. Intellectually I believe I do, emotionally I don't know (I'm torn between yes and no. Yes, I deserve (need) treatment, no I don't, I'm useless and worthless).
I'm stuck. Maybe an example will help.
Excerpt from letter from T (not my last one).
As you are aware, J [using my user ID here] has be re-referred to our service, with a specific request for psychotherapy. Given the complexity of her case, as well as the history of dissatisfaction with treatment and the continued disagreement within the treatment team as to what her treatment should comprise of, I want to request the following be considered:
Background: ...
History: ... [It says I showed significant improvement in my ability to empathize with other people, etc, etc. It also says I continued to access care by using behavioral patterns that relied strongly on threats of harm to self or others and became hostile and often abusive whenever I felt my needs were not met. This behavior and the management thereof frequently resulted in disagreement in the team which probably again contributed to my feeling's of fragmentation and anger. Although I showed important improvement, my behavior essentially remained unconstructive and resulted in strong dissatisfaction from me and feelings of helplessness in the team].
Problem statement:
After disengaging from the service approximately eight months ago, J has now again been referred to our service by her GP, with whom she has frequent contact.
As described above, it has been shown that in spite of the high utilization of service resources her pervasively unsatisfying engagement with us remains. In this, seemingly only supporting her apparent rigid belief that she is ultimately dependent on others who will prove themselves to be frustrating and unwilling in providing her the support she feels she needs. Her active participation in frustrating our attempts to provide "good enough" care is apparent. Given the relatively large amount of service resources usually utilized in J's care, the increased risk for clinicians involved in her care, and our repeated failure in maintaining a treatment framework that undermines her psychopathology as opposed to supporting it, external consultation should be considered.
Recommendation:
1. A second opinion by an independent clinician who has expert knowledge in the treatment of severe personality pathology should be sought, specifically gauging opinion with regard to:
a) The suitability of our service as primary care provider.
b) Suggested treatment frameworks.
2. Should care remain within our team and service, the provision of time limited team supervision in implementing suggested treatment frameworks.
At the time I was having one 50 minute therapy session per week.
This is from my more recent T (who left at the end of last year).
...
My aim from the start was to create a solid therapeutic alliance with J. A starting point for this was that she be involved only with me. ... It was vital that the therapeutic frame be contained and that no opportunities for splitting be created.
I initially saw J for two sessions a week but then added in a third session weekly. This was difficult for J but she settled down into this structure and came to feel safe and contained. It was within this structure that the therapeutic work could begin and she was finally able to talk about a range of traumatic issues. My departure is far too soon in this process for J but in the year that she has been with me she has experienced acceptance within a therapeutic relationship. For someone so traumatized by her past experiences in the service this has been vital for J. That is, she can, and should, never again be labeled as an untreatable patient.
My approach with J was psychoanalytic which means that the deficiencies in the self, emanating from her earliest childhood, were addressed in an experiential way. That is, it was through my experience of her that she came to understand herself. individuals who have to heal at this level employ the defense mechanism of splitting and projection. Clinicians who are not experienced or trained to deal with the consequences of these will find it difficult to treat such a patient. Unfortunately in such cases it is more often the patient who is labeled as untreatable rather than the clinician as insufficiently skilled. The techniques that I used to carry out J's treatment are part of an extensive doctoral training and cannot be summarized here. Be it said, however that for someone whose trauma is placed at such an early stage of development, it is inconceivable that clinicians use methods such as CBT and DBT. These models address the area of skills and until the earliest foundation in the self has been supported and corrected, these methods merely become an impingement to the self. ... At any rate, without a solid therapeutic alliance no method can work.
As this year with me has proven, J is a very treatable patient and is the most willing of participants when she feels understood. It is up to the clinician to find the healthy aspect of the client to facilitate growth. Should there ever come a time that J is uncontained, I would urge the system to look at the method rather than to blame J as has been done in the past. J has lost enough years in her life and I feel has the potential to develop into a functioning adult who could find work and a relationship. Her year in therapy with me has been challenging for her but she has taken this on board and weathered the storm.
Two months ago I requested that alternative arrangements be made for J for ongoing treatment, including the possibility that she be seen in another service. This request has been blocked at management level. The option for her to see a psychologist from our child service has not come to fruition because of the shortage of psychologists at [the hospital]. My replacement has not come on board at this point, ... Please can I recommend that you liaise with [HoD] on J's behalf so that she can be spared from the bureaucratic process.
It has been a pleasure working with J and I am extremely sad that I will not be witness to her ongoing growth.
Do I have a right to ask for, and receive, the psychoanalytic psychotherapy that has been beneficial for me? Or must I accept the status quo, regardless of how damaging it is?
Sorry for the long-winded post.
I start radiotherapy tomorrow. This other service will provide interim support for the duration of the treatment.
J
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