Ethics Question?

[Chronic_Pain_Survivor]

Hi, I am caught up in a dilemma with my current therapist...any advice?

Is it ethical for a private therapist to strongly suggest shorter times between sessions, when they know you are on a fixed Disability Pension and can't afford it?

Is it the responsibility of the patient to watch the clock during the session and stop the session after allotted session time is up?

Is it ethical for the therapist to suggest that because the time between appointments is long (3-4 weeks), resulting in extra time required in the session, causing overtime, and stating that the patient deserves to be "double billed" because of it, if it continues?

Is it ethical to suggest that EMDR requires shorter time between appointments, resulting in a higher patient cost?

 

[PrincessX]

Hello Chronic Pain Survivor,

Welcome!

Have you discussed any of these issues with your therapist? If so, what was the response? Did the therapist actually tell you that you deserved to be double billed? This would be terrible, unless you requested a double in length session.
Have you explained your financial constraints and the reason to have less frequent sessions? What kind of therapist do you have - psychologist, social worker, psychotherapist? Also, if the therapist believes EMDR requires more frequent sessions, why does not the therapist suggest another modality?

Really, the issues are between you and the therapist and only you and the therapist know what is going on. Most regulated therapists are bound by professional regulations and you can always contact their regulating body to request information.

On a personal note, I was never responsible for keeping track of time. I would find it difficult to focus and keep track on the time. I do not know if other therapists require their clients to do so, but at least you should be told if you are required to keep track of the time on your own.

Also, I found that the psychologists I went to were never pushy as to frequency of appointments. They would let me determine when and whether I wanted to go. Even though, with my second psychologist I was pretty much expected to go every week, she would always ask: "Do you feel like coming next week? What day works for you?" and so on. I can't imagine being told that I have to be there every Tuesday or something like that. This would not be ethical for sure. I have even stopped going to both therapists abruptly, something, which I do not recommend, but they never contacted me or pursued me for doing so. One of them I went to for one appointment only 6 months later and did not say a word about my abrupt closing.
I understand your concerns. Therapy, specifically in Canada is very expensive.

 

[Chronic_Pain_Survivor]

Hi PrincessX, yes the therapist is well aware of my financial situation...this does not seem to affect their suggestion as to length of time between sessions. They are a Psychologist. They did actually say I should be double billed, even though I never requested a double session. I thought I would get input here before I decide to go to the governing body, or them. Most of all this came up at last session, and I felt like I was being kicked out of the therapy because we ran so late, so I couldn't discuss before leaving. This is just me contemplating what to do next...I realize if I take this into the next session, the entire time will be spent discussing this, I also have lost respect for their professionalism and am hesitant to return, even though I have been seeing them for the past 9 months. This is the 3rd therapist I have seen in the past 3 years, as the other 2 left their practice for personal reasons and forced me to start with a new therapist, so I am not overly excited about going through a therapist change again. I am also contemplating sending the therapist an email to identify my concerns and my potential dismissal of their therapy.

 

[PrincessX]

Hi again. Yes, send them an email.
See what he or she replies. But, you also indicate that you have lost trust in this therapist. If so, unfortunately, this means that you might have to find a new therapist. I understand why you have lost trust in them. Keeping the boundaries of a professional relationship is expected to be a responsibility of a therapist. This, in my opinion includes time keeping, frequency of sessions, not blaming or belittling the client (you deserve to be double billed!), choosing an appropriate therapy approach and so on. You are in a more vulnerable position as a client. The therapist should have made an effort to prevent this situation from happening. Even if EMDR requires frequent visits, this would be something to clarify before engaging the client in it. I am not saying go and complain. I simply do not have enough information and I am not in a position to say that. I think sending an email is perfect as a first step. If you ask for my opinion though, you should find another therapist. The problems you listed are not minor.

 

[MHealthJo]

As frustrating as it is, the search for good therapy - which can unfortunately hit pitfalls and interruptions like you have mentioned, and take longer than expected - it is just so so important to find professionalism, politeness, empathy, and trust. It's so important to not settle for less. I don't think I'm feeling a vibe of faith in this current therapist you've described. That's frustrating and it's a shame.

It's a frustrating situation combined with the concern of also realizing that you wouldn't want other patients to be treated the same way, if that might be prevented somehow. I don't know if my instincts are good though, in trying to think about what's the best next step in that sense.

 

[PrincessX]

I agree with Mental Health Jo. This does not sound like a therapist one would want to encounter.
I said sending an email sounds good, even if you decide to do more about it, because I have also been told insulting things at times by the first therapist I went to. I left as soon as I realized this "therapy" was stressing me more than helping me. I personally think he was smart and knowledgeable, but very insensitive. I wanted to somehow provide him with a feedback, but I never had the chance to do so. I find that the worse the therapist, the less chance you are given to raise a concern or provide feedback. And, no, the client should not be charged for such a meeting.
I know, it is terrible to encounter unprofessional therapists. In my case it even affected my ability to actually go to any kind of in person therapy or to trust other therapists easy. I just could not stop thinking they are making fun of me or insulting me in their mind. I think if I had a chance to tell my first therapist what did I think of the therapy, I would have felt better at the time, because it would have given me a chance to express my disappointment.
I also believe that once your boundaries are violated, you have to run away from this therapist as soon as you can.

 

[GDPR]

Hi Chronic_Pain_Survivor

I dont really see anything wrong with your therapist suggesting shorter intervals between sessions.Maybe he/she feels that's what you need and is only suggesting it in order to help you,not cause financial burden.Have you discussed maybe being charged a lower fee?

Were you told to watch the clock or are you assuming that's what you're expected to do?When you go over your scheduled time is it due to you struggling with something and needing the extra time?If you are going over your time and it has happened often,I can understand your therapists point of view.If you are needing extra time often then going more often would probably be best instead of your sessions running over.I only got extra time when I was really struggling with something and I truly appreciated it because I knew by staying longer it was interfering with other clients scheduled sessions and threw my T's entire day off.It rarely ever happened and I would understand if he felt he should double bill me if it happened often.Time is money and they do have to make a living.

Did your T assume you would be going more often when starting EMDR?I agree that you should go more often if that's what you are doing.Do you want to do EMDR?Have you discussed whether you should continue it or not since you are not able to have more frequent sessions?

I personally think you need to discuss all these issues with your T,face to face.An email is a good idea,just voice all your concerns so that he/she knows and it can be taken care of at the beginning of the session so there's time leftover for other issues.

I suggest instead of dumping this T after all of these months that you talk about it.It is so easy to misunderstand what is being said and to take things the wrong way.It sounds like this person is wanting and trying to help you but you're just simply not happy with the suggestions.They're not demands,just suggestions,so they don't seem unethical to me.

 

[MHealthJo]

Hmm, good points. The way I feel depends on exactly the way things were said to you - like whether you are somewhat paraphrasing things that were said or recommended, or whether things were said in exactly the words you have written, etc.

 

[PrincessX]

Hi again CPS! (Stands for Chronic Pain Survivor )

I really feel your pain. The real question here is not if it is ethical. I think we have to ask: Is it possible? Is it actually possible for a professional therapist to not be able to keep track of the time and redirect the client as needed, and furthermore to let this happen repetitively? Is it possible to blame the client and tell them they "deserve to be double billed"? Whose responsibility it is to keep the boundaries of a professional relationship?
Isn't the therapist at least equally responsible for going over the time limit frequently?
Is it possible to treat a client who can afford only that frequent sessions with EMDR? Does EMDR with its controversial evidence even work?
A lot of questions to be asked...
I honestly believe the better part of psychologists, which I think is the majority are able to keep track of their psychotherapy sessions and redirect clients appropriately, and this includes also choosing and changing therapy modalities. Also, lets keep in mind that therapy cost in Canada is around 200$ per hour.

Good Luck, CPS! Keep us posted of your progress!

 

[forgetmenot]

I too think that in no way it is your job to keep track of the time no way that is the job of your psychologist

Your job is only to show up and get the therapy you need and to participate in that therapy to the best of your ability.

There is to me a belittling being done by this therapist and i for one would walk away Talk yes but if you are uncomfortable then the trust you need for therapy to work is not there so perhaps another therapist would be better for you.

When one gets that bad feeling inside and you have been hurt by your therapist it is hard to mend that trust again This therapist is not a professional he is not looking after your mental well being if he is attacking you with threats of double billing and pushing you to attend sessions instead of asking you what are your thoughts about the therapy

hope i make sense

 

[Chronic_Pain_Survivor]

Hi folks, thanks for all the input. I discussed the situation with my family doctor and they said you do not need to get stressed out from a Therapist, and get a new one. They also agreed that it was not my responsibility to watch the time, nor to be shamed about it. They recommended a good therapist to try. I have sent the email discussing my concerns to the therapist. I have not had a response yet. I am also researching the new therapist and perhaps will see them in the new year. I will see how this plays out.

 

[PrincessX]

I am so glad you have a supportive Family Doctor!
I kind of expected that you would not get response from this previous therapist. You probably forgot to pay the X/Y amount to compensate this individual for taking 2 minutes to reply, speaking also of the quality of this untherapeutic relationship as well. Gosh, such people make me angry for the way they presume they can treat others.

 

[Chronic_Pain_Survivor]

Hi PrincessX, finally got a response, apparently they were away from their office, vacation?...and apologized for their behavior and chalked it up to "having a bad day"...now I have to decide if I want to give them a second chance or not. Having a bad day I don't think explains that attitude, especially for a professional. One would think in their many years of training they would have been guided to not bring personal stuff into the session?? They have sent me a few emails since, trying to convince me to return. I'm perplexed again...what guarantee do I have they won't bring that bad day back to my session? I am not willing to pay for their services if they are having a bad day...that's like hiring someone to wash your windows, and they break them because they had a bad day...LOL.

 

[PrincessX]

Hello CPS! Happy to hear from you.

It is ultimately you who calls the shots whether you try the new therapist recommended by your doctor or you stick with the old one.

Also, consider the effectiveness of your last therapist. Did you get the results you were hoping for? What are the advantages and disadvantages of staying with the same guy?

Personally, I like to keep it flexible if I have to do any kind of therapy - I hate predetermined goals, I think it is stupid and arrogant of a therapist to tell me what am I supposed to achieve on the first or second time I see them, before they even got to know the person.

However, the client/patient always knows if someone is helpful or not.

Starting with someone new might look scary at the beginning, as you have to reveal yourself to a complete stranger. But, given the problems you listed in your previous sessions, it also given you an opportunity for a fresh start, for trying a new approach to your issue.

I have gone to ineffective therapy in the past. It was a waste of time and money and it made me feel desperate, because there I was, with a highly payed professional therapist, who could not do anything for me, nor send me somewhere else, or recommend self-help books. I would not go to someone like that again for free, that's for sure.

Good Luck! I hope you make the best for your health decision.