Isn't being told that someone with ODD can't benefit from therapy by 4 therapists - the last being the therapist everyone recommended as being the very best in his field in a 200 mile radius - being "fired". Notice the quotation marks. Isn't it the therapists responsibility to tell parents that a therapeutic course will not be possible for the child at this time? To continue to take money in this case would be dishonest and unethical. As far as a recommendation goes, the only recommendation he could make was in-patient hospitalization which the therapist said he could not recommend because "it would follow him around for the rest of his life." So there were no options. In effect, this child was "fired."
- Thread starter almost50
- Start date
Into The Light
MVP
Re: Facing reality - when should you accept the fact that you cannot make therapy wor
what's ODD? and what exactly did he mean by it following him around the rest of life?
what's ODD? and what exactly did he mean by it following him around the rest of life?
David Baxter PhD
Late Founder
Re: Facing reality - when should you accept the fact that you cannot make therapy wor
ODD = Oppositional-Defiant Disorder
ODD = Oppositional-Defiant Disorder
Re: Facing reality - when should you accept the fact that you cannot make therapy wor
You now have a definition of ODD (DSM 313.81). It's one notch down from Conduct Disorder and a couple notches down from Anti-social Personality Disorder.
My ODD clients tend to test and encroach upon every therapeutic boundary. Usually I accept it because I see it for what it is. Two clients have crossed that boundary and I have "fired" them (or let them go). They both were very hostile and abusive. The only other option for treatment was hospitalization, which I believed would haunt them in the future (follow them around). As they were not a danger to themselves or others (except maybe me), involuntary hospitalization was not an option.
These young men violated the boundaries of therapy so blatantly that to not let them go (ie "fire" them) would have been irresponsible. Does that make me unethical? I don't think so. There was no place to send these young men - except the hospital or home. That is not a decision I ought to be making so I could make no recommendation about either option. While I felt awful about the situation (yes, I had failed), I don't think I acted unethically. I'm not sure anyone would level that charge against me.
As for the hospital issue, medical records are permanent. In the US, this means that a young man will find it next to impossible to obtain health insurance unless he gets it through his employer or state funded high risk insurance pool. It will only get worse because many employers are dropping health insurance and placing the money into health savings accounts with which the individual can purchase their own plan. (We can only hope for national healthcare!) Hospitalization will follow these young men around.
Also, if I know that a patient has been hospitalized for a mental health issue, I tend to take a more conservative approach in my therapy. Any half-serious threat of suicide is met with a call to the nearest psych ward to see if they have an open bed. I have no choice - my risk assessment is impacted by previous hospitalizations. Does this make me unprofessional or unethical? I'll ask my attorney or risk management.
To get back to the initial point, unless one violates the boundaries of therapy to the degree that it can't be repaired, one is usually not let go from therapy. Perhaps "fired" was a poor choice of words because it could ignite feelings of abandonment. I tried to point out that one would have to try very hard to be abandoned.
RPWD (reasonable people with disagree/differ).
I hope I have cleared up the misunderstanding. I apologize if my word choice was offensive. Again, psychologist are not perfect.
You now have a definition of ODD (DSM 313.81). It's one notch down from Conduct Disorder and a couple notches down from Anti-social Personality Disorder.
My ODD clients tend to test and encroach upon every therapeutic boundary. Usually I accept it because I see it for what it is. Two clients have crossed that boundary and I have "fired" them (or let them go). They both were very hostile and abusive. The only other option for treatment was hospitalization, which I believed would haunt them in the future (follow them around). As they were not a danger to themselves or others (except maybe me), involuntary hospitalization was not an option.
These young men violated the boundaries of therapy so blatantly that to not let them go (ie "fire" them) would have been irresponsible. Does that make me unethical? I don't think so. There was no place to send these young men - except the hospital or home. That is not a decision I ought to be making so I could make no recommendation about either option. While I felt awful about the situation (yes, I had failed), I don't think I acted unethically. I'm not sure anyone would level that charge against me.
As for the hospital issue, medical records are permanent. In the US, this means that a young man will find it next to impossible to obtain health insurance unless he gets it through his employer or state funded high risk insurance pool. It will only get worse because many employers are dropping health insurance and placing the money into health savings accounts with which the individual can purchase their own plan. (We can only hope for national healthcare!) Hospitalization will follow these young men around.
Also, if I know that a patient has been hospitalized for a mental health issue, I tend to take a more conservative approach in my therapy. Any half-serious threat of suicide is met with a call to the nearest psych ward to see if they have an open bed. I have no choice - my risk assessment is impacted by previous hospitalizations. Does this make me unprofessional or unethical? I'll ask my attorney or risk management.
To get back to the initial point, unless one violates the boundaries of therapy to the degree that it can't be repaired, one is usually not let go from therapy. Perhaps "fired" was a poor choice of words because it could ignite feelings of abandonment. I tried to point out that one would have to try very hard to be abandoned.
RPWD (reasonable people with disagree/differ).
I hope I have cleared up the misunderstanding. I apologize if my word choice was offensive. Again, psychologist are not perfect.
Re: Facing reality - when should you accept the fact that you cannot make therapy wor
how did you fail?
I think you acted in an ethical and pratical manner. if you can't help the client then therapy can't continue.
We need to balence the clients needs with what is possible.
Regards
Ade
how did you fail?
I think you acted in an ethical and pratical manner. if you can't help the client then therapy can't continue.
We need to balence the clients needs with what is possible.
Regards
Ade
Into The Light
MVP
Re: Facing reality - when should you accept the fact that you cannot make therapy wor
almost50, i completely misread your first post in this thread. i thought you were speaking from the point of view of being a client with ODD, and that you were feeling bitter and that you had been told by 4 therapists nothing could be done for you.
when you talked about being following around, i thought that you meant the therapist was going to be followed around by the decision to hospitalize. your follow up post explained better what you meant, that it would be a problem for the client.
yes, i agree, there are situations where as a therapist one would be unable to help a client because they are violent. there does have to be a willingness on the client's part. but i think ryan was talking about cases where client's are let go when they shouldn't be. my first therapist told me that when i didn't do my exercises to work on my depression that if i didn't do them he would not be able to continue to see me. the reality was he should have explored with me WHY i wasn't doing them. there was something else going on that i needed help with but i didn't know how to ask for it so instead i stopped doing what he asked of me. so the fear of losing his support kept me doing the other work he wanted me to do but he was not giving me what i needed. then when this work was completed he felt finished and let me go. at that point in time i lacked the skills to be assertive and he knew i had difficulty speaking up about things. him letting me go despite the obvious that i wasn't done yet wasn't right and is a totally different situation from violent clients who are a threat to the therapist.
almost50, i completely misread your first post in this thread. i thought you were speaking from the point of view of being a client with ODD, and that you were feeling bitter and that you had been told by 4 therapists nothing could be done for you.
when you talked about being following around, i thought that you meant the therapist was going to be followed around by the decision to hospitalize. your follow up post explained better what you meant, that it would be a problem for the client.
yes, i agree, there are situations where as a therapist one would be unable to help a client because they are violent. there does have to be a willingness on the client's part. but i think ryan was talking about cases where client's are let go when they shouldn't be. my first therapist told me that when i didn't do my exercises to work on my depression that if i didn't do them he would not be able to continue to see me. the reality was he should have explored with me WHY i wasn't doing them. there was something else going on that i needed help with but i didn't know how to ask for it so instead i stopped doing what he asked of me. so the fear of losing his support kept me doing the other work he wanted me to do but he was not giving me what i needed. then when this work was completed he felt finished and let me go. at that point in time i lacked the skills to be assertive and he knew i had difficulty speaking up about things. him letting me go despite the obvious that i wasn't done yet wasn't right and is a totally different situation from violent clients who are a threat to the therapist.
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