I have been retraining/job searching for at least 2 years.
My psychiatrist expressed that it would great if I could help with filing and organization. This is something my previous job (that I RAN from, as to develop other skills) utilized my talent to the point of burnout.
In the past few months our office visits have been… bizarre. All of the regular staff is gone, and patients that I recognize are manning the desk.
While I have no problem with that at all (I have things to work out, no reason I can not be an admin) I am beginning to worry.
Last time I visited her as a patient my psychiatrist was the only person present, and has unofficially made texting our main form of communication.When I came in to speak about about job responsibilities (which we scheduled via text) my psychiatrist was disheveled and definitely not dressed for either visitors or a professional interaction. Her office is in her home, and she had probably just woken up, but it still took me aback.
I continue to receive text messages that I cannot make heads or tails of. Typically they are accusations or word salads that I cannot understand. I have mentioned that these messages scare me and think that whatever is happening sound more like a police matter.
I know something is up, but I care for my Psychiatrist because of the help they provided in my darker times.
What can I do to help? I don’t want to judge but this is causing me tons of anxiety.
Hello, Worried Patient!
You are kind to recognize that all is not well with your doctor, and you are also kind to want to help her. However, your therapeutic relationship is there to help you and take care of you, so my first suggestion is to look elsewhere for a doctor and prioritize your own mental health care. Ask your primary care physician for a referral or check out your insurance company’s roster for someone new – just have a few alternate mental health provider phone numbers in your pocket, ok?
My second instinct is to ask, do you want to do filing and office work for your doctor? Will you be paid, receive a professional reference from her, and/or gain experience that you want or need that prepares you for what you want to do? Was it positioned as a way to ease you back into the workforce? It sounds like the benefits to you are slim, at best, so….maybe…don’t do it? You don’t have to directly tie your refusal to her odd behavior of late if you don’t want to, saying “I really appreciate the offer & consideration, but I’d prefer to keep looking for xyz kinds of work, thanks” should suffice.
And hey, don’t just go with my instincts. The whole idea of patients working for their doctor (and handling confidential records of other patients) is SUPER-fishy to me, and it turns out that the American Mental Health Counselors Association Code of Ethics agrees:
Dual/multiple RelationshipsMental health counselors are aware of their influential position with respect to their clients and avoid exploiting the trust and fostering dependency of the client.
Mental health counselors make every effort to avoid dual/multiple relationships with clients that could impair professional judgment or increase the risk of harm. Examples of such relationships may include, but are not limited to: familial, social, financial, business, or close personal relationships with the clients.
When deciding whether to enter a dual/multiple relationship with a client, former client or close relationship to the client, mental health counselors will seek consultation and adhere to a credible decision-making process prior to entering this relationship.
When a dual/multiple relationship cannot be avoided, mental health counselors take appropriate professional precautions such as informed consent, consultation, supervision and documentation to ensure that judgment is not impaired and no exploitation has occurred.
Mental health counselors do not accept as clients, individuals with whom they are involved in an administrative, supervisory or other relationship of an evaluative nature.
Your psychiatrist should not be asking you to work in her office, and if the situation is unavoidable for some reason she should be documenting everything about it AND running it by her colleagues to make sure everything is cool. Don’t do it.
Workwise, if you haven’t already considered this and if you are able, think about registering with a temp agency and volunteering with an organization that interests you as a way to use your old skills and learn some new ones. Administrative work might not be your dream, but both temping and volunteering can be ways to hear about job openings that might better fit your skills and interests while having your foot in the door. Also, if your desired profession has a local professional organization or MeetUp group, join that, too. Put the organization membership on your resume, attend & volunteer at events, and build your network. Whatever you do, I want you to focus on getting what you need professionally and widening your own base of support in a way that makes you less dependent on your doctor.
If you get a strange text message that isn’t about an appointment or something specific, and you want to reply, try something like this: “Hi, Doctor, I don’t understand your message – is there something specific you wanted to tell me?” It’s true, it’s gentle, and it gives her the opportunity to catch herself and reply professionally. If you get more garbled text, you could try the same kind of measured response – “I don’t understand this reference, is there something about our next appointment I should know?” – or, if it lessens your stress, ignore anything that isn’t a specific, understandable message, like, confirming an appointment. Alternately, ask her to use email instead of texting and then block text messages from her. Or acquire a Google Voice # and funnel communications from her away from your cell phone.
I know you didn’t ask “How do I break up with my psychiatrist” but that’s a question I’m gonna answer anyway since if you don’t need it someone reading this does. “Dr. ______, I’m so grateful for all the help you’ve given me and the work we’ve done together. I’ve decided to seek out other treatment and wanted to let you know.” If applicable, add: “Can you make sure I have enough refills of my meds thru (date) while I transition my care?” and/or “My new doctor may call you, I’m happy to sign a consent form to allow you to communicate with her. Thank you again.”
Doctors have a professional code of ethics that should help her respond with something along the lines of “I wish you the best, thank you for telling me” + following through with necessary steps for ensuring your continuity of care with a new provider (The AMCHA code has stuff to say about termination of counseling relationships, too). It’s extremely inappropriate for her to pressure you to stay or for justification for ending treatment.
tl;dr Take care of you. Ensure your own continuity of care. Take steps not dependent on this one doctor to advance your employment and mental health goals. Secure your own oxygen mask before you do anything else. This is where your obligation to her ends.
That said, there are two steps you could take to “help” your doctor. One is to be truthful to her about the behaviors you’ve observed. You could send her a note once you’ve left her practice along the lines of:
“Dear Doctor, are you all right? Before I left your counseling practice, I saw a number of things that made me worry about you – from the replacement of long-time staff with current patients and disorganization around the office, to the disheveled way you answered the door the morning of (date), to some of the garbled text messages I received, for example (+ list examples). You really haven’t seemed like yourself these past few months. With all you do for others, I hope you are taking good care of yourself and that you can reach out to colleagues for the same care you give others.
I am very grateful for all the help you’ve given me, and wouldn’t feel right leaving without expressing my concern. I hope you are and will be well.
Very best wishes,
If she’s in the middle of a personal crisis, she might not realize that she’s been terrible at hiding it from patients. The truth, kindly and clearly stated, might be the wake-up call she needs to take care of herself. You are in no way obligated to do this, but if you are feeling like you want to help, this could help.
One other option I feel obligated to mention is reporting her behavior anonymously to whatever state board or authority oversees her profession where you live. If she is in the midst of a crisis and behaving unethically toward patients as a result, that might be the right thing to do for her and for them. Edited to add:
On the other hand, it can bring some really messy state interference into the life of an already vulnerable person, which is not a thing I personally would do lightly. Right now her behavior is “odd” – Personally I might save the reporting option for something more extreme, like, if you try to leave her practice and she tries to impede your departure in some way, or escalates the garbled texting in some disturbing way. I just don’t have good information or personal experience with what happens after you file this kind of report, but After hearing from commenters with experience, I am comfortable with recommending reporting your doctor’s behavior to the relevant medical licensing authority as a first/only step (rather than sending a letter yourself). The point of groups like these is to investigate and mitigate any problems they find while maintaining professional ethics & boundaries so that you, the patient, doesn’t have to be involved. I’m sure your general doctor and/or new mental health provider and b) our wise commenters will weigh in with more information & experiences about this. can help guide you to the right place.
Best of luck in your career path and in wrestling with this sticky situation. Keep us updated, ok?