#885: “My psychiatrist is not okay. How do I help her?”

Dear Captain,

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:

  1. 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.

    1. 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.

    2. 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.

    3. 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.

    4. 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,

Your name.”

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.

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Best of luck in your career path and in wrestling with this sticky situation. Keep us updated, ok?

 

 

137 comments
  1. Brigid said:

    Whoa, honey, this is not normal. Yes, please find a new care provider right away. You deserve all the best in your care and your career, may both go smoothly (and separately) from here on out.

  2. alexcansmile said:

    This situation is full of bees. LW, I second all of the Captain’s advice – please take care of YOU and find a new psychiatrist.

  3. A new psychiatrist for the LW is definitely the way to go. They will be able to understand the ethics of their field as well as the LW’s personal situation.

  4. Lilah Morgan said:

    I think a new psychiatrist or psychologist might be the best source of information regarding reporting to the relevant licensing board too (and may even be mandated to do so themselves if the situation warrants it). LW, I don’t think that necessarily has to be all on you either.

    • SarahTheEntwife said:

      That’s an excellent idea. They’ll have potentially a more objective view of it (it can be so hard to tell the difference between GETOUTBEES and “yeah, this person has some sort of Thing going on and is probably not a good therapist for you right now” when you’ve been steeped in it for a while) and given the comments below another practitioner in the same area may have a better idea of how much of a nuclear option reporting to a professional organization would be.

      • And they’ll know the local regulations and procedures, as well. I agree. Turn this issue over to your new doctor.

  5. Jill said:

    There is a saying, “Physician, heal thyself!” Which means a doctor cannot possibly help a patient when he, himself, is vulnerable or incapacitated with his own health issue. Your doctor is clearly unable to give you the help that you need right now. You, kind LW, cannot “heal” your own doctor. Seek out a new doctor. I think the Captain’s suggested note of concern – after you have a new doctor – is about the kindest thing you can do.

    If it helps, remove the emotion. Yes, the fact that you share private thoughts and share your problems and hopes and fears with this person creates a unique relationship, but it doesn’t mean you’re obligated to stay – or that you’re obligated to help them in their moment of need. You are a client paying for a service. That service was great…but things have changed and you are no longer getting the level of service you’ve been paying for. Please don’t feel guilty about ending this relationship. Captain is right – YOUR OWN mental health has to be your first priority!

    • Seconding. They are not your friend, even if you two were friendly. You paid for a service and now they are not in a position to continue to offer that service. It’s OK to leave. It doesn’t make you mean, or disloyal, or not understanding, or callous, or cold, or anything else. Leaving means you are prioritizing your own level of care and that’s 100% OK. Think of it as looking for a new dentist, or car repair shop, or hair dresser. It’s OK to make sure you’re OK and taken care of when you’re paying for services.

    • Hosta said:

      Ditto on her not being your friend. You are paying for a very important service you are not getting. Her asking you to work on the office is skeezy, and her accusing you is downright gross.

      ….and even if she WAS your friend, it would be pretty crappy of her to ask you to do work that she knows you burnt out on. If nothing else, that would make this a situation to flee from.

  6. DJ said:

    Making a complaint to the local medical boards might not be as terrible as it sounds. I had some issues with a doctor (not a psychiatrist) and my PCP suggested that I make a complaint. She said that the time she got a complaint from the medical board made her a better doctor because it highlighted an area she needed to improve. It didn’t sound like the board was overly harsh or did much other than pass the complaint along.

    • A lot of people pay more attention to complaints passed along through official means than complaints delivered directly from a patient/client/customer. If a patient/client/customer complains directly, they may dismiss it as just a grumpy person, and shrug it off, no big deal. But if that person went to the trouble of making it official, then they will believe that it WAS a real issue, after all. People don’t make official complaints just because they’re feeling grumpy that day. It takes effort, and so people only do it for something that has real meaning to them.

      Of course, people really ought to pay attention to the complaints in the moment. But what people ought to do and what they actually do are often two different things.

      Report this doctor, please. It’s for the doctor’s own good, as well as your own and the other patients.

      • rhythla said:

        Honestly, it really depends on the board. The board for my profession in my state is very strict – and some would say overly aggressive. So I would much prefer someone talk to me directly rather than going to the board about it first. (But I am also not at all like the therapist in this letter.)

        And unfortunately, “going to the trouble of making it official” still does not make it a “real issue.” The average person really does not truly understand how medicine or insurance works, so sometimes they get upset about something (it could even be legit) that really is not an issue – it is only an issue because of their lack of understanding.

        For example, I am out-of-network with X insurance that a patient just came in with. She already knew this walking into the office. After her appointment (after services had been rendered), she asked again about insurance. I explained the concept of out-of-network to her again. I asked her if she had a copy of her card because she did not know what coverage she had, so I offered to call and find out for her. She said she thought she had an HMO, which I explained would not cover any of the costs today since HMOs do not provide out-of-network benefits; but her card didn’t say HMO on it, so I told her that I would find out for her. So I called her insurance that day and planned to call her the next day, but before I arrived at the office the next day, she had sent an email asking me to cancel future appointments because “she can’t go if insurance isn’t paying.” I sent her an email back explaining her coverage and said that they would pay her part of it because she did have out-of-network coverage, but that she would still be responsible at the time of service (she pays each time then gets a check back later from the insurance company). When I had not heard back from her by the end of the day, I tried calling and left a brief message saying the same. I haven’t heard from her since.

        This situation is very typical. It does not matter what I say or how I say it – some people just do not get it. And I don’t blame them! The insurance companies make it difficult on purpose! But believe me when I say that I would be beyond pissed if she wrote a complaint to the board about it. Given, I have documentation so it would not go far, but it is a headache I don’t need.

        Obviously, this all really depends on the situation and the people in it. What the therapist is doing in this situation is 100% not OK and LW should go elsewhere ASAP. And I completely agree that people need to pay attention to complaints in the moment, but think twice about nuking a professional by going to their board (unless the situation obviously warrants it, like sexual assault).

        • I don’t see that she has anything to complain about, concerning you. You went way above and beyond, trying to help her with insurance. If anything, she should be praising you! Or at the very least, returning your calls. Geez.

          Some people WILL complain, though. Some people will complain about anything and anyone, and it makes it harder for the rest of us.

          Unfortunately, those people make people with real complaints less likely to be taken seriously. If all complaints were real and believed, we wouldn’t even need a board.

          I do not recommend “going nuclear” in the first place, unless, as you say, in the case of the practitioner doing something truly heinous, where it’s important to act quickly and completely avoid a personal confrontation until/unless you have big back-up. Sexual assault is an excellent example.

          I do believe LW’s situation to be rather egregious, and a complaint directly to the doctor, in this case, isn’t likely to get good results, because the doctor needs healing, first.

          These cases, like the people in them, are individuals, and blanket rules rarely work across the board.

          When we’re in the heat of anger, it’s hard to avoid those blanket statements, though.

    • I think that framing the idea of taking this to authority as ‘a complaint’ is the wrong framing. LW, if you do take this higher, it won’t be because you are *complaining* – it will be because you are raising justifiable concerns about this woman’s well-being and her ability to do her job in a manner that’s safe for others. It isn’t adversarial, it isn’t a ‘She’s so awful!’ approach – it’s a situation where you actually need to let someone know about the safety issues.

      And, yes, I am strongly in favour of reporting, for the reasons given by other people below. I have no idea how such things go in the US, but the thought of letting a woman who seems to have major mental health issues of her own go on being responsible for the mental health of others without being helped herself… I think the commenter below who compared it to driving with impaired vision absolutely nailed it. Someone needs to know about this, for the safety of all concerned.

  7. B. said:

    I concur with the Captain and commenters about looking for a new psychologist/psychiatrist ASAP. LW, my shoulders have migrated to around my ears after reading your letter. In my country, what your doctor is doing (letting patients access the records of other patients, having patients work for her) is illegal as well as unethical. I hope you can disengage from this situation quickly and painlessly, because I’m afraid it might get worse and, even if it didn’t, you don’t need the added stress.
    It’s your choice whether you wish to be kind to your current doctor and for how long you want to keep in contact with her, but in case you want to bail and are feeling guilty about it:
    – You do not owe any kind of loyalty debt to your psychiatrist. You have paid for the help she has given you. It was her job to help you and you paid her to do it. You are not a bad person if you leave.
    – If your brain is shouting “But I cannot leave her in her time of need!”, remind yourself that you cannot# help this time. She’s your doctor, her job is to help *you*. If she needs help, the one qualified to do that is another doctor; never someone whom she’s currently treating.
    – If continued contact with her is causing you more stress than the sessions alleviate, she’s no longer a good fit for you. It’s not a failing on your part to seek better care.

    # I think the note the Captain provided is the most help you can offer in this case, but I agree that you should send it after changing doctors. And even the note might not change things, if she’s not able to do something about her situation for whatever reason. You cannot fix this, LW, but that’s not any fault of yours.

    • Solestria said:

      Seconded. It is also worth noting that it would be unethical of her to accept the help and friendship of a patient. So not only should you, LW, not feel bad about not helping her, you are sparing her another ethical dilemma she seems unequipped to handle in her current state by leaving cleanly without trying.

      I hope she gets whatever help she needs, and you are a caring person, but you are not someone who can help her right now

  8. Hoo boy. I hope your situation and your psychiatrist’s both improve soon.

  9. ctruex said:

    Oh, you need a new psychiatrist, stat. That should be priority 1. Then, consider the suggestions on trying to speak about the old psychiatrist’s issues. She is NOT going to help you if you doubt her stability

    • ctruex said:

      To be clear, I mean that working with her will not help, not that she will deny you therapy

  10. Duly Concerned said:

    I agree with the Captain and the other posts I’ve read so far: this situation has gone way past anything that could be considered normal. I hope you take the Captain’s suggestion to find a new therapist.

    I see both arguments for not taking any steps to alert the state. As the Captain noted, any intervention by a state agency is highly likely to be intrusive at best and actively damaging to a vulnerable person at worst.

    On the other paw… let me reveal my own personal bias here. I was the victim of medical malpractice and could have avoided being rendered functionally deaf in one ear, losing my sense of balance and suffering facial disfigurement had someone spoken up sooner about the surgeon’s cocaine addiction. This is part of the public record; even though I am not naming him, I want to be clear that this is not some gossip I heard, it is information from the records of the state medical board that he presented in his own defence in complaints from other patients.

    When you wrote: “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” that set my spidey senses tingling pretty hard.

    What the quote looks like to me is the classic setup of an abusive relationship. Your therapist is sending you texts that are accusations and you have communicated that they scare you but the texts apparently have not stopped. That boundary in the doctor/patient relationship has been blown over so hard that I doubt you can even see it with binoculars. That at least some of those texts make you wonder if you should call the police seems to me like a potent message from your subconscious that goes something like “this is way more than you can handle by yourself.

    If you are not comfortable filing a report with whatever agency your therapist is accountable to, there may be a middle way for you, LW. If your psychiatrist has a partner or works frequently with a particular therapist, you might consider sending a note with your observations and experiences to the colleague.

    Maybe I’m wrong here but I keep imagining someone with bipolar or depression, suicidal and relying on a psychiatrist for help who is a psychiatrist who sends scary texts to other patients. If one of my nephews or niece were that patient, HELL YEAH I would want someone to speak up to give my seriously mentally ill loved one the chance to recover.

    • winter said:

      I don’t believe that it’s necessarily a malicious setup for an abusive relationship (meaning psychiatrist isn’t necessarily very well in control of their behavior), BUT fortunately that doesn’t change anything about the advice.

      LW, you need to be able to trust that the medical professionals who are there to help you know about and respect professional boundaries – because they are there for a reason. At this point, your psychiatrist needs to help herself before she can help anyone else, including you.
      And if you feel it might be necessary/safer for her patients to report her, then don’t feel bad about doing it.

      • Duly Concerned said:

        I’m not sure *any* abusive relationship starts out with the abuser consciously deciding to use abusive methods to control their brand new partner. I think it is much more likely (both in theory and in the abusive relationships I’ve seen up close and personal including my own with my ex) that the abuser wants something, gets frustrated in trying to get what they want from the other person and out of that frustration, commits some form of abuse, usually beginning small.

        From the abuser’s point of view, whatever it was that they did worked in the moment and since people have a strong tendency to continue doing what works for them, the abuser continues and even escalates the behaviour.

        I’m not saying abusers don’t realise what they are doing is abuse because the vast majority of them do realise that they are behaving badly. I’m just saying that I believe the beginning of control via abuse is something they stumble into without planning it out in advance. They come up with elaborate justifications and rationales for their behaviour to make it okay in their own minds.

        In the LW’s case, the LW has expressed that the texts scare her and yet they continue. I’m sure the psychiatrist has all sorts of explanations for how those texts aren’t really scary or aren’t really abusive or aren’t really wrong. The problem is that abusers are controlling via fear and choose to continue doing so even after the victim has communicated “(fill in the blank) scares me.”

        In some way that the psychiatrist may not even be able to articulate honestly, scaring the LW is working for her.

        • aebhel said:

          Thiiiis. IME, abusers very seldom set out with the intention of abusing their victims–they just don’t want to control themselves, don’t want to hear ‘no’, and can’t stop because that would mean owning up to the fact that their behavior is destructive, which would ruin their self-perception.

          • Duly Concerned said:

            aebhel, you put it so much more succinctly than I could. If some small wit I have, brevity is definitely not its soul.

        • winter said:

          I simply believe that framing this in terms of abuse might not help the LW, if that’s not what they experience (or don’t want to call it that).

          • Best Turkey said:

            Not sure I agree there. Obviously saying “THIS IS DEFINITELY ABUSE, YOU MUST CONCEIVE OF THIS AS ABUSE” is not helpful at all.

            That said, we kind of have to call it as we see it from the facts we’re given in the letter. At the very least, I think it’s fair to say that the combination of boundary-violating and sending messages which are scary and aggressive constitutes behaviour which, if it is not abuse, at the very least cannot be readily or easily distinguished from abuse using the information available to us. And if us saying “This looks an awful lot like abuse, based on the facts you have given us” helps LW have an epiphany along the lines of “Well, hot damn, when you put it that way I guess it is abuse” then that’s surely helpful.

          • Duly Concerned said:

            Best Turkey, exactly.

            Even if it isn’t the classic intimate relationship abuse, the situation may share enough characteristics that the reasons why victims stay with abusers may also apply here.

        • heffalumps said:

          all else aside, this post is *extremely* helpful to me in understanding the instances of abuse I have observed in my life. thank you so much for spelling this out so clearly.

          • Duly Concerned said:

            heffalumps, you made my face go all hot. A lot of people have helped me and I’m glad I could pay it forward in some small way.

    • Extra Nonny said:

      Seconding this, and going more anon than usual to share this: a friend of mine was physically and mentally abused by her psychiatrist mother. I wonder if any of her patients were experiencing erratic behavior from her and had an opportunity to speak up and spare my friend what she went through. So my first instinct is also to err on the side of finding someone to whom to report this. LW may not be seeing the most harmful of her psychiatrist’s behavior, though what she is seeing is scary enough!

      • Duly Concerned said:

        Extra Nonny, that is so sad. Both for your friend and for her mother’s patients, who may well have been receiving sub-optimal care at a time when they were most psychologically vulnerable.

        In the US, about 6 times as many people die each year due to *preventable* iatrogenic causes than are killed in auto accidents. Most people seem to assume that medical personnel associated with such deaths are sued for medical malpractice but various studies show that about 80% of patients who suffered medical treatment that fell below the standard of care do ***NOT*** sue. Contrary to the popular image of victims cackling and rubbing their hands gleefully over the chance to win a civil suit for damages, the vast majority of people just don’t do that.

        As a result, there are serious gaps in accountability.

        No one wants to make a fuss and potentially hurt someone who helped them as well as harmed them in the past but that tendency is why we’re losing almost 6 times as many people to preventable medical errors as we are to vehicle accidents.

          • Duly Concerned said:

            I had to laugh. I don’t live in Texas but I discovered that in my own state (which is not really like Texas at all), there are significant hurdles to bringing a medical malpractice suit.

            Years ago, the _Journal of the American Medical Association_ published an article about some research done in US hospitals. The researchers went to a number of different hospitals and examined all patient records for a certain length of time (something like three or six months). They identified records of patients who had, in the researchers’ definition, suffered actionable medical mistakes. They found that about 80% of the victims of medical malpractice never file suit, never even threaten to do so. At the time, I found it surprising and counter-intuitive.

            Now that I am older and have more life experience, I realise that many of those patients who never filed probably discovered exactly what I discovered: they could not bring suit because the possible settlement or judgment involved would not be high enough to persuade a lawyer to take the case on contingency.

          • Admission Note said:

            Out of nesting-intended for Duly Concerned- laws limit the window of time one can file a lawsuit in after the events. The right to bring suit expires about six months before people are well enough to think about finding a lawyer.

    • cruelmistress said:

      Yes, that “accusations” bit really threw me– we don’t know what LW’s psychiatrist is saying, precisely, but I’m hard-pressed to think of any accusations it would be appropriate for a doctor to be sending to their patient over text message! Intimate aggression of that stripe does not a good therapeutic relationship make, nor a good employer-employee relationship.

      Given the fact that this psychiatrist is entrusted with not only LW’s mental health but also that of we-don’t-know-how-many other patients under her care, who are by definition vulnerable to her, I lean toward reporting.

    • aebhel said:

      Yeah, if your shrink is sending you *scary text messages*, it’s time to terminate that therapeutic relationship. Good lord. That’s not showing up to work looking disheveled, that’s not letting the patient/therapist relationship get more friendly than it really should be–that is, at absolute best, a therapist who’s treating her client as a friend to lean on and lash out at in a rough time. Not even slightly okay.

  11. Big Pink Box said:

    What an awkward situation. Hopefully you can extricate yourself from the situation, and a gentle prod might give your psych the realisation that they should check in with their own MH provider, or find one they could work with.*

    *Mandatory counselling (a certain number of hours per year, at regular intervals) is required for MH professionals in some locales that I’m aware of, not sure if this is the case in your location.

  12. Not a doctor said:

    This sounds super unnerving and not a little frightening. I would set aside the job discussion and focus on getting help for yourself AND for your doctor. It sounds as though your psychiatrist is experiencing something that goes beyond stress or exhaustion – and which you are neither qualified to treat or to diagnose, or to deal with on top of your own requirements as a patient.

    I’d suggest that you consult with another psychiatrist immediately. Describe this person’s behavior, and seek their guidance as to what to do. Two possibilities that occur to me: your psychiatrist should be reported to the state or federal agency that licenses psychiatrists, and/or you should report your psychiatrist’s erratic behaviors to any local hospital where your psychiatrist has admitting privileges. The reason to report would be for the safety of other patients who see this doctor, and concern that your doctor needs medical treatment that they are not receiving.

    I would NOT suggest you contact the police, as they have limited training in mental health issues and can only intervene in situations where there are direct threats or threatening behaviors. (If your psychiatrist were part of a special population, like the elderly or a child, they could refer a state agency like elder services or DFCS, but I can’t think of a state program that covers this situation.) I”m not sure what “threatening texts” entail – I assume they’re not threatening YOU, or you would have cut off communication.

    In fact, I’m going to shoot a link of this letter to a couple of FB friends who are actual mental health professionals, and see if they want to respond, because it seems like there should be guidelines for this kind of thing out there.

    Best of luck to you. (And your doctor!)

    • tawg said:

      If the LW goes to a GP for a referral to a new psych, I think they should mention it to their general health doctor – it’ll be quicker than waiting to get in to a new psychiatrist, and will free up those first few sessions so the LW can talk about what’s going on with them, rather than what’s going on with their previous psychiatrist. And a GP should be able to guide the LW through making a complaint, or file a complaint on the LW’s behalf.

      • Admission Note said:

        This is a terrific suggestion! The GP is a Mandated Reporter. Upvoting not starting a new MH relationship by dragging the drama of the last one in.

  13. Just because a person is a mental health professional doesn’t automatically mean they are immune from mental health issues, themselves. It sounds like your doctor needs help.

    Basically, what Captain Awkward said. It’s sad, but it does seem that your doctor is in need of some help, and can’t help you, any more. Be grateful for what was, and hope for better days for both of you in the future.

    Good luck in your NEW career, and with a new, more professional doctor.

    • EchoFlower said:

      Agreed. I remember reading about a woman who was inspired to pursue a career in psychotherapy because of her experiences as a patient with schizoaffective disorder. She made quite a name for herself in the field of mental health and sometimes speaks at NAMI conventions.

      When I read the part where your psychiatrist is sending you texts that are nonsensical ‘word salads’ and/or are accusations, I started wondering if she’s experiencing a flare-up of a chronic psychiatric disease of her own. Unfortunately, I’m not sure what can be done about it if she is.

      You said the office is at her home. Perhaps others can weigh in: would it be appropriate for you, a patient, to discuss your concerns with the psychiatrist’s spouse or another close family member? If she does have a mental illness diagnosis of her own, family members would probably know about it, and, hopefully, be able to get her to suspend her practice until this flair-up subsides(with treatment).

      My other suggestion is to ask for advice from the National Alliance on Mental Illness(NAMI): http://www.nami.org. Go straight to the national level; They’re supposed to be experts, whereas I’ve had some mixed experiences with my local chapter. (Apparently, a handful of men with depression resort to the Men’s Rights movement in an effort to make sense of their problems. These people should not moderate a depression support group.)

      • Solestria said:

        I think it is unethical and in advisable for a patient to attempt to find mental health care for their provider. Reporting the behavior is probably the best thing to do to flag it in a way that might lead to the psychiatrist getting help.

        • B. said:

          Seconded! I didn’t see your comment before I started writing mine, but you’ve addressed what I was triying to say more clearly and in less words.

      • B. said:

        I’m not sure it’s a good idea for the LW to become more involved in this situation… if they’re suffering from stress because of the psychriatrist’s behaviour, I think it would be better for them to disengage rather than seeking help on behalf of the therapist. A patient has often enough trouble finding adequate care for themselves, let alone for someone who ought to be responsible for helping them. I think the task of seeking help for the psychriatrist should fall on a friend or loved one of the psychriatrist, but never on one of her patients. That falls far, far outside of the boundaries in a patient-doctor relationship.

      • BigdogLittlecat said:

        No, not appropriate to express her concerns to anyone other than the agency/board in charge of psychiatrists and to the doctor herself, in a goodbye letter. LW has no moral or legal obligation to try to help the doctor: the whole point of their relationship was for doctor to help LW. If that is reversed, it is unhealthy for both of them.

        LW needs to sever this relationship and get out. It’s hard because one becomes “friends” with one’s mental health care people, but it is in reality a professional relationship, in which the professional has various duties and obligations to the patient, including not becoming personally involved. The laws/regulations regarding behavior are in place specifically to prevent the relationship from getting tangled and unhealthy.

  14. Also, please save all the texts and other messages. Document this, for two reasons:

    1) if you report the doctor, you’ll need the documentation

    2) There may come a time, later, when you doubt your feelings or perhaps feel guilt about leaving your doctor, and looking back at these messages, from a distance, will help you process it from your newer, wiser perspective. People in the throes of gas lighting often can’t see it, but if they look back on proof of the past, they can see it clearly, and it can be a release to recognize it. Of course, I’m not saying that you certainly will want/need to do that. I’m just saying that if you keep the documents (in a place where you don’t have to see them, if you don’t want to), then if you decide you do want/need to see them, you’ll have them available.

    Shove them all in a file, somewhere, and don’t look at them until you want/need to. If you can afford it, I’d recommend getting a new cell phone number, and putting the old phone away somewhere, just collecting more texts that you don’t even have to see, in the first place. When you don’t need it any more, stop the cell plan for that phone. That costs money, but it means you won’t have to even see the texts, when they first come in, let alone in the filing process. Eventually, you’ll be able to process them safely, with your new doctor’s help.

    If you can’t afford a second phone, maybe enlist the aid of a friend to help file away the texts for you, so you don’t have to see them? You don’t open them up, at all; just read any texts but those, and let your friend file them away for you. That keeps the documentation process, without endangering your own mental/emotional well-being.

  15. Kay said:

    I am a mental health professional. I am horrified. Please, please, please quit the job and find new care. One of the best ways you can help her is to not take/stay at the job. It is a grossly inappropriate situation. She is not exercising good judgment. It is better, if/when things come to a head, for you to be out of harm’s way. If she were using her best judgment, you would not be in this position. You working for her would be a concern even if she were no longer providing your medical care, in my opinion.

    The captain gives good advice, as far as 1) Securing a different medical provider, 2) Getting out of the job, and 3) Sending a letter afterwards to kindly alert her to what’s going on, if you feel safe to do so. And I would strongly suggest reporting her if she continues to text you after you ask her not to or if she creates any problems with medication/referring you. (Frankly, there’s part of me that’s strongly in favor of reporting her now, but that’s my “outraged professional colleague” mode. If I think of times I’ve been in the role of patient, I know it would be very hard for me to do that short of an extremely gross violation.)

    ~~~~~~~~~~~~~~~~~~

    Also, if I might make some professional clarification, if she is a psychiatrist (i.e., has MD after her name, prescribes meds), she is not bound by a counselor’s code of ethics. For example, I’m a psychologist, I am bound by the American Psychology Association code of ethics, not the counselor’s code. Most mental health ethical codes are very similar, with slightly different wording. If she’s a psychiatrist, she’s bound by the American Medical Association Code of Ethics and the American Psychiatric Association’s Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry. (Frankly, after reading it over, I wish they WOULD adopt more specific multiple/dual relationship clauses. Alas.)

    https://www.psychiatry.org/psychiatrists/practice/ethics

    A couple of relevant quotes:

    “The psychiatrist should diligently guard against exploiting information furnished by the patient and should not use the unique position of power afforded him/her by the psychotherapeutic situation to influence the patient in any way not directly relevant to the treatment goals.”

    “Special consideration should be given to those psychiatrists who, because of mental illness, jeopardize the welfare of their patients and their own reputations and practices. It is ethical, even encouraged, for another psychiatrist to intercede in such situations.”

    “When significant relationships exist that may conflict with patients’ clinical needs, it is especially important to inform the patient or decision maker about these relationships and potential conflicts with clinical needs.”

    (I include that one because I believe that you working for your mental health provider does potentially conflict with your needs. What happens if she’s late with a paycheck and you owe a bill? If she knows that you’ve been absentminded of late and starts scrutinizing your work more closely because of that? If you have a conflict at work that makes you uncomfortable revealing problems you’re having? There are SO MANY potential reasons this is a bad idea.)

    Best wishes.

  16. Buttermilk said:

    Generally speaking, professional boards are run by people who are professionally licensed for that profession, not random state employees/bureaucrats. Reporting a practitioner to the board isn’t quite the same as calling the police on them, or bringing an overworked social worker in to potentially mess up somebody’s life. It’s more like telling other doctors that something may not be right with one of their fellows. In fact, practitioners get a lot of leeway and benefit of the doubt when they are investigated by boards (often too much leeway http://doctors.ajc.com/doctors_sex_abuse/?ecmp=doctorssexabuse_microsite_nav). It also sounds like the psychiatrist here has way overstepped professional ethics, and like something very weird is going on. I would definitely make a report to the state board.

    • Buttermilk said:

      Sorry, meant to put a warning w/ that link for sexual assault/abuse. It is a piece of longform journalism, but it could be triggering.

    • cruelmistress said:

      (I think the police comments address a line from LW’s original, about believing whatever is going on to be “a matter for police”; a professional board, where applicable, would be my choice for this situation as well.)

  17. BigdogLittlecat said:

    You need to “break up” with her. She can no longer help you, because she’s lost her ability to keep her life away from yours. It’s no shame to reach a point -for whatever reason – that you and your mental health professional have to part ways. Most

    The whole point of standard of conduct for psychiatrists and therapists is to allow them to develop a relationship with you so they can help you, but at the same time to maintain their own emotional independence and stability so that what they experience doesn’t flow back to you. A mental health professional has to have a “meta” relationship to you and your life: knows all about you, cares for you, you trust them, but they are not “in” your world.

    The original idea that the mental health treatment is an emotional one-way mirror behind which the professional is an unaffected observer is bogus. The professional *is* affected, but their job is to process it and not reflect any negative emotions back to the client. The professional loses objectiveness when their emotions get out of control, whether it’s their own personal life wearing them down, or because they can no longer effectively process the patient’s emotions to remain empathetic but not affected.

    Her crashing the professional barriers shows that she can no longer help you. That does not reflect on the help she gave you and your gratitude.
    I had to break up with the therapist who helped me more that all others combined. He helped me survive my family psychodrama that ended in zero contact with one family member, he gave me great insight into how my brain works and how to manage it better, so I’m not sure I’d be alive today if not for him. We had a good long run of it, but finally reached the end where he had nothing more to offer and my weasel brain had him so figured out that it was getting sneaky towards him.
    He will ever remain in my heart as one of the most important people in my life.
    But he couldn’t do his job towards me anymore, so it was time to end it.

    YOU are the patient. YOU are the one this relationship is supposed to be about. When you worry about your psychiatrist it’s the same inversion of roles as when a child becomes the “parent.” She’s 100% responsible for her own mental health. You can walk away with a clean conscience.
    And if she’s sending you texts that make you even think “police” you might want to consider running.

    I would send her a break up letter such as the Captain suggested, but without the opening question because you don’t want her to respond. Tell her you’re breaking up, express your gratitude, fondness, and worry about her, and then you’re done. It’s sad to close a door and go no contact on a relationship that was so important, but it has to be that way.

    Whether or not you report her is a matter for your conscience. You have no obligation to report her, so it’s up to you whether you’d feel better if you reported her or not.

    Good luck, and I hope you are able to find a great new job and a great new doctor quickly.

  18. Carla said:

    OMG. From someone who works in the psychiatric area of a large hospital….
    1) NO NO NO NO NO a patient of a psychiatrist (or any other type of doctor) should never work for that doctor, ever, even if you were to not be her patient any longer. Anyone handling such sensitive information has to be a professional and understand the strict need for privacy.
    2) The fact that the psychiatrist is asking her patients to help her, and the garbled text messages, show that she is likely suffering from her own mental illness. LW, find a new mental health professional right away. Don’t feel obligated to explain anything to your existing doctor if it makes you uncomfortable. Your own mental health is first priority.
    3) I strongly disagree with the captain in hesitating in reporting the psychiatrist. BREAKING PATIENT BOUNDRIES AND CONFIDENTIALITY IS ONE OF THE WORST THINGS A PSYCHIATRIST CAN DO. I feel so strongly I went all caps on that. Psychiatrists deal with suicidal people all the time…. a sick doctor is putting her patients’ lives in danger! Complaining to a state agency is not like going to court or suing someone…. they will hear your complaint and then investigate. They will help the doctor get the help they need, and suspend their license if necessary (sounds like it is) until they are better. I’m from Canada so I’m not sure what the state regulators of psychiatrists are called, but they will have one. Make the call, be clear you are concerned about their health and that you are not trying to sue or anything, and they should investigate promptly.
    Good luck, LW!

    • Jackalope said:

      Carla: Just out of curiosity (and not because this is a current life situation of mine), would you feel as strongly about #1 if it were a person who WAS a professional in that area? I’m thinking, former patient, relationship has ended, and they’re in the same field so former psychiatrist hires former patient. I live in a big city so it would be easy to avoid that, but it seems like small towns might mean there are fewer local offices if you’re in the same field.

      • Me said:

        I’m not 100% sure of the legalities but my feeling is that you would avoid that situation at all costs. For example, in terms of personal relationships, once you have a patient-doctor relationship, even if that ends, you are NEVER allowed to date that person.

        • Anonymous said:

          It is certainly discouraged, but at least according to APA guidelines, it is not correct that psychologists are never allowed to date former clients:

          10.08 Sexual Intimacies with Former Therapy Clients/Patients
          (a) Psychologists do not engage in sexual intimacies with former clients/patients for at least two years after cessation or termination of therapy.
          (b) Psychologists do not engage in sexual intimacies with former clients/patients even after a two-year interval except in the most unusual circumstances. Psychologists who engage in such activity after the two years following cessation or termination of therapy and of having no sexual contact with the former client/patient bear the burden of demonstrating that there has been no exploitation, in light of all relevant factors, including (1) the amount of time that has passed since therapy terminated; (2) the nature, duration, and intensity of the therapy; (3) the circumstances of termination; (4) the client’s/patient’s personal history; (5) the client’s/patient’s current mental status; (6) the likelihood of adverse impact on the client/patient; and (7) any statements or actions made by the therapist during the course of therapy suggesting or inviting the possibility of a posttermination sexual or romantic relationship with the client/patient. (See also Standard 3.05, Multiple Relationships.)

          [from http://www.apa.org/monitor/dec04/ethics.aspx%5D

          • JenniferP said:

            That did not read like ringing endorsement of the practice and let me be sooooo skeptical of the “Look, I Found This Loophole” doc who pursues dating a former client.

          • Kay said:

            Yeah. Definitely beware “the loophole” docs. It is not “two years, then do whatever you want!”

            Basically, in graduate school, how I was taught to look at it is, like, if three years ago you consulted with a company and did relaxation training for their employees, and this person was in the audience and you never saw them again, and didn’t even really remember them and never learned their name, then MAAAAAYYYYYYBE. But, actually, even in that circumstance, statistically speaking, there’s probably another soulmate for you around somewhere, so maybe go find that other person?

            I do not know one single professional who doesn’t actually read that as, “NOPE.” I suspect that next time they do a big overhaul, it will be.

            Any time a psychologist is leaning on that two year rule, BIG. RED. FLAGS.

      • resili0 said:

        I have worked as a temp in offices that work closely with my mental health providers when I was well and it never sat right with me; it brought a lot of the personal into my professional life (mostly internal mental and emotional conflict.) I got great feedback but the proximity made it harder work than it should have been.

  19. I dont think you can “help” her, LW, shes your psychiatrist not your friend. I know these lines can seem blurry, but she was doing her job by helping you all these years, she wasnt doing you a favour. It would be a kind thing to give her a reason as to why you are leaving, but you need to go.

    All opinions on the internet are the same, of course, but as an FYI I work at a mental health clinic and one of my jobs is to match people to mental health providers. This story actually had me saying “oh god no” out loud a couple of times.

  20. SMK said:

    LW, you sound like a lovely person with a generous and loving heart. You want to help people! That’s fantastic! I suggest channeling your helpful, loving, caring impulses to volunteer work. I’m 100% sure your skills would be appreciated locally at a homeless shelter, animal shelter, food pantry, etc.

    As to your doc … run/roll/crawl away, ASAP. As a life long mental health patient myself, get out now. This is not just a little garbage can fire, this is a house fire, and the sooner you can get out, the safer you will be. Call the authorities because you cannot fight this fire or save the people inside. Get out now, please.

  21. Anne said:

    You need to “NOPE” right out of this situation as soon as you can arrange for it! As a mental health professional my shoulders are up around my ears and my professional instincts/training is screaming. Your psychiatrist helped you a lot in the past and may be a lovely person but her reasoning/judgement looks seriously impaired right now. I’m sincerely worried for the well-being of you and her other patients! How can she safely prescribe treatment/mind-altering drugs when she seems so ill herself? The kindest thing you can do for her is notify her licensing board about her condition; psychiatrists with impaired judgement can seriously harm/kill a patient by accident, which I’m sure the lovely woman you’ve known would never want.

    To contact medical licensing boards in the US, visit:
    http://www.ama-assn.org/ama/pub/education-careers/becoming-physician/medical-licensure/state-medical-boards.page

    For the UK and crown dependencies:
    http://www.gmc-uk.org/doctors/licensing.asp

    For Australia:
    http://www.medicalboard.gov.au/

    Whatever you do, remember to take care of yourself! Licensing boards are set up to help in situations just like this; you don’t have to shoulder the burden alone.

  22. robotneedslove said:

    With all respect to the Captain, I would call this behaviour WAY past “odd”. This is completely Not Ok.

    OP, how scary and hard. I agree with everyone who is saying to extricate yourself from Ihis situation immediately. 100%. Like, you never have to speak to this person again, if you don’t want to. You should certainly take a break. You are vulnerable, and while she may be too, she needs help from someone other than you. Also, find new care as soon as possible.

    After you’ve put your own oxygen mask on, so to speak, you can consider what to do next. From my perspective, the only thing to do next would be to contact the relevant agency. Like Carla, above, I’m in Canada, so things may be different where you are. But here, doctors are licensed and regulated by provincial agencies, mostly called “Colleges”. Colleges investigate and deal with complaints. Some are dysfunctional, and some are great, but all are completely used to dealing with professionals who have mental health crises, because it happens All. The. Time. She might get into some “trouble” but trouble she already is in. And also in trouble are the many vulnerable patients who are in her care/employed by her/etc. [I am a lawyer, and part of my practice involves representing health professionals in investigative/disciplinary processes with their Colleges. It’s a scary process, and I would be very upset to be under investigation by my own professional body, but these bodies are necessary for the protection of the public.]

    I don’t think you have an obligation to report, but I honestly think it is your best choice, should you want to intervene.

    Also, remember that you don’t owe your psychiatrist any duty of loyalty in particular. She helped you, because it was her job. Kindness is good, but misplaced protection is not.

    • JenniferP said:

      I really appreciate perspective from pros in this field! The licensing agencies are there for precisely this reason and I have reconsidered my reluctance to recommend that step to the LW.

  23. hummingbear said:

    I honestly assumed when I first read this question that the Captain had returned to giving advice to fictional TV characters, as this sounds eerily similar to a plotline from “Unbreakable Kimmy Schmidt.” At any rate, the point of that plotline is that the crossing of personal boundaries involved in having a patient working for you is so unacceptable that it’s comedy gold.

    • JenniferP said:

      I didn’t watch the second season, how strange!

    • cruelmistress said:

      That’s exactly what I thought of, too, but I couldn’t think of a way to phrase the connection that would help the LW. You did well.

  24. Katamari said:

    Another thing that LW could consider is making a call to the relevant ethics board to ask for advice, i.e. describe the situation in general terms (not giving the therapist’s details) and ask their opinion about what to do and how severe an ethics violation it is. Not sure how helpful it will be, but you won’t have lost anything by trying.

  25. BEES.

    BEES BEES BEES.

    And probably some missing stairs too.

    • Kat said:

      ALL THE MISSING STAIRS. Like, it’s just an open hole in the floor at this point. It seems like all the doctor’s patients are stepping around it very carefully and pretending it doesn’t exist, but eventually, someone is going to fall down it (and perhaps we could argue that someone already has, although I realize I’m mixing metaphors here…).

  26. Chessie said:

    Yes to everything the Captain said. This all seems super sketchy and very not okay, and I completely agree that you should prioritize cutting ties with this person and finding care elsewhere.

    However, after you’ve got your bases covered regarding your own needs and safety, one other thing you might think about doing (apart from contacting some kind of local ethics board) would be to see if you can think of anyone you happen to know in your doctor’s personal life or family who seems trustworthy and who might be able to check in on her. What I’m thinking is that if you do happen know some of her friends or family members, and they seem like good people, you might reach out to one or two of those folks and let them know that she’s seemed not herself lately and that you’re worried about her.

    Though of course if anything about that feels unwise to you, please please please heed that worry! I don’t know your doctor, I don’t know her friends or her family, and you are the expert on this situation.

    Good luck!

    • Karyn said:

      I would advise against speaking to someone in the doctor’s personal sphere. That’s getting into game-of-telephone territory. Say something to the doctor herself, or don’t. File something with the state or local board, or don’t. But hazy warnings to people you’re not sure of doesn’t sound productive or helpful.

      • JenniferP said:

        SECONDED. The point is for the Letter Writer to disengage from the situation, not get more enmeshed in trying to fix it.

    • JenniferP said:

      I strongly disagree with this. Talk to a professional board/directly to doctor or leave it alone. Do not interfere in the doctor’s personal life or get further enmeshed in the situation.

  27. Nopetopus Cowgirl said:

    Um. It’s rare that I don’t agree with the good captain but this is one of those times. Your psychiatrist is vulnerable in some ways, no doubt, but she is also powerful. She is prescribing meds and is responsible for the lives of very vulnerable people struggling with mental illness.

    This is an awesome responsibility and one she is clearly not up to at the moment. At all. As in, her mental illness, dementia, addiction or whatever is ailing her is extremely dangerous to her patients.

    If you loved, respected and had reason to be extremely grateful to someone who was losing their sight, didn’t realize it, and continuing to drive, would you feel that reporting them was overkill? How would you feel if they drove everyday on the street where your kids play?

    Reporting her to her medical licensing body now is the right thing to do. If her problem is one that can be remedied, she will likely be allowed to practice again once she is fit. IMHO this is urgent and imperative. You don’t have to be a sexual predator to be unfit to practice. We should be able to expect competence from our medical practitioners.

    • TO_Ont said:

      I also wonder if the LW is the only patient who is getting garbled, ‘scary’ texts. I am imagining someone schizophrenic, or suicidal, getting similar disturbing senseless texts, from someone they trust to help them stay grounded in reality, or heal in whatever way.

      Even besides things like prescribing mind-altering medication (some of which can have very serious side effects) and deciding treatment on painful or even life threatening conditions (suicidal depression, anorexia, etc), the behaviour itself may be harmful to some of her patients.

      So I would be in favour of reporting this doctor to their professional board if at all possible.

    • aebhel said:

      This. This is a doctor who is practicing medicine and is clearly not capable of doing so in a responsible or competent manner. She could easily hurt or even kill someone in her current state. There’s a reason there are medical licensing bodies out there, and this is exactly that reason.

  28. apricity said:

    LW, sometimes it’s okay to judge someone, as in, “excercising your good judgement”. You have correctly identified that the situation is not going well and that it’s contributing to your anxiety. You can have compassion and yet still decide that the situation is not right. “I don’t want to judge” is better for situations like “My therapist has a visible tattoo but I will see whether her therapy style works well for me as the main deciding factor” or “This person owns a cat but I will only hang out with people who like dogs”, or something like that. I hope those examples help in your framing of the situation.

    • Kat said:

      Yes yes yes. “I don’t want to judge” can unfortunately be taken to a dangerous extreme — Geek Social Fallacy #2 comes to mind here. We can and should be “judgy” as hell when someone’s odd behavior is actively harmful to themselves or others.

      • apricity said:

        It’s a bit of practice to get the hang of excercising your judgement without being judgey but the good things is that you get better with practice.

  29. Angiportus said:

    Everything said here so far makes sense. I have not encountered quite the same situation, but I ran into a dodgy school counselor about 30 years back and it was just lucky for me that I had the confidence, and the encouragement from others, to make couch stuffing out of him.
    He was originally supposed to help me find help for math difficulties, but when that issue was helped, I went to him regularly just to chat (I’m introverted and sometimes short on friends.) It was included in the cost of my tuition so why not? He took me out to breakfast a couple of times and I didn’t think anything could go wrong here.
    Well, I was wrong. He got curious about my writing hobby so I let him read some fiction I’d done, a short piece. And what does he do but start finding Fraudian symbolism in it. The sort of thing that was supposed to be sexual but sounds actually more like violence, and which I can’t stand. [It was a dramatic scene but no one was hurt or molested.] I told him that was crap, but he started talking about my subconscious supposedly showing thru. I don’t think anyone else knows what’s in my subconscious any more than I do, and said as much. We went round and round and I left feeling like I’d been run over by a sewage truck. Gaslighting, is what it was.
    But next week I had done some thinking and was ready. We went round and round again and this time I countered him well, using logic. He gave up and said we should just drop the subject. I said okay and for a long time things were all right, it seemed.
    But then, some time later, he brings it up again, out of the blue, in a sort of joking manner that once again creeped me the hell out. I called him on it and said it was unprofessional but he didn’t agree. He took on an air of aggrieved innocence that should have got him an Oscar. I said we are thru. But I was worried about other students who might be more vulnerable than me, and who might be messed up by him handing them outdated and senseless theories. So I went over his head, to some higher up people on the counseling staff at the school. The denouement was, the head cheese had us both in her office to state our cases. He just seemed confused, still, but I laid it all out that I thought this sort of thing could be damaging to students, besides making no sense, and it needed to stop. Well, by the time I was done, he looked small enough to put into a shoebox, but he might have learned his lesson. Anyway, the head thanked me, saying some other students had had similar problems with other counselors and something would be done. I don’t know what, the thing never made the school paper or anything and I had had enough of counseling for a while. But I decided it was not a good idea to have a counselor take the role of a friend. And hearing some new opinions/theories is one thing, but not when they are just crap.
    I was lucky, there. You and some others here are/were in a more serious situation and I hope that you will find a way out and be safe and well.

    • Angiportus: Wow. Your teenage self sounds awesome beyond awesome!

      • winter said:

        Even though I find it quite shitty they called both of them in at the same time. How is that not intimidating for most teenagers (also most adults)?

    • MuddieMae said:

      “Fraudian”

      I love this alternative spelling.

      • Angiportus said:

        Thanks, but I was actually in my later 20’s at a community college. And I felt like the dept. head was on my side, that really helped. Some friends sympathized as well. But it’s damn creepy to have someone try and rape your MIND. People that claim to know more about me than I do, I don’t have time for. Counseling could help for specific problems, sometimes. But no potty-minds!

  30. EC said:

    “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.”

    This is extremely interesting to know.

    Background: I was sent to the EAP (employee assistance program) at work due to a situation I screwed up — basically, I had shitty boundaries and got inappropriately emotional, and my boss requiring that I go there was 110% justified. However, the counselor they referred me to started off our counseling relationship by, when I attempted to see if we could work out a different time for our second appointment, immediately threatening to notify my employer that I was noncompliant. Later, when our five sessions were up, she didn’t give me a chance to say no to doing further therapy with her, and when I hesitated she said, “They ~do~ pay you enough there, right?” When I went on vacation, she drilled me about why I wasn’t able to make the appointment (I was going to be in a #$%#$ airport at the time she wanted me to come in). Another time she literally yelled at me, full-throated, on the phone, and I decided I was just done. So I called the EAP and asked if, under the circumstances, I could see my regular counselor instead (who predated the EAP situation) instead, and they authorized that.

    I went in for my final appointment and asked her if the EAP had talked to her, she said yes, I said, “So they told you this will be our final appointment, then?” Obviously, this wasn’t nearly as professional as the Captain’s script above, so I understand where I bear fault in this too. But she immediately went off on me with, “What is so TERRIBLE about the care you have received in this office that you would do this?” and spent the next hour berating me, telling me I didn’t know how therapy worked, that I just wanted to get out of doing therapy with someone who would hold me to my commitments, accused me of blaming her for my problems (for the record, I had said not one negative thing to her about anything she had done), and accused me of trying to get out of paying (which I found really freaking offensive, seeing as how I had come with checkbook in hand).

    My family, my friends, my regular counselor, have all assured me that this woman was awful, and yeah, she obviously was, but I guess it helps to see it spelled out in public by someone who should know that chewing someone out when they terminate a counseling relationship is officially recognized as not OK. Because even though I know better, I still second-guess myself a lot and just… yeah, I think I’m going to end this right here. But thanks for making this clear, Captain.

    • Emily said:

      Yes! I want to reinforce what EC said and give LW a heads up that they may get a LOT of pushback from this psychiatrist upon terminating care, but that it’s still ABSOLUTELY A GREAT IDEA to terminate care with this particular practitioner.

      I broke up with a psychiatrist once–one who was not as troubled as yours is–and was shocked by how unprofessional his response was. He questioned my decision and said that I would never improve myself without his care.

      I told my mom about it (she’s an MD) and she kind of made it sound like psychiatrists are known for this within the medical community. Which of course sounds like members of one medical speciality making generalizations about members of another, but it’s another data point for you.

      • Admission Note said:

        Must chime in as that matches the most recent experience I had on leaving a PhD. Both he, and the LCSW who’d preceded him (and who had insisted I address her as “Doctor” before suddenly hugging me without permission, because She thought “I looked like I needed a hug!”) had been listed on an American mental health magazine’s web referral index.

        Disgusted, and a bit frightened at the case two practitioners could build against me if I complained, I’d concluded that I was OK just as I stand, and was strong in my broken places. I went back to journaling and this here Captain.

        But I think my problem was compounded at how I’d met these people. My experience with MH people essentially soliciting online prompts me to conclude- it’s not a valid resource to find qualified help.

        • Mary said:

          Oh, this.

          When I went into counselling I needed to find someone. Ideally close to work, took my insurance, and who regularly dealt with smart women (the first dude I visited said that from my call he thought I’d be a “neurotic office lady” instead of an engineer faced with enough sexism I was about to murder someone). So I asked my friends what they did – not who they saw – and they said:

          “Hey, why don’t you call [college] mental health and see who they work with/recommend?”

          And I did. And my current therapist has never implied that the problems I’m having are because I “won’t acknowledge that my (male) co-workers know more than I do.”

          • Brooks said:

            That’s how I ended up with my first excellent therapist as well. Though that was luck rather than cleverness on my part, as I was a student and so that was the obvious thing to do once it became apparent that the handful of sessions with the college counselors wasn’t enough.

            Also it seems that good therapists know other good ones, and if you have a friend with a good one, they may be able to offer useful referrals.

      • Ess in Tee said:

        (Apologies – this has become a bit of a rant)

        I had a psychologist who did the same thing. He pressured me into an appointment I didn’t want (“What time will you come in next?” “Well, I’ll have to think about that….” “WHAT TIME WILL YOU COME IN NEXT”) and, upon getting home, I realized I had just spent a whole bunch of money on an hour of being interrupted, talked down to, and having my intelligence insulted.

        My personal “favourite” bit of the hour was the fact that he bodyshamed me for considering going back on meds. He said, and I quote, “aren’t you worried they might make your chubby?” I tried to ignore this, but he literally kept asking the question over and over until I snapped and told him I was quite happy to buy new pants if it meant improving my mental state. He didn’t seem happy with this.

        Upon getting home, and telling my partner how awful going to him has made me feel, I sent him an email canceling my unwanted appointment telling him I was going to go with someone else. He emailed me and told me he could set me up with one of his colleagues. I declined, saying I would prefer to talk to a counselor. He emailed me again to tell me he thought I needed meds (indeed, he began pushing them on me not fifteen minutes into the session, despite his horror at the idea of me becoming OH NOOO! “chubby”), and that . Annoyed with this, I sent an angry email telling him that my future treatment was none of his concern and that I would not be using any service he suggested. He then called me at my home and laid into me in the most passive aggressive, shitty way possible. I had him on speakerphone and my partner was furious. Finally I cut the guy off and told him that the reason I would not be going to him was that he was unprofessional and overbearing and I did not want anything to do with him. And then I hung up. Cue ANOTHER email from him saying I was in denial about being depressed (despite seeing him because I know I have depression) and that I needed his services. I sent one last email telling him never to contact me again.

        He ended up contacting me again. Someone on Reddit made a post with his full name and I commented. The good doctor assumed I had written the original post (I didn’t) and this was an eeeevil scheme to play up his competition (who are really quite good) and accused me of “cyberstalking” and “bullying” him. The last bit is hilarious, in that he was the one emailing me over and over, despite me telling him again and again to leave me alone. It took three exchanges to get it through his head that it wasn’t me who posted it, and that the post had been deleted anyway because it had used his full name. He tried to get me to delete my comments, since it’s still accessible if you have the link. To date, I have not nor will I. And every thread that comes up that mentions him, I make a point of telling people what happened. I still get messages from people who have found the threads that mention him, saying “I thought it was just me!” There are so many people who have had terrible experiences with this guy, it’s incredible. And, thanks to him acting like a nuisance on the threads himself, the mods decided that he’s a public persona, meaning he’s fair game to be posted about.

        (Man, that felt good to get out.)

        • BigdogLittlecat said:

          Wow. If anyone needs to be reported to the oversight board, it’s that bozo! That kind of behavior should be slammed by the board.
          Glad you got away from the jerk.

        • How is this person still practicing? Gahhhhhh.

        • CommanderBanana said:

          Wow, that is terrible!

          I have had some bad experiences with therapists, including one scam artist who charged me $100 for an “evaluation” and bullshit “referrals” that were just a Xeroxed piece of paper with a handful of doctors’ names, all of which I could have found online and several of whom were no longer even taking patients/practicing.

          I did call her afterwards and scream at her, which felt really good and I think was justified. She’s a monster, preying on and ripping off people who are hurting.

      • monologue said:

        I have this issue just with scheduling appointments. I’m a student so my psychiatrist thinks of me as ‘flexible’ and schedules me pm whenever the fuck she wants. I do have some regular seminars I can’t miss though, and she’s forever trying to get me to come in at times I can’t make it. Whenever she has to rhyme off 3-4 times before we can find one that works, she starts getting exasperated. One time she actually said, “I thought you were flexible.” I’m fine with not meeting every week if the scheduling doesn’t work, so this really annoys me and feels unfair. I think she must have a personal guilt thing about not being able to see each patient each week or something, like she feels like she needs to do that so if she can’t she feels bad and turns that stress on the patients. Because from my side, I legit don’t care, it’s cheaper for me and easier on my schedule if we skip a week here and there. Anyway, it’s unprofessional and annoying. I basically only still see her because she costs 15% of what my former amazing psychologist did due to help from government coverage.

        • BigdogLittlecat said:

          Giving your psychiatrist a long distance side-eye for you.

    • Oh, boy, EC, I’m so sorry to hear that and so angry on your behalf. You did *nothing* wrong there and your script at the last session was perfectly appropriate. (Also – even if it hadn’t been, it was literally not your job to be professional in that situation. She was the one who was practicing her profession in that office!) That woman should not be a counsellor and I hope she no longer is.

      • EC said:

        Aw, thank you — that is very kind.

        Sadly, she is still a counselor and still advertises in a popular psychology magazine, claiming that her philosophy as a counselor is that the patient is the expert of their own life.

        • BigdogLittlecat said:

          I don’t even know what state she’s in and she’s a bitch eating crackers.

          So glad you got away from her. Jedi hugs.

    • BigdogLittlecat said:

      Holy ****! That “counselor” has no business being in the business. Aside from being so far off appropriate professional standards that she can’t see them with a telescope, what a terrible person. A walking sack of angry bees cannot help anyone.

  31. song of storms said:

    This is how I see it: you and/or your insurance are paying your psychiatrist to help you with your mental health. But it seems that she is currently detrimental to your mental health instead, what with asking you to do perform a job that she knows burnt you out and sending you accusatory texts(!). This means that she is not doing what you are paying her for, and so it is entirely appropriate to terminate your relationship.

    That may sound cold, but really, although you may like each other, you are not friends. This is her job.

    As an analogy, let’s say you have a leaky faucet and you call in a plumber to fix it. The plumber is very nice and friendly and they’ve done a good job on your pipes in the past. But this time when they try to fix your faucet, not only do they actually make the leak worse, but they also leave a big gouge in your wall with their tools. You know they probably meant well and tried their best, but it looks like plumbing is something they’re struggling to do properly right now. Will you keep hiring this plumber? You wouldn’t, right? Even though you like them as a person, you don’t want them anywhere near your pipes anymore.

    It’s the same with your psychiatrist. You may like her as a person, but she’s not providing you with the service you’re paying her for, so it’s best to part ways.

    Yes, it’s sad that the reason for her behavior may have to do with her own mental health, but there is nothing you can do about that. You are not her mental health provider – it’s exactly the other way around! You cannot help her by continuing to be her client and suffer her strange and borderline-abusive behavior. That wouldn’t be good for either of you, so it’s best to leave.

  32. neverjaunty said:

    LW, from your letter it sounds as though you may feel you ‘owe’ your therapist for being there for you when things are bad, or that you have guilt about possibly walking away from her. Please keep strongly in mind that helping you was literally her profession. You paid her to do this, or somebody paid her on your behalf. You owe her no emotional or moral debt of any kind. If she has told you that you do, she’s 1) lying and 2) very very dangerous.

  33. vass said:

    Not to alarm you, but… is it possible she’s already lost her right to practise? The fact that she’s running this out of her own home (which is somewhat common for counselors and psychotherapists and psychologists, although usually they set it up so the patient area isn’t near the rest of the house, but as far as I know nearly unheard of for psychiatrists) and that there’s no more regular administration staff and she’s getting clients to work for her and she sounds like she’s not managing her mental illness well enough to be practising… it makes me wonder whether maybe she already got disciplined by her board and instead of meeting their conditions for keeping her license/registration/affiliation, she’s trying to go underground. She wouldn’t be the first medical professional to do that.

    Psychologists and psychiatrists both have to jump through a number of administrative hoops (different ones for psychologists vs psychiatrists and other medical doctors) to keep practising. It’s not just a thing where once you’re qualified you keep that qualification until you retire or get kicked out. You have to keep paying dues and having professional insurance and doing continuing education modules and seeing a supervisor (a psych professional who gives therapy for psych professionals about being a psych professional.) Like how if you have a driver’s license you have to keep renewing that regularly or you’re not legally allowed to drive. She may have… let hers lapse.

    Whether or not that’s the case, definitely talk to her licensing board/registration board/college of physicians/whatever auspicing organisation applies for her profession in your area. No need to be guilty about it: they don’t want to drive her out of the profession, and they will give her every chance to fix things so she can keep working. If she’s mentally ill and it’s not managed, they’ll tell her she has to get treatment before she sees clients again. And if she keeps seeing clients without meeting their restrictions (or if that’s already happened) then depending where you are that’s a misdemeanor or a felony.

    • Gertrude is Gertrude is Gertrude said:

      I came to say just this. practicing out of her home I wouldn’t see as a bad sign, especially since it sounds like that is not a new development, but having patients run the admin aspects of her practice? Where did the usual people go? Why hasn’t she hired other usual people, in the usual manner? If she’s hiring patients (people she has power over) for this, it’s either because she can’t get anyone else, or because she *wants* her staff to be people she has inordinate power over. One of those is worse, but they’re both terrible.

  34. Frost said:

    Wooow, this isn’t just a red flag, it’s an entire parade. That is NOT the way a psychiatrist should behave, especially not to a patient. You should report her, and find someone else to handle your mental health pronto. That is unacceptable, and puts you in a situation that is honestly dangerous. Report, report, report.

  35. Admission Note said:

    A caveat on reporting- you may not be believed. I was a voluntary inpatient who was menanced by a male patient. When I said I was leaving, the psych changed my status to Involuntary, something that life insurance companies may now deny me coverage for.

    Once out, I wanted to file a complaint and learned that she could have me recommitted- as she’d be believed, over me.

    • MuddieMae said:

      Did you learn that from her, by chance? I wonder if she was trying to discourage you from reporting, as “filing a complaint” doesn’t generally meet the bar for involuntary commitment in the US. (Not to say people are never committed unjustly, but this would be a huge stretch for a judge.)

    • Also – what the holy fuck is this with insurance companies not paying for an involuntary admission? Shit, every time I think I’ve plumbed the depths of the scummery of insurance companies in the US health system I hear something worse.

      • Admission Note said:

        Ooh, let me clarify- the voluntary admission, covered by medical insurance as was her slash change to involuntary… The insurance I was warned I’d be turned down for, was Life Insurance. The salesman started hemming and hawing, then said he’d need all my psych records… OK, go back to throwing rocks; I really doubt they are HIPA compliant.

  36. zaracat said:

    Hi LW, I am a medical practitioner in Australia, so some things I say won’t necessarily apply to your situation.

    Here, the only absolute prohibition for psychiatrists and most other mental health professionals is against sexual relationships with current or former patients (EVER). As far as other dual relationships, pretty much the same rules as for counsellors that the Captain outlined – avoid like the plague, discuss and supervise and document if it absolutely can’t be avoided. The sort of situation where it might be genuinely unavoidable is a remote rural town where the psychiatrist is treating the bank manager, or their child’s teacher etc.

    As far as reporting, if a registered health professional (eg nurse, doctor, psychologist) believes another practitioner is impaired and that this might affect the safety of patients or general public they have a mandatory duty to report to the registration board. If a practitioner is impaired but voluntarily restricts their clinical activities to work within those limitations, another practitioner can voluntarily report them but isn’t mandated to do so. (The advice for them is usually to discuss the matter with their medical defence insurer first). A patient or member of the public could make a report to the board, and could phrase it as a “concern” rather than a “complaint”, or could make a complaint to the Health Ombudsman, which would then be forwarded to the relevant board.

    Reporting of impairment initiates an investigation, but unless someone has been harmed, it’s really all about putting a management plan in place that includes getting the impaired practitioner appropriate help and putting suitable (usually temporary) work restrictions and ongoing monitoring in place, and not about “punishing” the impaired practitioner (although it may not seem that way to them).

    There is only legal power behind this process in the case of practitioners regulated by a registration board, if a crime has been committed, or you want to take civil action (sue them). If someone is an unregistered counsellor or life coach or whatever, you have very little redress unless someone has been harmed.

    In LW’s case, it doesn’t sound as if the dual relationship is unavoidable. I agree with what everyone else has written about doing administrative work for your current or former psychiatrist being a really bad idea even if there were no rules against it, and for the reasons they’re giving. I would strongly recommend reporting your concerns to the medical licensing board either directly or via another health practitioner and including whatever documentation you have – it doesn’t have to be phrased as a complaint unless you want to make it so.

    • zaracat said:

      Meant to add – as someone who is also a patient of a psychiatrist and a therapist, I fully understand that even if there is NO pressure whatsoever from your psychiatrist, the attachment that develops within the relationship means you might feel a sense of obligation to him/her or guilt at the thought of taking the action you need to (leaving, finding another practitioner, reporting). If you have been seeing them a long time or had severe problems, or the sort of history that leads to attachment problems (such as trauma), these feelings may be very strong. This is completely normal, but please don’t let it stop you doing what is best for you. These feelings will almost certainly need to be discussed and worked through with your new psychiatrist.

  37. Admission Note said:

    I once did some actual, not-a-patient admin work for a therapist who’d gone back to work following an illness. She was owed thousands in unsubmitted insurance billings, and as I worked trying to reconcile dozens of files, as a very good sight-reader I injested some of her case notes.

    No way in hell should any patient “helping out” have access to this information. Not without training.I fought to unsee those terrible stories. For someone who may be in an acute point in their own therapy? Beyond the pale to expose them to that.

  38. Admission Note said:

    Regarding Captain’s suggestion to list with a temp agency- I’ve done this at three different points in my decades-long working history. Each time, I learned my skills were both transferable and had monetary worth. Once the agent I worked under saw that I understood my role, they opened new doors for me. It was a revelation. And I was offered permanent work at several companies, even though I’d felt shy and out of my depth.

    Having your business “friend” on the inside, calling you with places you can go to work at Today, is way, way better for the head than submitting resumes. There are general, “starter-job” agencies, and ones who specialize in fields like medical and IT. I met skilled friendly people who helped me get a re-start. Can’t recommend highly enough.

  39. Admission Note said:

    PS: LW, you say the text messages scare you and seem like more of a police matter.

    You’ve seen these, we haven’t; I believe you.

    Part of what police judge a threat on, is if it is possible for the threat to be acted on. “Assault” and “Battery” in the US, can cover a lot of behavior. The law is there to support you, and you may find you want to investigate your options to protect your safety.

  40. resili0 said:

    I am a peer mental health worker and so my work environment and role is based on equal and reciprocal status for me and the people I work with (patients.) It is a relatively new territory where the old hierarchy of ‘I am doing care at you because I am a qualified professional and you are a patient’ is shifted.’ I have also worked with some amazing professionals and been a patient – not simultaneously.

    Even in the place I work at; the emphasis is on what serves the person I am working with. So even if I have a job that needs doing, even if the person has a reason to offer to help, my job is to facilitate the person so they can do what will keep them from harm and keep them well. My needs and judgments are not their responsibility. Reciprocity is about being willing to respect each others contributions AND boundaries. So sometimes I will have an honest conversation about why we have a formal volunteer process that protects our people vs letting someone do admin who I know would be better off finding a more suitable place. I am mindful that a person might feel unworthy of support and try to earn that by helping. Lines get blurry if I take advantage of that. A burn out or spending two years working on wellness is a clue to me that my role would be a sounding board for you to think about what would move you on.

    The letter you write conveys a sense of stress and feeling responsible for making this situation work. It’s ok to take on a job and realise it is not right for you. I know you’be invested in the admin work and after a bad work trauma a couple of years ago, you might be wanting to make a go of this.

    May I suggest that actually, knowing your capabilities and responsibilities are owed to your wellness not your psychiatrists, that’s a sign you are smart?

    May I suggest that your compassion for your psychiatrist is a good trait you could value even if you do walk away/report her?

    You are allowed to let others deal with their problems. Your psychiatrist, her other staff, her patients, you are not responsible for them.

  41. resili0 said:

    It also occurred to me that that if/when psychiatrist gets it together, they will have to work through the emotional fallout of the bad choices they have made. It would be a kindness to consider that the longer you try to cover for them, the longer they go without help and the more they have to look back on with regret. By passing this onto to a board who can intervene, you’ll be saving your psychiatrist a lot of embarrassment and regret (if they are ill.)

  42. Best Turkey said:

    In all honesty, when I read the letter my instinctual, gut feeling response is “Oh shit, this is how cults get started.”

    That may well be completely unfair on my part and I can totally see how LW’s psychiatrist may be going through all sorts of stuff of their own right now and have no malicious intent whatsoever. But there’s a whole slew of red flags here which would be a bit of a problem on their own but add up to a really huge problem when you string them together:

    – The purging of the old staff, which it sounds like from the letter was very sudden. It is, of course, entirely possible that LW’s psychiatrist didn’t fire the staff, but that they quit of their own accord, but when everyone working for a practitioner in any field up stakes and quits that’s kind of a red flag in and of itself.

    – Replacing the old staff with patients, massively problematic for all the reasons raised so far.

    – Starting to intrude in LW’s life in odd ways, with all these text messages.

    – Abruptly changing their demeanour towards LW, showing a more aggressive side of their personality which scares LW.

    I’m even side-eyeing the whole “I come to the house at an arranged time and she wasn’t even dressed” deal, which may 100% be a “I’m in some sort of personal difficulty and I am having trouble keeping my schedule straight/taking care of myself” thing but also seriously comes across as a “I’ma going to establish this reeeeeeeeal inappropriate level of familiarity where I can basically not be properly dressed in the slightest in front of you, that’s how our professional relationship is gonna be” sort of thing.

    I’m not saying people are wrong to worry about the psychiatrist’s own well-being. There is nothing incompatible with on the one hand being in genuine personal distress and on the other hand behaving unethically towards people. But at the same time I can’t look at the facts outlined in the letter and *not* see a really alarming pattern of inappropriate and unethical behaviour which, even if it isn’t intentionally abusive, certainly sounds like it could turn abusive at any time (if it hasn’t already with those scary, nasty texts).

    So I think LW needs to disengage, see to their own care, and make some distance as soon as possible. Even if it’s just a 100% innocent personal breakdown and nothing bad is going to happen, LW still can’t be her psychiatrist’s psychiatrist (or therapist, or sounding board, or whatever), that just isn’t how that relationship works.

  43. Ookling said:

    Dear LW
    Hi! I’ve been going to a therapist for about nine years now. And iwhen ones been really open, vulnerable in front of someone else, to have some kind of closeness develops.

    But my therapist constantly reminds me that she is my therapist. I pay her for that. I pay her to point out to me when the dynamics of the situation shift in ways that are a bit not good for me. (Transference. It’s a thing for me.)

    One of the things you’re paying your therapist for is to be a professional- to keep her mental health issues (we’ve all got some) pointed away from you. She is not doing that. Not at all. This has the potential to be enormously damaging to both of you.

    You don’t owe her silence. You don’t owe her office work, you don’t owe accepting her weird and scary texts.

    You may feel you do owe her something, but if you do, what you owe her is walking away. Fast.

    You may owe her reporting your concerns to relevant authorities- that is for you to decide. But you don’t owe her anything that makes you scared, stressed or uncomfortable.

  44. Caroline said:

    Specifically on the matter of texting with your psychiatrist, this is no bueno. Texts and emails are a much less secure form of communication than traditional phone calls. Should it ever come up, your text and email communications with your psychiatrist could be subject to subpoena. For this reason many practices these days have very specific policies regarding the forms of communication they use with patients and ask that you limit text and email communications to very specific matters such as “I’m running late” or “can we switch my time on Thursday.” LW, you must look to your own privacy!

  45. This sounds way outside the ethical code boundaries. A mental health professional should never be in a dual relationship where someone is an employee and a client at the same time. My guess is this person is at risk of being sued and potentially could lose their license to practice. It also suggests that there might be some abuse of power potential if they’re even willing to put a client under their authority as an employee. This person shouldn’t be practicing right now, and their client would do well to get another psychiatrist and report this one because it could do a lot of damage to mix such volatile power dynamics as mental health professional and boss together.

  46. AltoFronto said:

    LW, I am sorry that your psychiatrist is no longer able to help you. You need to find a new psychiatrist, immediately, and sever your relationship with the psych who is the subject of your letter. SEVER. IT. NOW.

    What your current shrink is doing is not appropriate, not ethical, and not really safe for you or her other patients. Whether she has underlying problems of her own, it is NOT your role to figure that out, and you must only refer this issue through professional channels. I advise that for YOUR wellbeing, for HER wellbeing and for the wellbeing of her other patients.

    Remember: You have literally already paid her for all the help she has given you. That is the entire extent of your relationship, there should be no other context to your interactions. As long as you have paid all fees due for the professional sessions, you owe her nothing. It is not your role to “help” her by becoming more entangled in her problems.

    I would use The Captain’s script to break off your professional relationship. Keep it short and to the point, and make it clear that you are no longer in communication with her either professionally or personally going forward.
    You may feel that it’s fair to approach her and to cite her behaviour and your concerns about her practices as the reason for your break-up, but I would AVOID saying this to her, even if she presses you, ESPECIALLY if she has been in any way accusatory or abusive towards you.

    Especially as you are going to report her to her professional body. I say “you are going to”, because her behaviour is SO alarming that I think you really must. This is the only thing that you can or should do to help your psychiatrist and her patients.

    I strongly recommend that you act as a whistleblower, because her actions would probably be described as “serious miscunduct”. Points 1-4 are all HUGE breaches of ethics.

    1. She has employed patients, which conflicts with her relationship as their psychiatrist. This is not even remotely ok.
    2. The work she is paying patients to do involves handling sensitive data about other patients.
    3. She is contacting you with inappropriate and “scary” messages.
    4. She has continued to contact you with inappropriate messages despite your saying that they scare you.
    5. These messages make you think that police should be involved (!)
    6. She has stopped maintaining a professional schedule and appearance. This is a smaller red flag compared to the boundaries she has already overstepped, but leads me into the next point:
    6. She may be going through some personal stuff that makes her behaviour unpredictable, and means that she is NOT in a fit state to be seeing patients right now.

    You’re a kind-hearted person and you understand that she is probably dealing with some rough times right now. It is not your business to speculate on what that underlying problem is. It is not your business to maintain any kind of contact with her, or anyone else in her personal sphere. It is your business to report your concerns to the appropriate professional body, and any organization that she is officially accredited with.

    She needs to not be practicing for a while. This is to safeguard her patients, and to safeguard her own wellbeing.

    Document all the weird text messages, if you can, and offer them as evidence when you make your report to the General Medical Council (UK) or whatever is your country’s equivalent accredited body.* The APA suggests that you should submit your concern to your local or state regulatory oranization. -> Handy Contact List I’m not sure if Psychiatrists are regulated under a different body to Psychologists, but hopefully whoever picks up the phone would be able to give you good advice on how to report your concerns.

    * Do not be fooled into reporting to the Citizen’s Commission on Human Rights, which is the first link I came across when trying to Google this. – They are an organization run by Scientologists, and not an appropriate accredited body.

    If the content of what she has disclosed to you makes you think that police involvement is needed (as in, she is committing a crime that poses immediate and serious harm to others), then I think you should trust your gut, but without knowing exactly what that content was, I can’t advise you either way. I’d consider police involvement as an emergency-only measure in the kind of situation that is a) dire, and b) that the above channels could not respond to quickly or strongly enough, e.g. if your psychiatrist were actively abusing patients physically or sexually.
    If your concerns are confined to her professional conduct listed above, and she doesn’t pose a serious and immediate risk of harm to others, then I would hesitate to call the cops, but do seek advice on this when you contact the regulatory body.

    This is a big, scary issue to have to deal with, LW, so I want you to remember your self-care. Once you have ended your relationship with your psych, and filed your report, that is the point at which you have done all you can do, and you should take deep breaths and try to forget it all.
    I wish you every success in your relationship with a new psychiatrist, and in finding work that suits you, and in generally moving your life forward in health and wellbing. Your desire to help others is to your credit, but remember to prioritise your emotional, physical and mental health first. We’re all rooting for you.

    • Duly Concerned said:

      This is purely speculative and I can see no evidence to support this possibility in what the LW wrote but I think there is a fair chance that psychiatrist in question is making overt or covert references to suicide.

      Mulling it over, that’s one possible explanation for a situation where a person is receiving text messages that simultaneously seem accusatory, scary and as though police involvement may be necessary but is still concerned and questioning whether severing the relationship is the right step to take.

      I think if the LW knew the psychiatrist were physically or sexually abusing other patients, the LW would not have any hesitation about what to do.

      • Elsajeni said:

        My speculative interpretation was that the texts might be about scary things that are happening (or that the psychiatrist believes are happening) TO the psychiatrist — that she’s accusing the LW of something like stealing from her, stalking her, or sending her threatening messages. That’s another thing that’s obviously scary and seems like police involvement might be called for (if she’s really being stalked or targeted in some way), but also might leave the LW concerned about the psychiatrist’s well-being and feeling like she shouldn’t “abandon” her (if she’s in a serious mental health crisis and perceiving stalking or threats that aren’t really happening).

        • JenniferP said:

          This was my read on the situation.

        • AltoFronto said:

          That interpretation would make sense, but from what I’ve heard of police, they may or may not be a good port of call for someone in that situation, so I think my point still stands. The LW should probably seek advice from the professional body on whether to call the police, unless the psychiatrist is doing immediate harm to others.
          I don’t know if there are other services that specialise in responding to people in crisis, but I’d personally err on the side of not helping at all over calling in the wrong kind of help. Maybe that’s not the right thing to do.
          Of course, my sense of perspective is almost certainly skewed by the fact that the only interactions between police and the mentally ill that make the news are the ones that go horribly wrong.

          Can we safely assume that the psychiatrist in question is still capable of advocating for herself if she felt she was in danger, or that she has friends and family members who would be in a much better position to decide whether to call the cops than one of her (former) patients?
          I think it would be useful to steer away from the idea that LW is solely responsible for this person’s welfare, and look to other people who would be qualified to intervene on the psychiatrist’s behalf.

          • On the flip side, though, I would probably call the police if someone was making weird threats or accusing me of things like that. A former neighbor of mine had some sort of serious mental health issues, and kept accusing the people in the apartment next to her of spying on her through the television and breaking in to steal stuff while she was asleep. They had to call the police to protect *themselves*, so they could get a restraining order. (They are friends of mine, and I promise, they were not doing any of the things that she accused them of.) We ignored her behavior when it seemed like she was only a danger to herself, and was merely doing strange things.

  47. dreambig said:

    Please take care of yourself first. They didn’t help you out of the goodness of their heart (although this could be part of it), it’s actually their job that you pay them for. You’re not indebted at all. If anything, this psychiatrists seems like a horrible human being and is absolutely shameless.

  48. SmolCactus said:

    Oh golly gosh! Yeah this isn’t okay. I’ve been in therapy before (should probably be in it now) and even if I wasn’t underage, this is a whole Color Guard made entirely of red flags! Red flags carried by EVIL BEES!

    Please get out of there, find a new practitioner, and, if you feel up to it, report your psychiatrist to a professional group.

  49. Francesca Davis said:

    I would contact the medical board. I used to know someone who worked as counselor for an alcohol and drug abuse diversion program for doctors. My understanding is that, even with serious problems, medical boards usually put doctors into programs aimed at helping them rather than punishing them.

    Someone who is suddenly disheveled and sending word-salad texts may have gone off his/her meds and need help getting back on track.

  50. Will I Am said:

    You’re right Jennifer , your psych’s gone off the deep end. My suggestion would be take some of the current patient’s files home with you and thoroughly familiarize yourself with their case(s). Once you’ve done this send something to each of them (on your psych’s letterhead) stating you (as her) are retiring and they may continue treatment with her esteemed colleague (you!!). Close the letter giving your phone number and address, then sit and wait for the phone to ring. I can tell from your letter you most likely have at least as much common sense as the good doctor used to, so why not? Psychiatrists make decent money – so get it while the getting is good and remember it’s all on the DL, so “be careful” is the key phrase. Almost forgot. Grab the script pads and say the (real) doctor will continue writing prescriptions during the “phase-in” period or something to that effect. Be believeable! Practice her signature often. Good luck!
    PS. If you get snagged – DENY, DENY, DENY. It’s the only way…

    Respectfully,
    Bill M.

    • JenniferP said:

      Between this completely bizarre comment and the last one you left, I think your days of commenting at Captain Awkward Dot Com Enterprises are done, Bill M.

      Respectfully,
      Thor descending from on high with his banhammer

  51. thebearpelt said:

    I understand that Captain has changed the advice to encourage contacting a professional board or whatnot to report her behavior. But my concern is how organizations could treat someone who’s multiply oppressed, such as if the psychiatrist is also a woman of color. It sort of rubs me the wrong way that people are simply jumping on the “yes totally report her” bandwagon when, for some people, doing things like that could be detrimental or even deadly.

    • JenniferP said:

      This is one of the reasons I didn’t foreground reporting in the initial answer, and I def. do not support involving the police in any way. The biggest priority, I think, is to get the LW away from this doctor. I don’t think they have an obligation to report things, and I suggest discussing what happens when you do that either anonymously with the relevant board or with a fellow medical professional is a good idea so that the LW can be fully informed.

    • Except, this woman is providing services to people who are mentally ill. She could do a lot of damage to a lot of vulnerable people, and your comment really seems to erase or completely ignore that possibility. Her patients could also be multiply oppressed, with the additional power differential that comes from relying on a service provider for something as critical and personal as mental health services.

      • XtinaS said:

        It remains not the LW’s job to report the therp, and it’s not the LW’s fault if they prioritize their own safety.

      • JenniferP said:

        The LW’s responsibility here is to their OWN mental health and safety. Adding “And you MUST report your (kind doctor who has helped you) for the sake of everyone” is a lot of pressure to add when they are vulnerable and anxious.

        We don’t know what the doctor’s life looks like or what her patient’s lives look like, let’s cut short the “But what if?” speculations and focus on this LW, today, here.

  52. Seconding The Captain wholeheartedly. Your therapeutic relationship is to benefit you, period. Yes, totally, psychiatrists are human too… which is why most not only have their own counselor to unpack things, but also personal and professional networks to support her… and if she’s struggling, a nice letter as above would be very kind, but NOT necessary in the slightest.
    Mental health is healthcare, and beyond violating mental health standards, having patients or former patients doing filing and scheduling violates HIPPA – like, she might be having a hard time, and I hear that, but HIPPA laws are to protect the patient and she’s being tremendously unprofessional. I hesitate to tell you to just report this behavior as well, but is she part of a network? Maybe with a supervising psych? Because her unprofessional behavior puts them in direct jeopardy AND they have the most likelihood of being able to provide her legitimate help while taking your concerns seriously. You’re surely not her only patient dealing with this, and her other patients may not have the awareness or ability to bring it up to someone.
    It’s also worth a shout-out, IMO: this is your doctor, and you can leave her (or anyone’s) care guilt-free at any time. Certainly inform them you’re changing care professionals, but if you’re not getting what you need, even if you once did, and especially if you’re being expected to decode strange texts and don’t have actual privacy of your records (however you feel about that, it’s unprofessional and illegal), you deserve the help you need without this wholly unnecessary drama.

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