According to therapist-cum-speaker Dr. Julie Gurner, "A responsible psychologist will always make a referral if the client continues to need treatment elsewhere, but it is ultimately the client's responsibility to follow through with that referral. An exception to the client taking responsibility for follow through might be if they are feeling unsafe (suicidal) or are compromised in some other way."
Two years ago, on a hot New York Summer's day, still drunk from the night before, I walked into my shrink's office and told him I needed to quit drinking and wanted to kill myself. I'm not sure if it was as cohesively articulated as that, but rather a rambling about how high a sixth floor walk-up apartment is, various uses of a cleaver, and that Lenny Kravitz had jumped out of the audience to play drums at the show I attended the prior evening. Regardless of my exact words, my psychiatrist's response was clear: "I am no longer qualified to treat you, and I must terminate this relationship." My ex-shrink told me he would be in touch with names of doctors who would be a better fit, and I wandered into Washington Square Park, shielding the sun from my eyes.
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The Summer of 2013 was brutal for me: a sexual assault, followed by an alcoholic bottom, a breakup, and my parent's divorce--I was a suicidal nutcase. As it was August, my ex-shrink was going on vacation, so by the time he got around to calling me with those recommendations he promised, I was already in treatment with someone else, primarily because I was taking antidepressants and benzodiazepines, which were going to run out. Benzodiazepine withdrawal can involve seizures, so it's something you don't want to fuck with. "If the patient is taking medication, sometimes they will simply continue the medication under the supervision of the same psychiatrist, but their visits will be less frequent. This would all be an ongoing discussion with the patient," says Amanda Itzkoff, MD.
I'm too crazy for a boyfriend right now, but am I too crazy for a psychiatrist?
Being broken up with by your shrink can be a brutal blow to the ego--it has you thinking "I'm too crazy for a boyfriend right now, but am I too crazy for a psychiatrist?" Flipping through old diaries from that period feels like stepping into a horrific rape scene that I've seen in a movie--there's a fearful recognition, but I can't believe I ever actually lived it. Back then; even I didn't want to be around myself, so I don't blame the guy for ending the client/patient relationship. But I was curious: why do shrinks break up with patients? Are they even allowed to do that?
"There are guiding principles you should follow, rather than an official set of protocol," explains Dr. Gurner. "In graduate school, the act of separating with a client is referred to as "termination." A fair amount of attention is paid to how you separate from a client...because how we say goodbye and end our relationships is so important."
Often, a psychologist or psychiatrist will terminate a relationship because the patient is exhibiting symptoms they don't feel qualified to treat, as doctors typically have specialties. A common occurrence of this lies among patients diagnosed with Borderline Personality Disorder, as 10 percent of individuals with BPD successfully complete a suicide attempt. "Some disorders are certainly more difficult to treat, but I have not known of someone ending a patient relationship because of liability. The only reason I would see someone ending a patient relationship based on a diagnosis, is if they did not feel they could provide the specialty treatment required," says Dr. Gurner. "Almost everyone I know has unfortunately had a client end their life, but none of them have ever faced legal action or fear that element of their practice."
If the client is not committed to treatment, I would terminate our time together.
It may not happen often, but shrinks can be sued, which is maybe why my very handsome doctor felt I was out of his control. "Yes, therapists can get sued," says Dr. Barbara Greenberg. "If the survivors feel that it was inadequate care. That's why with all of your patients you have to access carefully for suicidality, or any predictors of violence, and you are responsible, and yes, you can be held liable," said Dr. Greenberg. One of Dr. Greenberg's specialties is treating BPD, so fear not Borderlines, there is indeed someone for everyone. "In my practice I get a lot of borderline personality disorders-I like people who are very energized who really need help; I find that stimulating. Substance abuse on the other hand, I might refer that person to see somebody else who had substance abuse as a specialty."
How many psychiatrists does it take to change a light bulb? One, but it has to really want to change it. An acquaintance of mine from high school was in treatment for alcohol abuse, and her doctor ended the relationship upon continuously catching her in lies about her drinking habits. "If the client is not committed to treatment, I would terminate our time together. People come to therapy for various reasons, but I would never accept a patient or keep someone as a client who was there at the wish of someone else," says Dr. Gurner.
If you're suffering with substance abuse, please get some help. Find an AA meeting, or if you're like me and don't jive with the 12-steps, understand that there are other options. There's the Buddhist recovery group Refuge Recovery, the science-based SMART Recovery, harm reduction, ayahuasca healing, Satanism, honestly whatever helps you get your life together, I'm in support of.
Because we all really are different beautiful little fluffy fucking snowflakes, aren't we? As with recovery, when seeing a shrink, it has to be the right fit, or it's not going to work out. "There has to be chemistry. I call it the "relational bond." If that bond doesn't exist, you really can't do good therapy," says Dr. Greenberg. A cool thing for me about quitting drinking, is when I was drunk, I checked off all the boxes for probably dozens of diagnoses. When I stopped, it turned out I wasn't insane; I'm just someone who absolutely does not mix well with alcohol. One spanking new fantastic shrink and two years later and I'm no longer drinking, and no longer suicidal. Maybe, if it continues to go well, the eventual breakup will be amicable. "The goal of any good therapy is separation, and that you've taught them how to manage their symptoms well enough that they don't need you anymore. You hope for them every good thing," says Dr. Gurner.