Need suggestions about therapist

[klmno]

difficult child and I started with a new therapist a couple of months ago. We see him every 2 weeks and when I first spoke with him, he spilled out everything about the best counseling approach when BiPolar (BP)/mood cycling is involved with an adolescent. What he said was consistent with what I had read in various books and with what is recommended on the bpkids website, so I thought we had a winner here. No other counselor has even come close to saying any of these things. We are still seeing one other counselor, but this is being tapered off- for one thing, he is getting ready to go on a 4 week vacation. The idea was to gradually transition.

Anyway, so far, this newer counselor really hasn't started with ANYTHING that he mentioned. I don't know how common this is in most places, but it has happened several times with us here. Now, I do understand that it can take a while to move into things, but if he says in one seesion that the next session we are going to discuss X, Y, and Z and he will give use each mood cycling charts to fill out, shouldn't at least one of these things happen within the next 2 sessions? Is it my responsibity to establish the plan and keep it on track?

And, the other thing that really bugs difficult child and me both- the guy wants to talk a whole lot about his work he does as a substance abuse counselor for young adults. Well, I didn't seek out a substance abuse counselor. I don't mind him letting us know this, but difficult child and I both noticed that he seems to almost brag about it and wants to relay horror stories about heroin addicts and such to difficult child every session. I don't mind difficult child getting a jolt of reality occassionally about the dangers of drugs, but we aren't there to spend 1/3 of the session talking about another one of his patients who OD'd. Is there a nice way for me to tell him this and asked him to stay focused on why we are there?

Any suggestions? I'm either really bad at "interviewing" potential counselors, or, I've also wondered, if it has something to do with asking specifically for a male when there is a real shortage of male counselors around here, so we have just been getting "male" and not one who really does have experience with the issues we need addressing. Or, is it that what is written in the books and recommended on the bpkids website is too idealistic to expect?

 

[Sara PA]

We went through something like that. The guy touted as THE therapist for teen boys -- a PhD -- turned out to be a total dud. I have no idea why anyone thought he was good. My son thought he was a complete waste of time My son wanted to get better and was as compliant a patient as he could be (beyond the fact that he was slowly becoming psychotic and violent because of the Celexa). The guy talked a good race but when it was time to run, he was all talk. And quite full of himself.

Ah, it was all my fault anyway. Poor parenting skills, dontcha know? We fired him before we fired the psychiatrist.

We did find a MSW who was about as big a geek as you could get. He did help my son and would have helped him more had the psychosis not progressed to the point where the three of us realized he was too unstable to benefit from talk therapy. I think my son might have gone back to him at some point had he not been in the same building and under the same management group as the other two.

 

[susiestar]

Well, I had a reply, then my 'puter did something funky and I lost it.

Start making appts with other tdocs, while you wait for your next therapist appointment. It may take time to get in to a new therapist, and you don't want to be totally with-o one.

Ask the therapist if he can spend the time you PAY for focussed on your difficult child, NOT on his research, heroin Oding patients, or whatever. If yes, give him a few sessions to see if he can. If no, cut him loose.

Write a letter to GAL, attorneys, judge, etc... saying you feel difficult child would be better served with a therapist who spent the session working on difficult child's needs and not bragging about the sub abuse patients he sees. Also that you are uncomfortable with the info he gives you on other patients, as he might also breach your son's confidentiality. You want a therapist who will spend the session working with difficult child on difficult child's issues.

Then you can cancel other appts with other tdocs if current guy can do what you want, or you can keep them and see who you like.

FWIW, the "best" therapist here for teen boys is a total idiot. Told difficult child I was a bi&ch (in front of me!), told him I was way too involvedin his school (asking about homework is a crime apparently, as is answering calls from school about difficult child's issues), told him I should let him do all the pokemon he wanted, and more. all in ONE session.

Follow your instincts, but be sure to CYA in regards to the GAL, with things in writing.

Hugs!

 

[klmno]

Thanks so much for the support, Sara and Susie! I just spoke to my MOm on the phone and told her that the biggest mistakes I have made regarding difficult child (not including the ones at home regarding discipline- because I thought with appropriate discipline, I could snap him out of this), was believing everything the people at sd, psychiatrists, and tdocs told me and taking it all for face value. Knowing what I know now, I would have fought several of them so much harder so much sooner.

Fortunately, I had already prepped the GAL some and the last court order doesn't list any specific therapist or psychiatrist by name, but it does require that he continue in counseling and with medications, if/as prescribed. I spoke with the psychiatrist who did the MDE (in Oct) last week- actually we had an appointment for a consult. This wasn't as helpful as I'd hoped. She said both males being hired were psychologists in training. Personally, I don't care if it is Joe down the street if he has more common sense than what we've been getting. This psychiatrist has her secretary trying to get an appointment lined up for us. At first, I was thinking this would be worse. But, now I am wondering if it might be better. Maybe they won't already be stuck in one mode and might actually be willing to listen to the parent and read the book TEC.

I am just sooooo tired of the apparent attitude that they can justify misrepresenting what they have experience doing because their way will work no matter what- and if it doesn't work, then it will be mine, or difficult child's, or both, faults. Who trains these people anyway? I should know already- my mom has a phd in psychiatric- that is enough to scare anyone who knows her history. She basicly got no training. She was hired to consult people and had a supervisor that she had to answer to. But the super wouldn't have had a clue if my mom was completely incompetent at this or not (she was) because the super only heard my mom's version of what happened with each client. Ultimately, my mom was never able to pass the test (after several tries) to get her license. Thank God! (Not that she is stupid- she got this phd around the age of 65- but psychiatric is not her forte- shoot, parenting was not her forte.)

 

[Wiped Out]

Just wanted to pop in and say I'm sorry there is trouble with this new therapist-I know you were hopeful he would be good.

 

[janebrain]

Hi,
this t-doctor reminds me a little of difficult child 1's t-doctor. She always had great plans for what they were going to do but each session would get way off track and she never ever did anything she said. Also, she bragged about her own children and talked about herself way too much. She was simply awful but back then I was too intimidated to just quit--she was very "aggressive" I guess you could say. Also, difficult child wanted to go to her, she liked her. Well, sure, she never had to actually do anything--she had t-doctor fooled into thinking she was actually helping her.

I am so sorry--you had great hopes for this t-doctor and they don't seem to be panning out. Go with your gut--your gut tells you this guy isn't all he says he is. I don't understand how there can be so many bad therapists around. My own therapist admitted to me that there are so many really awful therapists who don't know what they are doing. I would certainly steer clear of anyone who has an ego problem.

Hugs,
Jane

 

[susiestar]

We had some tdocs at Childrens in Cincy. The best was teh head, but it was hard to get in to see her. Then there was Jack. The student - I didn't care if he was a student or licensed if he could help. He is the one who wanted me to "pay" Wizard for being nice to Jessie. GREAT message to send to Jessie, don'tcha think?? when I asked what that would do to Jess, to think her bro had to be "paid" to be nice to her, Jack was stumped. flummoxed. He had never thought of a patient in the context of the family - how these things he wanted us to do would affect anyone else.

I guess HE learned, but it stunk for US.

I hate when they say they can do what they can't. And the 1 size fits all therapy.

I hope you can find someone who will be effective as a therapist soon.

hugs,

Susie

 

[TerryJ2]

Aaargh. How frustrating.
We've only had 2 sessions that were a total waste of time. Now husband and I bring written lists along of what we want to talk about and we just jump in. If the therapist gets too carried away, we bring the subject back to difficult child.
Paying the amt we do, I have no qualms about interrupting and asking point blank questions. Such as, "When difficult child is cycling and agitated, we've tried XYZ with-no luck. What else would you suggest?"
Let him talk for 5 min. and if he stays on topic, turn to difficult child and say, "Does this work for you?"
Your difficult child is certainly old enough to do that. No one likes time wasters.
Sigh.

 

[klmno]

Ok, what should I do when it is like this: the therapist asks what has been going on since the last time we saw each other. This ends up to be a 20 min discussion. Then, therapist asks if I'll leave room so he can talk to difficult child. 25-30 mins later, they come out. End of sessioon.

 

[smallworld]

OK, I'm confused. How does your last post relate to your first post? And who is the counseling for?

My middle daughter's psychiatrist (she sees a psychiatrist for medication management AND weekly psychotherpy) runs her sessions exactly as you described. The psychiatrist asks me how the week went and what issues came up because my daughter tends to forget events she should bring up. Then I leave and the psychiatrist talks to my daughter about her week. I'm fine with this arrangement because after all, it is my daughter's therapy.

I would be unhappy if a therapist talked all about his work with other patients, however.

 

[klmno]

Well, oddly enough, this is the only counselor who has used this method with us. If he was supposed to be difficult child's individual counselor and he was doing anything effective, I would be fine with that. He was supposed to be helping me learn strategies to help de-escalate difficult child when need be and help him in other ways and help me cope. He was also suppopsed to be helping difficult child understand and accept what is going on with him (mood cycling) learn to identify triggers, help with coping skills and problem solving strategies. I understand this is a lot, but these things were discussed before he was hired.

As I said before, I don't expect to run through all these things and have them solved in 2 months, but it appears more like he's completely forgotton all about why he was hired. The gal, po, and others asked, "so, how's it coming along with learning these strategies, etc." All I can tell them is that we have yet to learn ONE thing from counseling.

If they guy were just having a little trouble staying on topic it would be different.

And I am extremely cranky today, so I hope I don't sound harsh with you. It has just been a very stressful and trying day already.

 

[smallworld]

In the five years since either one or all of my children have been in therapy, it has been my experience that a good therapist will spend a lot of time working on relationship building at the beginning. It seems to be the only way real therapeutic work can be accomplished. I have to tell you that my son spent the first 6 months of seeing his current psychiatrist just playing board games and building with Lego (and it was fine with husband and me). We knew the psychiatrist, who is a skilled psychotherapist, was building a foundation of trust with our son.

If you think the therapist has forgotten the original goals, I recommend scheduling an appointment without difficult child and remind him of your expectations.

I personally believe that it can be hard to sustain the momentum of therapy every other week. Given that your goals are extensive, you might want to consider weekly therapy (I know it's expensive).

I think you should also consider parent alone and difficult child alone sessions to really delve into issues. Twenty minutes for difficult child to talk about cycling triggers and coping strategies is not enough time, in my humble opinion.

This therapist may turn out not to be "the one." But I also think you need to have a realistic view of how therapy can work over time.

 

[klmno]

Thanks, Smallworld. It was the therapist who said every 2 weeks- I tried to get it every week. (Really, another thing I've found is that they are like attny's- they get more clients than they have time for.) Also, I already tried the separate tdocs for each of us- the tdocs said they couldn't work on the issues I was asking for that way- they had to know and work with both of us.

If you don't mind me asking (just don't answer if you do), did you ever have a therapist work with you and /or husband and your difficult child 1 about triggers, de-escalation, awareness of the cycling, etc? If so, what was the method they used?

difficult child had an individual counselor for a year. He never had one converstaion with him about that stuff. difficult child discussed age-appropriate "male" concerns with him, which was fine with me, until difficult child told therapist that he was tempted to try drugs and therapist told him a little wouldn't hurt him. That, along with therapist telling me that "his appointment schedule was booked for a while" just drastically ended things.

 

[smallworld]

I'm sorry if I wasn't clear. I didn't mean separate tdocs; I meant separate sessions with the same therapist for you and for difficult child (not sharing the same session).

I may have told you that my middle daughter fell through the cracks with a completely dysfunctional psychiatrist/therapist team. The psychiatrist only saw her for 15-minute medication checks once a month, and the therapist blamed all my daughter's anger, aggression, suicidal talk and OCDish cleaning frenzy on bad parenting. And the psychiatrist and therapist never once talked to one another on the phone! When I finally asked the psychiatrist point-blank if Paxil could be contributing to my daughter's totally out-of-character behavior, the psychiatrist said no. But husband and I had our suspicions and sought a second opinion. Good thing we did because it was the Paxil.

At that point, we decided that the psychiatrists who prescribed the medications also had to do the therapy so they could get good first-hand observations on what was going on. In this day and age of managed care, I know this arrangement is unusual, but we have been fortunate to locate three psychiatrists who practice intergrated care for our three kids. So we absolutely do not deal with tdocs at all.

We as parents are not privy to a lot of what goes on behind the closed door of our kids' therapy sessions, but we do have our own sessions from time to time in which we talk about how to parent our children with significant mood issues. In general terms, I know that the psychiatrists talk with our kids about their feelings, what triggered those feelings, coping strategies to deal with unpleasant feelings, etc. I think they use a variety of methods, not just one, but some of it is based in Cognitive Behavioral Therapy.

Because my kids are relatively stable on medications (we still need to do some medication changes on my youngest daughter), we don't deal with major cycling, rages or unsafe behavior at this point. So some of what you are asking about just doesn't pertain in our case.

Good luck. I hope you find exactly what you're looking for.

 

[Marguerite]

klmno, you said, "If you don't mind me asking (just don't answer if you do), did you ever have a therapist work with you and /or husband and your difficult child 1 about triggers, de-escalation, awareness of the cycling, etc? If so, what was the method they used?"

YES. Always, it seemed. It varied a bit, but generally I would be involved in the first part of the session, we would talk about any problems that had been a concern for me' reports from teachers, for example. Then about halfway through (sometimes less) I would let the counsellor have time along with the difficult child (it was generally difficult child 3) during which time the counsellor would often bringup stuff I'd mentioned, leaving difficult child 3 convinced the counsellor was a mind-reader.

If we had time (and we often didn't) the counsellor would then debrief me on the session (very quickly - it was usually on the steps while difficult child 3 was running around the yard) so I could dovetail in with what they had agreed on. Then on the drive home, difficult child 3 & I would talk about the session, any strategies recommended and try to develop a plan of action.

This worked better than anything else. This was perhaps the second-best counsellor we found.

But we moved on - I didn't feel we were getting enough proactive help. At the time I needed a therapist to tell me what to do with regard to schooling and the problems I was having with bureaucracy blocking our applications for correspondence school instead. And this guy just wouldn't stick his neck out that far, although when I told him tat was what we would be doing, he almost stood up and cheered.

Later on, we needed a counsellor for other aspects of difficult child 3's ongoing management, especially his evening rages ("Explosive Child" did most of the work; it was about the time I found you guys). This therapist had some great strategies for difficult child 3, although it did involve bribes. But non-material bribes, and this is how we've continued. difficult child 3 needs to learn to knuckle down and work, and not stress about the mechanics of getting started with his work. He's willing to work, just doesn't always know how to get started.

We've also had therapists for easy child 2/difficult child 2 and difficult child 1, with respect to their own issues (anxiety, plus rages, with easy child 2/difficult child 2). For most of those, I was present throughout.

When easy child was molested and we got her into counselling at age 7, the counselling was done almost entirely in my absence. I was also given NO feedback, "because it's confidential". I had absolutely no way to assess whether the counselling was doing good or not, or whether it could have been adding to the damage done. I also was not given any information about the abuse itself, and now easy child is older and blocked it out, she wants to know about it and I can't tell her.
It was easy child who told me that her counselling could stop and could I please tell her therapist. It shouldn't have had to be left to a 7 year old, even one as perceptive and capable as she was.

difficult child 1 was the first of my kids identified with a problem. His first doctor was a paediatrician by qualification (this is usual in Australia; paeds are often the ones who treat ADHD and Pervasive Developmental Disorder (PDD)) but played therapist a great deal, to the point where the doctor would make appointments with me and tell me to not worry about taking difficult child 1 out of school for that appointment; my report would suffice. He then increasingly began to treat me as a client with him as the therapist, trying to analyse me. He actually said that I was too cool, too in control of my emotions and that this was unhealthy since I was clearly cold, repressed and so uptight that if/when I cracked, it would be a disaster for everyone around me, especially my family. It would do me good, he said, to lose my temper.
By this stage I was starting to hear "Twilight Zone" theme playing in my head, so I carefully did not react but just thanked him for the latest prescription slip and left. I really got nervous when this bloke tried to make an appointment for the next session and chose a particular date which suited me well. "Oh good," I said. "That is my husband's flexiday. We can come in to see you, then continue on to the mall to do our grocery shopping. I wouldn't have to drive, which would be good."
The doctor's response was, "Oh, sorry, that day won't be suitable after all." And he wouldn't be budged. It was clear he was refusing to see me with my husband present.

I won't go into details about how I responded; I did wait until the next appointment before tackling him on the subject (and husband managed to shift his day off so he could come; but at the last minute waited in the car outside, since the doctor clearly didn't want him there. husband was actually in line of sight through the doctor's window, only the doctor didn't know it).

End result - we waved bye-bye to the loony doctor who thought he was a psychiatrist and who was so determined to make me angry and react, that he was prepared to muck around badly with difficult child 1's medications to do so. "You want your next prescription? What dose? Well, we could halve his dose; or we could double it. Or leave it the same. What do you think?"

I thought it was time to leave, but I needed the piece of paper. So I GOT the piece of paper, THEN left. After I had the prescription filled I rang the doctor to cancel all future appointments and gave the name of the doctor to whom difficult child 1's file should be sent.

Some therapists are really good at ideas and selling themselves and not so good on the follow-through. Some ARE good, but are biding their time and also trying to reassure you that they have handled difficult clients in the past, so don't feel too concerned they'll be out of their depth.

I don't know which this one is. However, he made some promises and you are quite within your rights to begin each session with, "On [x date] you suggested the following as strategies you intended to put in place next session. Is there a reason you have delayed? And are we going to be working on this today?"

Lessons I learned:

1) Trust your instincts. If you feel frustrated at lack of progress, then it's likely things ARE progressing too slowly.

2) Speak your mind. It can be done politely, but still be firm and effective. Follow standard conflict resolution rules and use "I" statements, not "you" statements. For example, with the creepy doctor I described above, I did NOT say, "You are one sick puppy, wanting to see me alone like this. What on earth are you trying on?" Instead, I said, "I felt very uncomfortable when you wanted to see me without my husband, and also without the patient himself - my son."
The fact that I got the same reaction with the second method that I would have got with the first - told me I was on the right track, I was right to feel "icky" about it. The guy hit back hard with "What sort of sick mind do you have?" when really, I hadn't said anything at all to accuse him. When I pointed this out, he squirmed. I refer back to (1). That told me I had been right to trust my instincts.

3) Do your homework. If you have a tentative referral in place, and a firm appointment with the possible new therapist, then you can feel safer in confronting the current therapist and asking for action. If action is forthcoming and you leave thinking that at last you had a good session, you can always cancel the appointment with the new bloke. But if your feelings are correct, then you have a back-up plan already in place.

Good luck with this.

And one last point - the last tdocs my two youngest kids have seen both terminated the session series each time, when they felt they had done all the kid needed, for now. The sessions were terminated with, "Keep doing the breathing exercises, follow the strategies you and I agreed on, and call me if/when you want to pick up again. But I think you're doing great right now, you don't need me for the moment."

A therapist with a finite goal - there should be more of them.

Marg

 

[klmno]

Smallworld- thank you! I was thinking a few weeks ago that it seems things would go a lot better if we could find a psychiatrist to do counseling. I'm not sure my insurance co. would pay the higher fee though, even if we found a psychiatrist who was willing.

Marg- thanks so much for your experience and insight. I agree- a therapist with a finite goal would be wonderful thing! This might be what is bugging the most- I don't see any of them talking about a goal, much less any work toward it. And this is what I wish the PO and GAL and judge understood. But, after reading your post, I think I might be more comfortable and able to discuss this with him. therapist needs to know that we aren't just there to chat and that I do expect some expertise in action here!