As I write this, it has been several weeks since I last saw Robert. I doubt that I’ll hear from him again. If he does call, I’ll ask him if he has an objection to my speaking with his psychiatrist, but even if he wants to continue with group I fear that the prognosis is not good. I can’t imagine working with a group member whose individual therapist won’t speak with me. It’s like estranged parents unwilling or unable to put their animosities aside to cooperate and work together in the best interest of their child.
Is there a way to work out a contract with the referring therapist at the beginning of the conjoint treatment? What special considerations need to be taken into account when we don’t know each other? I certainly don’t want this type of scenario to play out again. Accepting referrals for group from individual therapists is always a complicated matter. Certainly the individual therapist must feel secure about his or her work, since it will be on display in front of the group. On occasion I’ve gotten referrals where I had the sense the individual therapist had had enough of a particularly difficult patient, and was looking to dump him or her into a group. Obviously, it’s even more complicated when the individual therapist is a complete unknown to the group therapist. While I don’t expect to see eye to eye with the psychiatrist on every treatment decision, and agreeing to disagree is a fine compromise in most cases, what if I have serious doubts about the individual therapist’s judgment? What if I believe that the group member’s mental and even physical health may actually be in jeopardy?
In my book (Pepper, 2014), I write about the paradox of being a patient. Prospective patients often seek treatment when they realize that they can’t trust their own judgment about relationships. The selection of a therapist, however, may be made using the same flawed judgment. Dorpat (1996) notes that some patients in abusive treatment relationships don’t realize that they have been abused until they enter treatment with another clinician who treats them differently. In the movie Love and Mercy, the point is subtly made that Brian Wilson’s relationship with the abusive therapist mirrored the relationship with his abusive father. What do we do when we think the patient is in an unhealthy relationship with the other therapist?
It sounds like the client is repeating a relationship from his past with his psychiatrist. Unless the psychiatrist is aware of this and can work with this transference in the service of the client, I am not sure what more you can do about it. The psychiatrist needs to be self-aware, have good insight and understanding of how transference works. I am not sure if this is the case here.
Susan–Thanks for your cogent and thoughtful comments.