Re: -- Part 4, the things that came to mind

[Guest guest]

Hello-----------

I want to thank everyone for your responses to this tale.

As regards the " diagnosis " issue:

I think it's important to distinguish between the diagnosis made by a

professional who is treating someone and the diagnosis -- which maybe

we should call something else, like " assessment " -- made by a family

member who is trying to decide how to deal with the person.

When a patient decides to enter a therapeutic relationship with a

professional (general doctor, church counselor, psychiatrist, MSW,

analyst Jungian or Freudian, whatever) part of that relationship is a

commitment on the part of the professional to be, in some sense, a

neutral or objective witness to the events of the patient's life.

This is possible for a therapist because the therapist has specific

training on how to do it (handling counter-transference, etc.) and

also -- very important -- because the therapeutic relationship is the

only thing going on between these two people. The nature of that

relationship creates a set of boundaries, i.e., we see each other one

hour a week, always in the same place, we talk about me & I don't

know very much about your personal life, we do not have mutual

aquaintances, financial entanglements, or sex, and so on. So,

ideally, the therapist can use his/her skills to arrive at a

diagnosis of the patient's situation, and the only purpose of the

diagnosis is to be helpful to the patient. Because the therapist

makes this commitment, it's safe for the patient to be comparatively

un-defended vis-a-vis the therapist -- to tell the therapist all

kinds of personal information, cry in sessions, be hypnotized,

whatever.

It isn't possible (or desirable) for a person to make this kind of

commitment to someone who is actually involved in his or her life,

the way a spouse, SO, or family member is. If Doe made this

kind of commitment to his wife, for example, he would be promising to

think about the question " Should this person quit her job, leave her

husband, and go bicycle across India seeking enlightenment? " without

considering his own needs. He can't do this, and he shouldn't do it -

- standing up for his own needs is one of his duties in life.

This is why mental health professionals are not allowed to treat

members of their own families.

When anybody -- say one of us -- is dealing with a spouse or family

member who seems to be having mental problems, we may use some of the

ideas and the language that professionals have developed over the

years in working with their patients. We may do research and draw

conclusions about the person's condition that sound very much like a

therapist's diagnosis. But what's really going on is a completely

different activity. The point of a family member's assessment is not

to be useful to the patient, although that may be a side effect. The

point is to help US decide what to do. Example: it's a fact (read it

in the DSM!) that BPs who are not getting treatment have a very low

chance of recovering. My best guess about my mother is that she's

got BPD. Consequently, I won't resume my relationship with her

unless she's in treatment. This is my decision, for the purpose of

protecting me. If I happen to be right, and the situation motivates

her to seek treatment, and she gets better, well, cool beans. But

that's just an unexpected bonus.

I don't expect my mother to trust me as if I were her therapist,

because I can't begin to be neutral or objective about her. This is

fine: being neutral about her isn't my job. Being a fairly

sophisticated person, and familiar with psychological concepts, she

sometimes throws out the idea that I don't have any right to make, or

act on, judgments about her unless I can act totally in her interest,

like a therapist. This is ridiculous-- it's just a way of disputing

my right to have boundaries.

The problem I have with my sister's behavior is, basically, that she

expects her family to give her the kind of trust that she gets from

her patients. This is, in my opinion, out of line.

Ivy

[Guest guest]

Ivy,

I have really enjoyed reading your posts. I know the topic is not

pleasant, but girl, you have it together in what you are writing.

YOu express your thoughts very well.

Take care,

sylvia

>

> Hello-----------

>

> I want to thank everyone for your responses to this tale.

>

> As regards the " diagnosis " issue:

>

> I think it's important to distinguish between the diagnosis made by

a

> professional who is treating someone and the diagnosis -- which

maybe

> we should call something else, like " assessment " -- made by a

family

> member who is trying to decide how to deal with the person.

>

> When a patient decides to enter a therapeutic relationship with a

> professional (general doctor, church counselor, psychiatrist, MSW,

> analyst Jungian or Freudian, whatever) part of that relationship is

a

> commitment on the part of the professional to be, in some sense, a

> neutral or objective witness to the events of the patient's life.

>

> This is possible for a therapist because the therapist has specific

> training on how to do it (handling counter-transference, etc.) and

> also -- very important -- because the therapeutic relationship is

the

> only thing going on between these two people. The nature of that

> relationship creates a set of boundaries, i.e., we see each other

one

> hour a week, always in the same place, we talk about me & I don't

> know very much about your personal life, we do not have mutual

> aquaintances, financial entanglements, or sex, and so on. So,

> ideally, the therapist can use his/her skills to arrive at a

> diagnosis of the patient's situation, and the only purpose of the

> diagnosis is to be helpful to the patient. Because the therapist

> makes this commitment, it's safe for the patient to be

comparatively

> un-defended vis-a-vis the therapist -- to tell the therapist all

> kinds of personal information, cry in sessions, be hypnotized,

> whatever.

>

> It isn't possible (or desirable) for a person to make this kind of

> commitment to someone who is actually involved in his or her life,

> the way a spouse, SO, or family member is. If Doe made this

> kind of commitment to his wife, for example, he would be promising

to

> think about the question " Should this person quit her job, leave

her

> husband, and go bicycle across India seeking enlightenment? "

without

> considering his own needs. He can't do this, and he shouldn't do

it -

> - standing up for his own needs is one of his duties in life.

>

> This is why mental health professionals are not allowed to treat

> members of their own families.

>

> When anybody -- say one of us -- is dealing with a spouse or family

> member who seems to be having mental problems, we may use some of

the

> ideas and the language that professionals have developed over the

> years in working with their patients. We may do research and draw

> conclusions about the person's condition that sound very much like

a

> therapist's diagnosis. But what's really going on is a completely

> different activity. The point of a family member's assessment is

not

> to be useful to the patient, although that may be a side effect.

The

> point is to help US decide what to do. Example: it's a fact (read

it

> in the DSM!) that BPs who are not getting treatment have a very low

> chance of recovering. My best guess about my mother is that she's

> got BPD. Consequently, I won't resume my relationship with her

> unless she's in treatment. This is my decision, for the purpose of

> protecting me. If I happen to be right, and the situation

motivates

> her to seek treatment, and she gets better, well, cool beans. But

> that's just an unexpected bonus.

>

> I don't expect my mother to trust me as if I were her therapist,

> because I can't begin to be neutral or objective about her. This

is

> fine: being neutral about her isn't my job. Being a fairly

> sophisticated person, and familiar with psychological concepts, she

> sometimes throws out the idea that I don't have any right to make,

or

> act on, judgments about her unless I can act totally in her

interest,

> like a therapist. This is ridiculous-- it's just a way of

disputing

> my right to have boundaries.

>

> The problem I have with my sister's behavior is, basically, that

she

> expects her family to give her the kind of trust that she gets from

> her patients. This is, in my opinion, out of line.

>

> Ivy

[Guest guest]

Great way you expressed this!

BM

>

> Hello-----------

>

> I want to thank everyone for your responses to this tale.

>

> As regards the " diagnosis " issue:

>

> I think it's important to distinguish between the diagnosis made by

a

> professional who is treating someone and the diagnosis -- which

maybe

> we should call something else, like " assessment " -- made by a

family

> member who is trying to decide how to deal with the person.

>

> When a patient decides to enter a therapeutic relationship with a

> professional (general doctor, church counselor, psychiatrist, MSW,

> analyst Jungian or Freudian, whatever) part of that relationship is

a

> commitment on the part of the professional to be, in some sense, a

> neutral or objective witness to the events of the patient's life.

>

> This is possible for a therapist because the therapist has specific

> training on how to do it (handling counter-transference, etc.) and

> also -- very important -- because the therapeutic relationship is

the

> only thing going on between these two people. The nature of that

> relationship creates a set of boundaries, i.e., we see each other

one

> hour a week, always in the same place, we talk about me & I don't

> know very much about your personal life, we do not have mutual

> aquaintances, financial entanglements, or sex, and so on. So,

> ideally, the therapist can use his/her skills to arrive at a

> diagnosis of the patient's situation, and the only purpose of the

> diagnosis is to be helpful to the patient. Because the therapist

> makes this commitment, it's safe for the patient to be

comparatively

> un-defended vis-a-vis the therapist -- to tell the therapist all

> kinds of personal information, cry in sessions, be hypnotized,

> whatever.

>

> It isn't possible (or desirable) for a person to make this kind of

> commitment to someone who is actually involved in his or her life,

> the way a spouse, SO, or family member is. If Doe made this

> kind of commitment to his wife, for example, he would be promising

to

> think about the question " Should this person quit her job, leave

her

> husband, and go bicycle across India seeking enlightenment? "

without

> considering his own needs. He can't do this, and he shouldn't do

it -

> - standing up for his own needs is one of his duties in life.

>

> This is why mental health professionals are not allowed to treat

> members of their own families.

>

> When anybody -- say one of us -- is dealing with a spouse or family

> member who seems to be having mental problems, we may use some of

the

> ideas and the language that professionals have developed over the

> years in working with their patients. We may do research and draw

> conclusions about the person's condition that sound very much like

a

> therapist's diagnosis. But what's really going on is a completely

> different activity. The point of a family member's assessment is

not

> to be useful to the patient, although that may be a side effect.

The

> point is to help US decide what to do. Example: it's a fact (read

it

> in the DSM!) that BPs who are not getting treatment have a very low

> chance of recovering. My best guess about my mother is that she's

> got BPD. Consequently, I won't resume my relationship with her

> unless she's in treatment. This is my decision, for the purpose of

> protecting me. If I happen to be right, and the situation

motivates

> her to seek treatment, and she gets better, well, cool beans. But

> that's just an unexpected bonus.

>

> I don't expect my mother to trust me as if I were her therapist,

> because I can't begin to be neutral or objective about her. This

is

> fine: being neutral about her isn't my job. Being a fairly

> sophisticated person, and familiar with psychological concepts, she

> sometimes throws out the idea that I don't have any right to make,

or

> act on, judgments about her unless I can act totally in her

interest,

> like a therapist. This is ridiculous-- it's just a way of

disputing

> my right to have boundaries.

>

> The problem I have with my sister's behavior is, basically, that

she

> expects her family to give her the kind of trust that she gets from

> her patients. This is, in my opinion, out of line.

>

> Ivy

[Guest guest]

Sylvia--

Thank you.

Ivy