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View Full Version : A couple of mental health-related queries, pretty please (UK-based)



Los Pollos Hermanos
05-27-2017, 08:10 PM
When I say UK-based, I mean specific to England in case there are differences between different parts of the UK.

Disclaimer: The views in this post are merely those of my character. I am fully aware that many people find CBT a valuable experience in regaining control and enjoyment in life. I am not judging, although it may be difficult to say the same about my character.

Backstory: Character is absent from work as their employer has declared them unfit for work. Character suspects they are being gaslighted and has evidence to substantiate this.

Scenario 1: Character has been ordered by their employer to attend CBT sessions if they wish to be signed as fit to return to work. Character believes CBT to be a crock of faeces, but has decided to go along with it as a means to returning to work (as they are unable to apply for new jobs whilst signed off/suspended).

Question 1: What are the ways in which Character could convince Therapist they are successfully engaging with the CBT, in order to facilitate a swift return to work?

Scenario 2: Therapist prescribes antidepressants, which Character has no intention of taking. Character humours Therapist, intending to throw the pills in the bin (because flushing them down the toilet is really irresponsible).

Question 2: Are there any ways of proving that Character is not taking the medication (e.g. compulsory blood test)? If so, what are they? If not, what could Character say to convince Therapist that all is now hunky-dory, thanks to the prescription?

I think that makes sense? I've done some Googling, but the answers are ambiguous, so where better to ask than here?!

Big thanks in anticipation,

LPH.

p.s. I should point out that in this case the therapist is actually a medically-trained psychiatrist and therefore permitted to prescribe medication.

p.p.s. Ideas from outside the UK are more than welcome!!

Old Hack
05-27-2017, 10:26 PM
When I say UK-based, I mean specific to England in case there are differences between different parts of the UK.

Disclaimer: The views in this post are merely those of my character. I am fully aware that many people find CBT a valuable experience in regaining control and enjoyment in life. I am not judging, although it may be difficult to say the same about my character.

Backstory: Character is absent from work as their employer has declared them unfit for work. Character suspects they are being gaslighted and has evidence to substantiate this.

As I understand it (working at the level of company director but not directly involved with employment issues) an employer can suspend someone pending an investigation, or give written or verbal formal warnings that if a certain behaviour continues the employee will be at risk of losing their job: but they can't declare anyone unfit for work. They can just object to specific unprofessional behaviours. A doctor could declare someone unfit but that doctor would have to be the employee's GP or consultant, I think, or be involved in a significant investigation into the employee's behaviour--so, this would have to happen as part of an investigation into a major employee problem.


Scenario 1: Character has been ordered by their employer to attend CBT sessions if they wish to be signed as fit to return to work. Character believes CBT to be a crock of faeces, but has decided to go along with it as a means to returning to work (as they are unable to apply for new jobs whilst signed off/suspended).

Question 1: What are the ways in which Character could convince Therapist they are successfully engaging with the CBT, in order to facilitate a swift return to work?

Again, from what little I know of employment regulations, an employer can't demand that an employee attend such sessions; and employers can't prevent employees from applying for new jobs, not even while they are suspended. I'm sorry to be so negative here, and I know it's not what you asked for, but I am trying to help! I can see how this might be so if the company involved were some highly secret Government organisation, for example, so ignore me if that's the case, or if the employer is controlling and difficult and the employee is very nervous about being unemployed for Important Backstory Reasons. But for an everyday company? You're going to have to be very careful.

In order to appear to be engaging with CBT you would probably have to engage with the CBT to some extent. All this means is talking with the therapist, listening, filling out the questionnaires they give you (why, yes, I have had CBT!). It could be an interesting intellectual process even if you don't believe in its effectiveness. What might be useful for your plot is that it's possible to benefit from CBT even if you don't believe it's effective, so long as you participate in the sessions. So perhaps your character could make this clear to the therapist, agree to take part but from that cynical position, and then the therapist would be happy and the patient could remain unaffected (or not!). Just a thought.


Scenario 2: Therapist prescribes antidepressants, which Character has no intention of taking. Character humours Therapist, intending to throw the pills in the bin (because flushing them down the toilet is really irresponsible).

Question 2: Are there any ways of proving that Character is not taking the medication (e.g. compulsory blood test)? If so, what are they? If not, what could Character say to convince Therapist that all is now hunky-dory, thanks to the prescription?


Unless you're sectioned you're not obliged to take any medications you're prescribed. So a decent therapist isn't going to do anything more than talk to the employee about antidepressants, and to decide with them whether or not they're an appropriate treatment. They're very unlikely to demand proof that the person is taking them as prescribed and again, it's extremely unlikely that an employer would be able to force a blood test or anything else on someone in the way you're suggesting--unless they were controlling and abusive etc. Which might be the case in your book, of course.

Antidepressants aren't magic pills which make everything better instantly. It can take months to find an effective medication and to then adjust the dose. I've got a friend who trialled half a dozen different medications over eighteen months before finding one which suited her, and then it took another six months to get the dose right; after that she took it for six months before her GP would even consider talking about weaning her off them. So getting your character to be able to convince the therapist all is ok and to do this realistically is going to take some time. Generally you'll get some side effects within a few days of starting to take the stuff, then an improvement won't show for a couple of weeks, even if it's the right medication for you; and after that, it takes weeks or months for you to feel better, and "better" here means "less bad", often, not "all bouncy and happy". So the therapist is not likely to expect or believe for the patient to feel fine very quickly.


I think that makes sense? I've done some Googling, but the answers are ambiguous, so where better to ask than here?!

Big thanks in anticipation,

LPH.

p.s. I should point out that in this case the therapist is actually a medically-trained psychiatrist and therefore permitted to prescribe medication.

p.p.s. Ideas from outside the UK are more than welcome!!

Thank you--I was going to ask.

In addition to all these therapy/medication details, you're going to have to work out a way to justify this employer's involvements in their employee's mental health issues and treatment. Because as I've said, it's just not how things work on a general level and there is legislation in place to prevent people being targeted by their employers like this. I'm not trying to tear your premise apart, just trying to give you some background so that you can make sure you don't end up with plot holes. I hope that's a help and I'm sorry if I've caused you more problems than you started off with.

Los Pollos Hermanos
05-27-2017, 11:18 PM
Ahhh! Many thanks for your excellent and informative reply, and I should have included more details. I was trying not to be too waffly - ha! I've got the basics okay; it's the fine details I need the info for. You've certainly not caused me any problems!

Employer (dodgy - and gaslighting?) has said Character is too mentally unwell to be at work (debatable), as evidenced by their "behaviour" (can't ruin plot by saying more) and suspends them on medical grounds.

Employer forces Character to see workplace-associated doctor, who (falsely?) backs up Employer. Character told to engage with CBT, or they won't be allowed back to work (yes, the legalities of this are questionable, that's part of the plot).

Therapist suggests antidepressants, so Character agrees as part of the charade (this is why I needed the "can they check you're taking them" issue clarifying). Character researches side effects, etc., so knows how to present themselves to Therapist (safe in the knowledge I now know there won't be a blood test) for the benefit of Employer. I've got a couple of friends who've taken them in the past, so had vague knowledge that they're not magic instant bullets - and what works for one doesn't necessarily work for another.

The applying for new jobs issue surrounds Character not wanting to mention on any applications that they're currently not at work, if they can avoid doing so. The situation will eventually work in Character's favour, shall we say?

Sorry it's all a bit ambiguous - I've honestly done a fair whack of research, even if it doesn't sound like it!

Big thanks. :-)

Parametric
05-27-2017, 11:21 PM
I did a course of group CBT classes recently through IAPT (https://www.england.nhs.uk/mental-health/adults/iapt/) and there was no requirement for anybody to contribute in any way, so if the character is forced to attend, he could just sit in the back row and do the crossword. The teachers try to draw out answers and engagement from the participants, but they're not allowed to single anyone out. Just a FYI.

Los Pollos Hermanos
05-27-2017, 11:26 PM
I didn't know that - many thanks! Unfortunately, Character is 1-to-1 with Therapist, so hiding at the back sadly ain't an option.

Actually, if Character refuses to engage with the CBT, can Therapist report that to Employer, or is doctor-patient confidentiality in play here? Hmmm... that could give me something new to work with!

cornflake
05-27-2017, 11:42 PM
No, a therapist isn't going to tell the employer anything at all.

Parametric
05-27-2017, 11:54 PM
Is it possible for an employee to consent to the employer accessing their confidential information? Maybe the fictional employer sneaked a clause into the signed employment contract that allows them to request a report from the therapist - so the employee opted out of confidentiality, like you can opt out of the European Working Time Directive?

bombergirl69
05-28-2017, 12:10 AM
Well, US based psychologist here and I agree with Old Hack. Yes, while someone could have issues at work (say, an angry outburst) and the employer might say, "you need anger management" (not the correct name but that's what people think it is). The "you need anger management" is based on the "if you want to work here" condition. The employee certainly could say, "Screw this" and just leave. The employer can't put out a big public notice HEY THIS GUYS UNFIT FOR WORK.

He might be referred to an EAP therapist (Employee Assistance program) If this guy really really wanted to work for the company, he'd go and would sign a release so the therapist could report his progress to his employer. He might not want to sign the ROI, but then the therapist couldn't say what his progress was (or anything else) so his employer would have no way of knowing if he were compliant. Most people sign pretty readily. Personally, I've never had someone referred for "CBT" - that's a little like showing up at a doc's office saying, "I need an MRI." The doc is going to want to know - what are we looking for? CBT is an approach - a very broad approach that can encompass a LOT, so CBT is used for anger stuff, for depression, for trauma, for medical procedures, for anxiety, for insomnia, etc. That might be a US thing - that referrals come for issues.

I agree that people play along all the time (criminal thinking classes are pretty much CBT) Many clients learn how to be more skillful criminals using some neat new techniques. Sadly, I've probably helped a few. I like the idea of skeptic playing along then realizing how helpful it is!

And meds, not sure your guy can be compelled to take meds. Certainly not for work. And no, they wouldn't check. The "outcome measure" would be that he feels better (self report) so he could say he felt great.

If your plot is some version of employer is screwing around with this guy, gets him into counseling where he is more vulnerable, and they keep messing with him, one angle might be to refer him to substance abuse treatment (for some minor drinking thing, at an office party or something.) So, there (here in the US) you have poorly trained (if at all) people making decisions about length of treatment, type of treatment (in or outpatient), and "progress." I have, unfortunately, seen many "progress reports" where the client is actually doing fine but the "therapist"--term used very, very loosely--"just doesn't think he's 'getting it' recommends more groups/consequences, etc. And the client is stuck(if they are mandated, like parole) So, again, can't "mandate" him but could make it a condition of his continued employment (or he could get picked up for a DUI, which would put him in the CJ system, and from there, depending on the state, he would be mandated for both DUI classes and as assessment (also rife with fraud and poorly trained people)

Anyway, good luck!!

cornflake
05-28-2017, 12:11 AM
The therapist would go over that, specifically and carefully, with the client. Privilege is discussed in the first session, in detail -- with any and all exceptions noted. Usually that only includes something like everything you tell me is strictly confidential ... potentially except in the event I believe you present an immediate danger of harm to yourself or others or specific instance of X type thing, but in a court-mandated evaluation can include that nothing is privileged, or that records of an evaluation will be sent to the legal team and... etc.

It is all laid out, verbally, and sometimes in writing as well to the client, and you're meant to ascertain the person is clear on their rights and your legal and ethical obligations. There's no way something like that would be slipped in and not mentioned, no, not if the person is an actual licensed professional who isn't a total quack or fool. Also, in a general sense, no decent psych would take on clients for whom the employer wanted reports, and certainly not that the employer wanted confidentiality waived. It's just a gross violation. There are psychs working in gov't positions, who see law enforcement personnel, gov't workers, etc. It's all confidential, same as anyone else, and they're very clear on that (save if you go in talking about you're gonna go kill Bob in the next cubicle at lunch, this is how, see, this is what you're going to use <insert clear, specific, viable, immediately dangerous plan>' or you say you're molesting your toddler or something -- but again, these are specific scenarios covered in the first meeting's discussion of basic confidentiality).

If you go in to an appt. with your psych and tell them you murdered someone last year, well, they're not telling. Same as if you tell your lawyer. Your lawyer will get more mad at you for telling them though. :)

bombergirl69
05-28-2017, 12:12 AM
Is it possible for an employee to consent to the employer accessing their confidential information? Maybe the fictional employer sneaked a clause into the signed employment contract that allows them to request a report from the therapist - so the employee opted out of confidentiality, like you can opt out of the European Working Time Directive?

Most clients sign a release of information (ROI) very readily as they WANT the therapist to report their progress. A good ROI is specific in scope, though. So, I could report attendance, progress on the referral issue and so forth. I would not report on unrelated stuff, history of child abuse, marriage problems, etc.

bombergirl69
05-28-2017, 12:22 AM
Yeah, confidentiality can be tricky (entire workshops on just that!!) The key is being clear and upfront. Certainly assessments are quite different than therapy, and issues then come up as to who the client really is, the person in front of you or the agency hiring you!! (and most therapists form very different relations with assessment clients than therapy clients, as you are NOT the advocate, you are an objective assessor. Again, most clients do sign ROIs because they want to be compliant. Forensic evals can have stacks and stacks of them. But therapists do see clients who are referred for therapy from a third party - Child protection Services, Parole nd probation, and employers. Again, the key is clarity, what does and does not get reported. Sometimes clients get really engaged in therapy and will hire the therapist on their own - again, the employer may want progress reports or to be able to find out "how Bob's doing" and the client has to decide whether they will grant that or not. Good therapists are able to answer employers' concerns without giving up much information. Shitty therapists approach case conferences like a gossip session. Evil characters in books might collude with the employer in some way! :)

Old Hack
05-28-2017, 12:24 AM
Ahhh! Many thanks for your excellent and informative reply, and I should have included more details. I was trying not to be too waffly - ha! I've got the basics okay; it's the fine details I need the info for. You've certainly not caused me any problems!

I'm glad to hear it. I didn't want to fall into the gap of critiquing your story rather than helping you with this issue.



The applying for new jobs issue surrounds Character not wanting to mention on any applications that they're currently not at work, if they can avoid doing so. The situation will eventually work in Character's favour, shall we say?

Strictly speaking, though, Character IS in work. Character is employed, still, so doesn't have to say anything about their break on their application. The only way Current Employer would be able to tell New Employer about the whole CBT/antidepressants thing is via a reference, and companies do not send out negative references. They just return the reference forms blank, because of the legal issues of saying bad things about people. So I do think you're going to have to rework this bit, or at least find a way for Nasty Manipulative Employer to twist things to their own advantage.


I have, unfortunately, seen many "progress reports" where the client is actually doing fine but the "therapist"--term used very, very loosely--"just doesn't think he's 'getting it' recommends more groups/consequences, etc.

The focus in England's NHS right now is to cut back on all services, though. So even when people are being forced into therapy (which doesn't really happen because the NHS is so strapped for cash at the moment) they are only usually allowed a maximum of ten, sometimes twenty sessions, and therapists are encouraged to end therapy ASAP even if the patient has not had their full quota of sessions.

bombergirl69
05-28-2017, 12:37 AM
[QUOTE=Old Hack;10177752
The focus in England's NHS right now is to cut back on all services, though. So even when people are being forced into therapy (which doesn't really happen because the NHS is so strapped for cash at the moment) they are only usually allowed a maximum of ten, sometimes twenty sessions, and therapists are encouraged to end therapy ASAP even if the patient has not had their full quota of sessions.[/QUOTE]

That can happen here too (EAP sessions are usually 5! Insurance will definitely limit if they can) but in the substance abuse world, things are a little different. Then employers and anyone else who refers, not to mention the client, can be at the mercy of very poorly trained people who can keep one in the system fo'EVAH. Insurance companies may (and do) balk, but if the client is referred by their employer or parole, they're stuck as those folks are waiting for the "All fixed!" from the counselor, so one way or another clients need to finish (usually)

cornflake
05-28-2017, 12:39 AM
Yes, sorry, I mean reports to an employer in the vein of 'how open Bob is in therapy/how Bob is progressing in therapy/with his personal issues' not 'Bob has attended therapy/Bob imo should be allowed to return to full duties/etc.'

Those are different -- when I said no good psych would take on clients for whom the employer wanted reports and confidentiality waived, I was talking about in the way it seemed laid out in the OP's scenario and Parametric's q., which sounded like 'write me reports on how Bob is doing in his personal therapy sessions,' not in a 'Bob was referred for Anger Management, has Bob completed the program and is he ready to be back at work now?' way.

bombergirl69
05-28-2017, 01:15 AM
yes! I got that difference! And yes, that's just what therapists (good ones) do - Bob's attendance is whatever, I might even say, let me see how I can answer that without violating confidentiality (even with an ROI)- just as a reminder. MOST third parties don't ask, are fine with can he work now? has he attended? but you'll get some who think it's a gossip session (so, has he told you all about his sister?? what has he said about his mom?) I just ignore those (so, I'm trying to think of what else might be helpful...) :)

Los Pollos Hermanos
05-28-2017, 03:36 AM
Chuffin' 'eck!! I disappear for a short while and return to lots of ideas/help from the good people of AW. Actually, in the crime trilogy I'm currently sending off to agents, the good people of AW are mentioned in the acknowledgements!

Sooooo... I'll add a few more snippets of detail. This query isn't about the main storyline, btw. However, it all ties together in the end.

Employer has repeatedly stuffed up an issue relating to Character, under the Equality Act 2010. Character is fed up and planning to cause well-deserved ripples for Employer. Employer gaslights Character over something else (can't say for deeper plot reasons) and then medically suspends them, stating they're too "mentally unwell" to be at work and in collusion with Employer-connected doctor who "confirms" this.

Character continues to be gaslighted, but isn't fooled and is told that for a return to work to be considered they have to attend an initial appointment with Therapist (i.e. the psychiatrist). Employer wants feedback from Therapist. These are private rather than NHS-funded sessions, as Employer is trying to cover their @r$e after the Equality Act 2010 stuff up. Therapist and Employer-connected doctor seem to be rather pally with each other too, but to what degree hasn't been decided yet.

Character wants to stay in their current job until they can secure alternative employment purely because they've got a mortgage to pay!! They also want to later expose Employer's incompetence and unpleasantness.

Two more questions I do have:

1). Character attends on a 1-to-1 basis. Say for the sake of argument they were to answer every question with "no comment", would Therapist report to Employer that Character has refused to engage (but not specifics)? Or, can Character stipulate nothing is reported to employer, apart from their attendance at each session? I get the release of info form thing, but I want Employer to receive the absolute minimum of info.

2). Could/would Therapist report back to Employer-connected doctor, who'd then report back to Employer? Or, can Character re-stipulate that the doc can only report back if they've been authorised to do so?

More big thanks to all you lovely people! xx

bombergirl69
05-28-2017, 05:32 AM
So, lemme see. IF you get a chance, you might want to watch a youtube of a therapy session, or video, to get a feel. One hopes (sadly, in vain sometimes) that therapy is not a series of questions to which a client can simply respond, no comment. It's not a grilling!! It's (should be) interactive -with OPEN ended questions. A client who doesn't feel like engaging just won't, or will just give the briefest answers. Few therapists enjoy playing dentist and extracting responses, so they'd ask about that. And if they client doesn't engage, they don't engage. Sometimes there are consequences (if they're mandated.) If they aren't mandated, a therapist would probably just share they don't feel like they're being helpful and suggest a referral elsewhere.

Regarding releases, if a client has not signed a release, there is no communication with anyone (short of the exceptions Cornflake pointed out-self harm, harm to others, sometimes subpoenas) client doesn't engage, end of session, good-bye. Sure, a release can be very specific, attendance, general progress on whatever the issue is, fitness for work, whatever. IF a client doesn't engage, and there is a signed ROI, I would tell the referent the client appeared but didn't engage, and recommend somewhere else. Sometimes clients freak out when you tell them that's what you'll do, and amazingly can find topics around which to engage! Excellent! I have refused to complete assessments if clients won't engage - no hard feelings but it's not going to work, and/or been very clear in my write-up about my impressions (it'll be validated in testing, a big part of assessments)

Not sure why the therapist would go to the doc and not to the employer directly. And the Character can a) not sign the release (which might lead to termination) or b) sign the release (which is the only condition under which the therapist can speak with the employer.) But again, the character (I think) would WANT to sign, would want to look compliant and cooperatve, right? good sociopaths are terrific at this (unless pushed)

On the gaslighting bit, I'm not sure i'd buy a character hanging in a job for that. Why not quit and report them? What's the thing that 's keeping them at the job? (you don't have to say it but it would need to be really super duper compelling--- > medical experiments! Character figures it out but needs evidence which they canonly get if they stay, but to stay they need treatment themselves (a little like Coma?) :) don't mind me!

cornflake
05-28-2017, 05:47 AM
Again, I think you're missing that the default, the assumption in all therapy in a professional psychological setting, is ABSOLUTE confidentiality (save immediate harm exceptions, which are, believe it or not, quite specific. If you tell your psych you want to kill your spouse, and you seem to mean it, but you have evidenced no plan and no specifics, the psych is not likely to do anything, and they're protected -- they may delve deeper to see if there is a plan, etc., but I'm going for an example here).

I'm not kidding -- you come in and confess to having murdered someone last year, they will not be calling the cops. Same as a lawyer. Confidentiality is no joke to professionals in which it is the bedrock of the profession.

It would not occur to a psych to start calling someone's dr., or supervisor, or spouse, or etc. Simply wouldn't, because that's not a thing that is done. Confidentiality is the given, the default.

There are exceptions, but those are specifically noted when you start, and the relationship is guided by them to some degree, but you seem to have the idea (I could be wrong, just what it seems like), that the therapist is like, working for the employer, or paid by the employer, or the employer sent the guy, so therapist would talk to the employer like a teacher would talk to a parent about a recalcitrant kid.

Even if a child is in therapy, there are guidelines about confidentiality. Any breach is going to be sussed out beforehand -- psych isn't going to think 'maybe I'll call the dr. and see what s/he thinks of how the person has been behaving in therapy,' any more than a lawyer would call your boss and say 'you know, LPH and I were discussing his case and he said this...' Out of bounds unless that's the agreement beforehand.

shizu
05-28-2017, 08:31 AM
I just straight up lied to my CBT therapist once or twice. One of the big techniques CBT uses is goal-setting wrt areas you want to address in your therapy. So you can say "I aim to do X, Z amount of times between now and the next appointment," and discuss the success/failure thereof at the next appointment.


Since my issues were centered around agoraphobia, I'd say something like I wanted to go for a 20 minute walk, by myself, three times a week (specificity of the goal is encouraged). On a couple of occasions, for various reasons, I said I'd achieved the goal even when I hadn't. Therapist then asked how it made me feel, what techniques helped me, where I wanted to go from there etc., and basically the answer is whatever they want to hear in order to assume you're getting something out of it all. "Yeah, it was a little stressful at first but I did the breathing exercises we talked about in earlier sessions and that helped a lot." "It was okay, but I learned something-or-other, and next time I could also try this-or-that which might make it better." And so on.

If there are specific things your character's employer has decided they need to address in relation to their behavior, and if the goals involved could be situations that rely on self-reporting that can't be contradicted, they could always just pretend to go along with it if that's plausible for them. Just like they could lie on questionnaires or quizzes their therapist might ask them to take.


In my experience, CBT tends to be quite patient/client-driven in the sense that you set the pace and the direction. I realize that might be different for your character if outside influences are directing things, but in general patients/clients have a huge amount of control in 1-on-1 therapy sessions when it comes to what they want to work on. So in that respect, your character could lead the therapist in a merry dance by making up issues they wanted to pretend to work on, and make it seem like they were accomplishing a lot when in reality they weren't.

I was self-employed at the time of my therapy, so employer confidentiality wasn't an issue. What was made very clear to me, right at the beginning of my treatment, was that everything that was said during the sessions was absolutely confidential. Only the police with a court order could learn what had been discussed, in the unlikely event that ever became necessary or relevant (such as me being a danger to myself or others, or in the course of a criminal investigation). If the therapist isn't somehow colluding with the employer or the employer's doctor -- or unless the client explicitly consents to a certain amount of info sharing with certain parties -- then as others have said, that confidentiality overrides everything else.

(You've probably run across all of these before, but if your character has been referred via an EAP, they have guidelines (http://www.eapa.org.uk/wp-content/uploads/2014/10/Counsellors-Guide-to-working-with-EAPs-FINAL.pdf) regarding ethics and confidentiality, both in terms of employers and clients. There's also the BACP's ethics framework (http://www.bacp.co.uk/ethical_framework/new_ef.php), and the BABCP's standards of conduct (http://www.babcp.com/files/About/BABCP-Standards-of-Conduct-Performance-and-Ethics.pdf), which might be of some help. And there's this info from a privately practicing counsellor (http://www.icounsellor.co.uk/articles/2012/01/will-my-counselling-be-confidential/) that could be useful too.)

bombergirl69
05-28-2017, 05:41 PM
you might be in a different country, so my comments might not apply, but in the US...


I just straight up lied to my CBT therapist once or twice. One of the big techniques CBT uses is goal-setting wrt areas you want to address in your therapy. So you can say "I aim to do X, Z amount of times between now and the next appointment," and discuss the success/failure thereof at the next appointment. clients lie all the time to their therapists! All the time! How much they drink, what they said, did, etc, how they feel. We don't have a truthometer--we take their word for it, because the outcome is their (client) wellbeing, so if they're lying...not likely to improve. with mandated treatment, ie third party referral (CPS, parole, sometimes employer),it's a little different bc the client may not want to be there anyway. I could write you a book on how to engage clients who don't wish to engage, but in the case of that type of treatment, there could be a consequence for not engaging (lose job, don't get kid, spend a weekend in jail) because it can be interpreted as client is unmotivated to change. Again, specifics are rarely discussed but overall, client in working in therapy, certainly can be (with a release)


Since my issues were centered around agoraphobia, I'd say something like I wanted to go for a 20 minute walk, by myself, three times a week (specificity of the goal is encouraged). On a couple of occasions, for various reasons, I said I'd achieved the goal even when I hadn't. Therapist then asked how it made me feel, what techniques helped me, where I wanted to go from there etc., and basically the answer is whatever they want to hear in order to assume you're getting something out of it all. "Yeah, it was a little stressful at first but I did the breathing exercises we talked about in earlier sessions and that helped a lot." "It was okay, but I learned something-or-other, and next time I could also try this-or-that which might make it better." And so on. And again, most therapists are going to think great, s/he's feeling better--good ones tend to be able to suss out the "oh I'm just great" folks who make unrealistic progress--and leave it there. If, in fact, you were not feeling better and not telling your therapist, then...not much a therapist can do. Engaged clients who are committed to feeling better will tell their therapists - this isn't working! I don't want to do this! Can we talk about something else?

If there are specific things your character's employer has decided they need to address in relation to their behavior,bolding mine (and this applies only to the US) So an employer can refer a client for some issue (anger, usually, because there has been a behavioral problem) but they DO NOT set treatment goals. That's between the client and the therapist. A therapist (with an ROI) could say that treatment goals are relvant to the referred issue but no third party actually sets goals (in my experience anyway) and if the goals involved could be situations that rely on self-reporting that can't be contradicted and again, at least in the US, we don't follow clients around to monitor compliance! OTHERS can do that--say a parole officer busts a client for drinking--and tell us we need to address the infraction, but we don't play policeman. If I think a client is drinking, I'll ask them about it. , they could always just pretend to go along with it if that's plausible for them. Just like they could lie on questionnaires or quizzes their therapist might ask them to take. Hahahahaha, clients always think they can hoodwink us on these, and on some testing batteries, the face valid ones, they try. But on several common testing batteries, we have profiles that tell us-the client is exaggerating in one way or another, is NOT responding to the content of the questions, or whatever. Very helpful (questions are NOT face valid) VERY hard to fake those (we pick those up) :)


In my experience, CBT tends to be quite patient/client-driven in the sense that you set the pace and the direction. I realize that might be different for your character if outside influences are directing things, but in general patients/clients have a huge amount of control in 1-on-1 therapy sessions when it comes to what they want to work on. So in that respect, your character could lead the therapist in a merry dance by making up issues they wanted to pretend to work on, and make it seem like they were accomplishing a lot when in reality they weren't. And in that case, a decent therapist will notice. "A merry dance" can look like unrealistic progress, too many unrealistic goals, etc. Again, with no mandate, the therapist may just let it go--the client's the one paying, or may ask the client about it, but it's all on the client.

I was self-employed at the time of my therapy, so employer confidentiality wasn't an issue. What was made very clear to me, right at the beginning of my treatment, was that everything that was said during the sessions was absolutely confidential. Only the police with a court order could learn what had been discussed, in the unlikely event that ever became necessary or relevant (such as me being a danger to myself or others, or in the course of a criminal investigation)not exactly. Confidentiality is a little more complex. What Cornflake said ---> criminal investigations don't trump confidentiality unless a court issues a subpoena (and even then, sometimes they're contested) Certainly if a client is a danger to self or others (more complex than it looks), if a child or vulnerable adult is in danger/being abused, for billling purposes, some people have it so for emergency care limited info can be shared. When there is a third party, this gets more complex--ROIs are tailored for this. And again, when a client is showing up with a third party, they WANT you to tell the referrant they are doing well. If they don't, they don't show up. Also a client can quash an ROI whenever they want and a therapist can't reveal anything further (but may have already) Then the therapist just tells the referrant they cna't discuss anything further (and usually that referrant takes it up with the client) Again, this can look straightforward but can be quite complicated. I've had get legal consult on stuff with third parties (who gets an assessment, who can release it, and so on) If the therapist isn't somehow colluding with the employer or the employer's doctor -- or unless the client explicitly consents to a certain amount of info sharing with certain parties -- then as others have said, that confidentiality overrides everything else Most things, but again, with an employer, the client has two choices. They either a) show up and sign releases or b) don't sign releases. If a) the therapist can share certain info with employer. If b) the therapist can't share shit (so the employer will assume the client is not compliant and will terminate) But there is a LOT of grey area here. And some employers have their own therapists and confidentiality iis NOT assumed (police, in some cases) any time you have a third party paying, you get issues of who the client actually is a and it's complicated.

(You've probably run across all of these before, but if your character has been referred via an EAP, they have guidelines (http://www.eapa.org.uk/wp-content/uploads/2014/10/Counsellors-Guide-to-working-with-EAPs-FINAL.pdf) regarding ethics and confidentiality, both in terms of employers and clients. There's also the BACP's ethics framework (http://www.bacp.co.uk/ethical_framework/new_ef.php), and the BABCP's standards of conduct (http://www.babcp.com/files/About/BABCP-Standards-of-Conduct-Performance-and-Ethics.pdf), which might be of some help. And there's this info from a privately practicing counsellor (http://www.icounsellor.co.uk/articles/2012/01/will-my-counselling-be-confidential/) that could be useful too.)

And again, I'm in the US so I know zip about NHS, or how it works in other countries!!!

Venavis
05-28-2017, 08:13 PM
Here in the US, a shady employer would be better off slipping drugs to the employee somehow then having a random drug test or tip off cops to pull over the employee and bust them for driving under the influence. Discredit and that way they can get court ordered treatment going.

Los Pollos Hermanos
05-29-2017, 01:21 AM
I do really, really like you good people of AW -- I often feel guilty when I flick onto this page and find very little I can contribute to -- makes me feel like a freeloader -- haha!

Character wants to remain in employment with their current workplace so they can pay their mortgage and bills, choose when to eventually leave AND also create Big Ripples about the gaslighting and what led to such nefarious conduct. I'm a bit bloody-minded like this, so it's not outside the realms of possibility, I suppose.

I haven't yet worked out the finer details of whether they "no comment" or play along with Therapist by feeding them BS in order to be allowed back to work. Character is concerned that if they sign a release saying Therapist can report their attendance or (non)engagement to Employer, Employer may twist the info to stop them returning to work and exposing the gaslighting and other dodgy (UK version of hinky) goings-on.

Character needs to get back to work asap, and needs to know how best to manipulate the situation to their advantage to achieve this. Employer is paying for private CBT (i.e. not "free" on our over-stretched and underfunded NHS) in an attempt to look clean and caring. The employer's doctor is not trustworthy and colludes with Employer, shall we say?

Big thanks once again! xx

bombergirl69
05-29-2017, 02:06 AM
Well, I like the suggestion above about having the employer getting your MC busted for a DUI or caught with drugs or something (I like the DUI better) I like it because you wouldnt' even need a corrupt therapist - just an inept substance abuse counselor who will of course consider your MCs protestations as "Denial!"So your MC is saying I DON'T HAVE A DRINKING PROBLEM" and the therapist is lecturing them about how hard it is to admit powerlessness. It would be interesting because then the MC would really have to lie (okay, I do drink) if they want to be assessed as "making progress."

Los Pollos Hermanos
05-29-2017, 10:00 PM
Employer isn't *that* dodgy - if it came out in the local/national press they'd done such a thing all hell would break loose, their reputation would be down the swanny and the business would likely fold.

I'm currently exploring the idea of Character playing along with Therapist, in order for Employer to get positive ROI (based on BS) and allow Character back to work.

Actually, can Employer deem Character fit to return to work based on the fact that they're (pretending to - ha!) engage with the CBT, or does this authorisation have to come from Therapist? Would Therapist deem Character fit to return to work if they appeared willing to engage, and/or would Employer-related doctor need to get involved here? I think I know what I'm trying to ask?!!

Humungous thanks again!! xx

p.s. Yup, here's another question(s):

Assuming Character arrives for first CBT session, are there any baseline assessments Therapist will do first?
If so, what are they so I can do some additional Googling to add to the relevant scenes?
Also, what sort of answers could Character give that may alert Therapist to a whiff of BS?

bombergirl69
05-29-2017, 11:28 PM
Just a quick answer - an ROI is a Release of Information, so that wouldn't be pos or neg. It just gets signed!! :)

Los Pollos Hermanos
05-29-2017, 11:33 PM
Thanks - when I first saw ROI I had to Google it as ROI means Republic of Ireland to me!!!

When I said positive, I meant Therapist says something like Character is attending and engaging, but doesn't give any other info to Employer. Sorry, should have been clearer!

Again, big thanks for the goodies!!! :-)

EMaree
05-30-2017, 12:07 AM
UK reporting in, Scotland with lots of experience with English-majority companies and companies with big healthcare infrastructures.

I would definitely steer away from any framing that has the employer declaring the employee 'unfit to work' -- in my experience, it just doesn't happen. Only an employee (and their doctor, usually, who provides a medical 'fit note' (https://www.gov.uk/government/collections/fit-note)) can sign themselves off. And they'll still get company sick pay for a set term, if applicable (since they're paying private CBT I would assume they would), and statutory sick pay afterwards.

If the employer wants to look good -- and private CBT makes me think this is true -- they'd give the employee a week or fortnight's leave on full pay, or assign them to work-from-home only if possible, and send a private therapist to visit the employee's house. Most companies would do phone therapy to cut costs, though.

Something to consider -- a 'caring' dodgy boss could give a distressed employee the afternoon off work, as long as before they leave they go into a private meeting room and use the phone there to speak to the company's therapy line to discuss the issues. Boss frames it as ensuring the employee isn't leaving the office in a state of distress or upset, and ensuring they receive trained support after a bad day at work. Dodgy boss could then pull the phone recordings and listen to the call.


Character continues to be gaslighted, but isn't fooled and is told that for a return to work to be considered they have to attend an initial appointment with Therapist

This really wouldn't fly. A return-to-work is an act done by the employee, the employer can't block it or set terms. They can do a 'return to work' interview, be condescending dicks, and really really push the necessity of continuing therapy for the employee's own good, but they can't block the return.


Actually, can Employer deem Character fit to return to work based on the fact that they're (pretending to - ha!) engage with the CBT, or does this authorisation have to come from Therapist? Would Therapist deem Character fit to return to work if they appeared willing to engage, and/or would Employer-related doctor need to get involved here? I think I know what I'm trying to ask?!!

If the employee states they're fit to work, the employer really has to take that. A dodgy company could request a 'fit note' showing fitness to work from the doctor, just to inconvenience the protag and stall for time -- it isn't standard but it feels believable.

Therapists don't authorise anything like that here as far as I know.


Assuming Character arrives for first CBT session, are there any baseline assessments Therapist will do first?

If so, what are they so I can do some additional Googling to add to the relevant scenes?
Also, what sort of answers could Character give that may alert Therapist to a whiff of BS?

These sort of Qs would be well worth e-mailing actual UK therapists about.

From experience, CBT therapy in the UK is often used as a 'low cost' solution -- the NHS pushes it as a first step, arranging for patients to get sent CDs and giving them website URLs while they're added to the long queue of folks waiting for face-to-face therapy.

I struggle to think of answers that would make therapists call BS. They've seen it all, and a patient refusing to talk won't really phase them. They're still getting paid, at the end of it.

Los Pollos Hermanos
05-30-2017, 12:52 AM
Massive thanks for taking the time to share all the tartan-flavoured goodness! ;-) ;-) Know what you mean about the tea as well.

Due to the dodgy stuff and recent gaslighting, Character has been suspended on medical grounds, despite assuring Employer that they are genuinely fit for work. Could this affect Character's right to assert they are fit to be at work?

Employer is having none of it, sends Character to Employer-associated (private) doctor, who is in cahoots with Employer (hmmm... could add in something about splitting the £££). Doctor makes appointment with Therapist (more £££ splitting?), despite Character being adamant they don't need a shrink. Employer says in an indirect way that failing to attend Therapist's appointment means a greatly delayed return to work. Therapist works out of fancy private hospital linked to Doctor's private practice.

Apologies if that's even more confusing! xx

EMaree
05-30-2017, 02:00 AM
A sticking point for me is that, as your employee isn't currently in the office, the boss loses a lot of their power. Bosses have power in the workplace. They can have meetings, bring in people, control the narrative.

An employee in their own space becomes the one in control of the situation. Most employees suspended for dodgy reasons, once at home, would pull their socks up and get on the phone to lawyers/go visit Citizens Advice/go see their local GP/visit relatives and draft a plan of action.

(The 'go see their local GP' thing is something to watch for, now that I think of it. No matter what the corporate healthcare people do, the OP could counter it using their regular GP. If the local GP thinks the protag is fit for work, how will the office fight it?)


How is your boss maintaining his control over the protagonist? You mention that they need the money, but nothing so far about them deciding the employee is unfit to work would threaten their financial stability.(If the employee's job was really at stake, making them redundant would feel more likely. It gets hard to argue discrimination if you're 'downsizing' or dismissing lower-performing employees..)




Due to the dodgy stuff and recent gaslighting, Character has been suspended on medical grounds, despite assuring Employer that they are genuinely fit for work. Could this affect Character's right to assert they are fit to be at work?

Oooh, this is a good question and I don't know how to answer it. I honestly didn't think it was possible. I'm going to ask a managerial acquaintance, stay tuned...


Employer is having none of it, sends Character to Employer-associated (private) doctor, who is in cahoots with Employer (hmmm... could add in something about splitting the £££). Doctor makes appointment with Therapist (more £££ splitting?), despite Character being adamant they don't need a shrink.

Bribing a medical professional seems plausible to me, though I think bribing two would be pushing believability, maybe? I'm not sure. I don't have a good feel for how corrupt the private medical industry in the UK could be.

Also, I know you mentioned earlier that the employer isn't *that* dodgy and doesn't want to risk bad press. Bribing two medical professionals seems unlikely for them, given that.

----

Honestly, there's a loooottt of this plotline that is really going to stretch believability. Every time you explain in, new things jump out that feel impossible.

This seems like a very, very complicated set-up to orchestrate. It might be worth examining the overall goals of this and seeing if there is a simpler way.

Los Pollos Hermanos
05-30-2017, 02:19 AM
Again, big thanks for such a detailed reply. I'm kind of thinking on my feet and throwing different scenarios around until I manage to fit as many pieces as possible together without the aid of a hammer. I've got so many ideas, but they won't all fit together at present, so some will have to be cast aside (I did this years ago when I stared the crime trilogy I'm currently submitting to agents) to enable a feasible sequence of events to take shape.

Character currently isn't at work, despite wanting to be (it's complicated!) and I'd certainly be interested to know if Character's own usual NHS-based GP can state Character is fit to return to work, therefore overriding Employer and Employer-associated private doctor. That could facilitate an interesting twist!

I'll also get Character to work on their battle plan during their enforced time off work - thanks for that idea.

Employer is behind the scenes dodgy; in public, they appear squeaky clean. I've worked for a similar set-up in the past - corrupt isn't the word and I eventually managed to escape.

Cheers! :-)

bombergirl69
05-30-2017, 03:23 AM
Just to address one other thing, what a referral sources gets is something like progress report (no idea what they call it in the UK, NOT a progress note!)
As far as suspicious, any mandated client who reports ecstatic progress would be viewed a little skeptically-oh wow that that is so helpful! Yes, no more anxiety/depression/psychosis for me--all healed! Damn you're really good! No, no more drinking for me. Just gave it up--no problems! Thanks for all the help!

Just as would the reverse - yeah, i'm psychotic and I have horrible PTSD and terrible mood swings--been diagnosed with bipolar but I also have terrible depression on top of that! It's the worst!! Then I have this Tourette's thing, it's a fucking nightmare! I can't sleep at all--I mentioned the voices, right? And my ADHD? Yeah, just can't focus at all... Truly, people do say things like that!

bombergirl69
05-30-2017, 03:25 AM
Just adding, why a referral to the doc and not straight to the therapist? That would cut out one professional! :)

Los Pollos Hermanos
05-30-2017, 03:34 AM
Haha! That first reply made me chuckle - I can imagine some clowns saying stuff like that and thinking you'd be fooled. Even I wouldn't be fooled!

Employer sent Character to private OH (occupational health) doctor, who then "recommended" Character see private CBT Therapist (a psychiatrist, rather than a psychologist), who is in cahoots with Employer. In a nutshell: No shrink = No return to work. Employer is doing all this to continue to gaslight Character (i.e. hoping they'll eventually believe/accept they're mad (they're not, btw)) and also as an arse-covering exercise to look all kind and caring as part of their squeaky clean front.

Big thanks! :-)

p.s. Would love to know if Character's own NHS GP can legally override the Employer and their associated private doctor...

neandermagnon
05-31-2017, 01:06 AM
Haha! That first reply made me chuckle - I can imagine some clowns saying stuff like that and thinking you'd be fooled. Even I wouldn't be fooled!

Employer sent Character to private OH (occupational health) doctor, who then "recommended" Character see private CBT Therapist (a psychiatrist, rather than a psychologist), who is in cahoots with Employer. In a nutshell: No shrink = No return to work. Employer is doing all this to continue to gaslight Character (i.e. hoping they'll eventually believe/accept they're mad (they're not, btw)) and also as an arse-covering exercise to look all kind and caring as part of their squeaky clean front.

Big thanks! :-)

p.s. Would love to know if Character's own NHS GP can legally override the Employer and their associated private doctor...

There are a whole load of things that I'm finding implausible about the whole scenario. Medical things, employment law things and also the motivation of the employer. Why would any employer want an employee signed off on long term sick? They're being paid, doing no work, and the employer has to get a temp to replace them or get someone else to do their job as well as their own. It's a huge pain in the arse. Doctors notes are to ensure people have job security in spite of being on long term sick. It's a legal protection for the employee. Not something an employer wants to enforce.

Employer's can't choose employee's doctors. They can't ignore sick notes (the official ones used to sign people off work) from an employee's GP.

I also think that you're taking the gaslighting thing a bit literally. Usually, gaslighting doesn't come from the intention of one person to make another think they're insane. More often it's when there's bad things going on (often bullying, but can be any bad thing that the employer wants to hide) and when the person that's being subjected to the gaslighting asks questions or makes complaints in relation to it, the employer (or whichever person is in power that's doing the gaslighting) responds by denying what's going on and implying that the person questioning/complaining about it is mistaken, being too sensitive, being paranoid, etc. It's an elaborate form of victim blaming in most cases.

It's done in subtle ways and the person doing the gaslighting may not fully realise they're doing it, i.e. they're so intent on covering up their own or colleagues shitty behaviour that they convince themselves that the person complaining really is just imagining it (paranoid, too sensitive, etc). When subjected to this kind of gaslighting for long periods, the person does start to question their own judgement, especially when it seems like the whole workforce is saying one thing and they're the only one that perceives it a different way... it often happens when there's a whole gang of bullying employees who are covering up what they're doing with victim blaming and gaslighting.

The deliberate kind of gaslighting, where person A sets out with the intention of making person B think they're going insane is different. Yes it probably does happen occasionally. A very controlling, abusive spouse/sexual partner may do this to have more control over their spouse/partner. An employer to an employee... not so much as the employee can just leave. Maybe the employer knows that the employee isn't in a financial position to find another job, but even in that case, they can control the employee when the employee's in the office, but not when they're at home, and if they're on long term sick, then effectively that employee has temporarily broken away from being controlled by them. This is probably the most important of all the reasons why your scenario seems implausible. It seems far more likely that the control freak employer wants the employee at work, and if the employee's doctor signs them off sick, they can't legally override that doctor's decision, however they might resort to telling the employee that they're a malingerer and they don't trust the doctor's opinion ("yeah you can pull the wool over your doctor but you can't pull the wool over my eyes" kind of response). Forcing them to not return to work? ... doesn't make sense.

Also, controlfreakery and gaslighting go hand in hand, and they go hand in hand with bullying. Not only does this kind of think make people think they're going mad, it can cause actual mental illness. Anxiety, depression and even PTSD in extreme cases, especially if the person has no chance to get away (e.g. they can't just go and find a new job) and they feel physically in danger from the bullying.

And if the therapist and employer are in on this together... what are they trying to achieve? The employer might be doing this because they're a total control freak, but what's in it for the therapist? Why put your entire professional reputation on the line for some control freak who's trying to convince an employee that they're insane?

The process of making someone question their judgement and sanity comes from the abuser pretending that reality is different to what it is (denying things have happened, claiming things happened that didn't, claiming things happened differently to what they did, claiming things are different to what they are (e.g. insisting that the walls are yellow and the victim is mistaken by saying they're blue... when really the walls are blue)) What is the therapist actually going to be doing in terms of gaslighting the patient?

Regarding the question of an NHS GP overriding an employer plus associated private doctor - the whole question makes no sense. The employer has no legal jurisdiction in determining if an employee's fit for work or not. If you're talking about things getting legal, the employer doesn't have a leg to stand on in this. The employee does not need a doctor's certificate to prove they are fit to return to work. No sane employer would try to prevent them from returning to work, and if they did, an employment tribunal would side with the employee and wouldn't need any doctor to prove that the employee is fit for work. The question of whether someone needs to be sectioned or signed off work rests with doctors. If employers are concerned, they can advise employees to see their doctor, or if concerned that an employee is so mentally ill they can't make rational judgements they can call the emergency services. Employers can tell you to go home if you're obviously ill at work, but this is for cases where the employee turns up in spite of having flu, because they're dedicated, then they get sent home as an act of compassion.

Apologies if this comes across as very negative... when you jam all your ideas together (with or without a hammer) it's important that they come across as plausible to the reader, especially in terms of characters having believable motivations, not just in matters of employment law and medicine. There's potential in your ideas and I hope you manage to get them all smashed together in a plausible yet exciting way. :)

bombergirl69
05-31-2017, 02:14 AM
So, this does not apply to the UK!! But

here, an employer could certainly work to discredit an employee. When said employee feels or demonstrates instability, a company could say they pose a safety risk or something and as a condition of continued employment, have to get therapy of some kind (so...choice, therapy or leave.) The employee could go where they wanted for therapy, but they might use their EAP, which would get them 5-6 sessions with an EAP therapist who is contracted by the employer (meaning they'll accept whatever the reimbursement rate is from the company.)

I've never heard of a company mandating therapy with a particular therapist (can't do that). The onlyl thing I could see is it being worth it for the employee to either terminate (headache gone) or be busy with therapy (discredited, unable to ferret out what's really going on) I don't see a medical doc involved. The compromised therapist could apply for extended sessions because the guy is so "impaired." Never heard of that happening but then again, I dio't work with impaired therapists and I have certainly advocated for more sessions with certain (non EAP) clients, so I think it could.

So, you'll have a bit of an uphill climb to produce motivation as to why an employee would hang in there! Clearly, he'd just quit, skip therapy and find something--anything--else. so what I could imagine is (and really, excuse the horrendous writing, it's just to make the point) something like - Fuck this, Cedric said to himself as he read the referral to Dr.Janus. An anger management program? He'd call Clyde tomorrow and see about his old delivery job. But then he saw that boy's face, smudged and scared. He heard the small voice, "Please sir, help us." He dialed the number.

Just making the point that you'd have to come up with a really compelling reason for your MC to stay (abused children/animals! a bomb/gas/whatever that will take out London/the world--something with REALLY high stakes!

Los Pollos Hermanos
05-31-2017, 03:12 AM
Many thanks to both of you for the amount of time and detail you've put into your replies. I have the scenario which started all this, and I know how it will end (this is a sub-plot, btw); it's just tweaking the main part in the middle which is causing me a severe headache. Character has valid reason(s) not to quit and Employer is dodgy and trying to cover their arse. That's the long and the short of it.

Character gets medically suspended and told/made to see Employer-associated doctor (occupational health) rather than their GP. Working on a "suggestion" from Employer, this doctor tells Character they MUST see Therapist (the usual one Employer uses for any employee, if required) before a return to work can be considered. Character knows they're fine to be at work and is angry that they are, in effect, being blackmailed to see a shrink when they genuinely don't need one. Employer is hoping Therapist will somehow convince Character that they are indeed as mad as a box of frogs.

The gaslighting is of the insidious, discrediting variety - I've encountered myself it in the workplace and once they know you know what they're doing, they don't like it!!

I intend to print out this thread at some point and go through it with colour-coded highlighter pens - "Yes", "Maybe", "Iffy" and "Nope" could be a good starting point!

Cheers! :-)

bombergirl69
05-31-2017, 04:26 AM
Well people here have been so tremendously helpful with me as I had to sort out plot tangles - but what if? NO! But...NO. But..okay, how 'bout..THAT MIGHT WORK. :)



Character gets medically suspended and told/made to see Employer-associated doctor (occupational health) rather than their GPSo this is where, in the US, things could get sticky. I don't know that employees can be made to see any one particular doc. They can go where they want (as long as the person is licensed/credentialed in their speciality) or use their EAP. But usually EAPs offer several options and not just one person. I don't know anything about the UK!! :) Working on a "suggestion" from Employer, this doctor so this also might be a UK vs US thing, but usually an employee is given their choices, and are not sent to an MD for a referral. At least, I've never heard of that. I've gotten plenty of referrals from MDs but not as "middle men" for employers. If the employer suspects a disabling mental health issue (employee attempts suicide or threatens) they get a mental health professional. tells Character they MUST see Therapist (the usual one Employer uses for any employee, if required in the US, there would be a choice. Sometimes police but few companies have a company shrink. They have several with whom they contract, for their EAP. The employee would also have several available on their insurance plan. before a return to work can be considered. Character knows they're fine to be at work and is angry that they are, in effect, being blackmailed to see a shrink when they genuinely don't need one. Employer is hoping Therapist will somehow convince Character that they are indeed as mad as a box of frogs.So, there must be a very big payoff for the therapist., because employee who is angry, if they feel the therapist is sketchy, can file a complaint with the licensing board (of the therapist) which would keep them (the therapist) busy for quite a while. Fraud really is tricky business!!! That's why I was mentioning substance abuse, which gets you incompetence rather than corruption. Perfectly healthy, non-addicted people can get stuck in the system for a long time, at the mercy of someone with not even a college degree. And many of them are quite susceptible to client BS. that may be quite different in the UK! Anyway, hope any of that helps.

The gaslighting is of the insidious, discrediting variety - I've encountered myself it in the workplace and once they know you know what they're doing, they don't like it!!

I intend to print out this thread at some point and go through it with colour-coded highlighter pens - "Yes", "Maybe", "Iffy" and "Nope" could be a good starting point!

Cheers! :-)

Beanie5
05-31-2017, 04:39 AM
A couple of things that often go hand in hand with cbt are becoming a Buddhist ( live in the moment) and yoga( control of mind and body), As for testing you can test for just about anything, it would require a specific request though most readily available tests only test for proscribed substances.
p.s. on shaky ground here but a lot of the normal rules go out the window where national security is involved. ( they could be given a sensitive contract and he is portrayed as a security risk)
p.p.s. you should also probably decide if the prescripton is for a serotonin based medication (prozac / or more likely zoloft or ) or a antipsychotic / sedative (seroquel)

Old Hack
05-31-2017, 08:40 AM
A couple of things that often go hand in hand with cbt are becoming a Buddhist ( live in the moment) and yoga( control of mind and body), As for testing you can test for just about anything, it would require a specific request though most readily available tests only test for proscribed substances.
p.s. on shaky ground here but a lot of the normal rules go out the window where national security is involved. ( they could be given a sensitive contract and he is portrayed as a security risk)
p.p.s. you should also probably decide if the prescripton is for a serotonin based medication (prozac / or more likely zoloft or ) or a antipsychotic / sedative (seroquel)

I've had several courses of CBT and have never felt the urge to become a Buddhist or take up yoga. Nor have these things been suggested to me. I'm not sure that a change in belief is part of a counsellor's remit.

Snitchcat
05-31-2017, 08:59 AM
Here's another angle for you to consider if it's not too late:

You can have the employer also accuse the character of "being over-emotional". That one can be an insidious accusation and lead to eventual firing of the employee, and the employer can claim they didn't know about x issues, because the employee didn't confide in the employer.

Beanie5
05-31-2017, 09:03 AM
Hi the query was aimed at things that might show the person was engaged in their program A simple google search will throw up many authentic psychologists comparing Buddhism and Cbt and also yoga I have no alterior motives here the knowledge has been forced on me
here is an exert from wiki

Buddhist texts also contain mental strategies of thought modification which are similar to Cognitive behavioral therapy techniques.[19] A comparison of these systems of cognitive behavioral modification has been discussed by professor William Mikulas[20] and Padmal de Silva.[21]
p.s. I perhaps should have mentioned it is to an extent endemic that people feign interest in programs or taking psyche drugs and psychologists have a reasonable ability to detect this ( but they get fooled all the time)

Helix
05-31-2017, 09:22 AM
Hi the query was aimed at things that might show the person was engaged in their program A simple google search will throw up many authentic psychologists comparing Buddhism and Cbt and also yoga I have no alterior motives here the knowledge has been forced on me
here is an exert from wiki

Buddhist texts also contain mental strategies of thought modification which are similar to Cognitive behavioral therapy techniques.[19] A comparison of these systems of cognitive behavioral modification has been discussed by professor William Mikulas[20] and Padmal de Silva.[21]


Just adding the link -- Buddhism and Psychology (https://en.wikipedia.org/wiki/Buddhism_and_psychology) -- so the context is available.

EMaree
05-31-2017, 01:39 PM
The CBT materials and methods used be the UK medical industry tend to deliberately strip any religious references away to make it more universal. It is unlikely you'd be pointed to Buddism, more likely non-denominational 'mindfulness' programs instead.


p.p.s. you should also probably decide if the prescripton is for a serotonin based medication (prozac / or more likely zoloft or ) or a antipsychotic / sedative (seroquel)

Not your fault, Beanie5, but this is really bad advice for OP -- it's very USA-centric, these brand names and don't apply outside of America.

The actual non-branded name for Prozac is fluoxetine, which is commonly prescribed in the UK for depression. But without knowing the protag's symptoms it's hard to know if they'd be likely to get this--most doctors these days prefer for paitients to try unmedicated CBT for a while first, unless there's an urgent need for medication. And OP hasn't mentioned the details of their protag's mental health issues.

If fluoxetine is relevant to the story....
The dose prescribed to new patients in the UK is also very low, and gets scaled up gradually if required. A lot of media portrays 'Prozac' as a dramatic mood-altering substance, but fluoxetine in low doses is very gentle. It doesn't create the massive highs, zombie-like fugues or relaxed stoned states that you see in TV and movies.

If taken regularly as prescribed, it levels the brain out. When taken correctly, a person on fluoxetine is indistinguishable from a person not on medication. The aim is to restore a 'normal' emotional state.

Mental health medication gets a lot of undeserved bad press, but it helps so many people with neurodiverse brains live normal lives.

bombergirl69
05-31-2017, 03:23 PM
Not "commonly linked" to Buddhism in US either! It can be consistent --ie use things mindfulness--but that's hardly one of the theory's tenets (it's consistent with the Native American sweat lodge too! I can't think of faiths with which it would not be consistent! Plenty of Christian psychologists use CBT. That fact that it lends itself to a variety of contexts makes it a powerful tool!)

CBT is a theory of behavior and as such can be applied to a HOST of things - addiction, depression, anxiety, pain management, sports performance, anger management, trauma, marital therapy, etc. Because it's an approach/theory about behavior, plenty of behaviors are consistent with it - owning a pet, taking up tennis, keeping thought records or a journal, going to church, learning nutrition- but they are not part of nor prescribed by the theory. Narrative therapy is one form of CBT.

I would NOT go down that road--linking CBT with a religion or practice--at all!!

:)

bombergirl69
05-31-2017, 03:43 PM
The CBT materials and methods used be the UK medical industry tend to deliberately strip any religious references away to make it more universal. It is unlikely you'd be pointed to Buddism, more likely non-denominational 'mindfulness' programs instead.



Not your fault, Beanie5, but this is really bad advice for OP -- it's very USA-centric, these brand names and don't apply outside of America.

The actual non-branded name for Prozac is fluoxetine, which is commonly prescribed in the UK for depression. But without knowing the protag's symptoms it's hard to know if they'd be likely to get this--most doctors these days prefer for paitients to try unmedicated CBT for a while first, unless there's an urgent need for medication. And OP hasn't mentioned the details of their protag's mental health issues.

If fluoxetine is relevant to the story....
The dose prescribed to new patients in the UK is also very low, and gets scaled up gradually if required. A lot of media portrays 'Prozac' as a dramatic mood-altering substance, but fluoxetine in low doses is very gentle. It doesn't create the massive highs, zombie-like fugues or relaxed stoned states that you see in TV and movies.

If taken regularly as prescribed, it levels the brain out. When taken correctly, a person on fluoxetine is indistinguishable from a person not on medication. The aim is to restore a 'normal' emotional state.

Mental health medication gets a lot of undeserved bad press, but it helps so many people with neurodiverse brains live normal lives.

Yes to all this, although these days Prozac tends NOT to be first line (in the US) Interestingly here, people's GPs (docs) tend to be the prescribers as finding a psychiatrist or nurse can be next to impossible in small communities! Actually many people stroll into their doc's office, mention they feel down or blue, and walk out with a script! And yes yes yes to meds being a Godsend to so many people - life changing, like the sun coming out! They do indeed help many live normal happy lives!! :)

Bolero
05-31-2017, 10:56 PM
A lot of CBT therapists are not MDs - they can't prescribe medication. Presumably would make a recommendation to a GP if they thought it needed.

Los Pollos Hermanos
06-01-2017, 12:22 AM
Again, big thanks for so much help in trying to iron (hammer?) out a feasible sequence of events.

Character does not have mental health issues, but has a condition recognised as a disability under the Equality Act 2010. Employer is trying to wriggle out of making recommended reasonable adjustments, knows Character knows they're doing this, and has tried to gaslight Character into thinking they're cracking up. Character calls out Employer when the penny drops. Employer twists this to say Character is unhinged, medically suspends them and sends them to OH doc, who's in cahoots with Employer (a whole other sub-plot in itself!) and says Character needs CBT (or similar) in order to return to work. Employer covertly blackmails character by implying "No shrink = No work".

Character has a Big Dilemma because whilst they want/need to return for work (again, a whole other sub-plot in itself!), they don't see why they should see Therapist because there's nothing "wrong" with them. I'd feel exactly the same way, so I can't see it being too much trouble writing Character's PoV when I get to that part of the story. Hypothetically, say my boss pulled a similar stunt (although I'm sane - honestly!!!), what could I say or do during CBT to convince a shrink that I was engaging with it enough for a back-to-work recommendation? I know if I was in that situation and they recommended happy pills I'd play along by pretending to accept the prescription, take it to the chemist, pick up the pills and then at "dosage time" drop each pill in the bin - unless one of you lovely people has a better idea for my story?!

Thanks for all the suggestions and hopefully it'll all come together and make sense soon! :-) xx

neandermagnon
06-01-2017, 12:34 AM
I've been thinking about this, and thought I'd just throw in a suggestion. Feel free to use or ignore completely or adjust to fit or whatever you need.

If the idea is that a manipulative boss wants to make an employee believe they're mentally ill and see a therapist who is also in on the manipulation*, then rather than the boss signing the employee off sick and refusing to consider them fit for work (which strikes me as very implausible for all the reasons mentioned in my previous post), maybe have the boss frame the whole thing in terms of performance management. Bosses have no jurisdiction over sick leave, beyond ensuring that employees aren't malingering (more than 4 days absence requires a sick note from the doctor). However, performance management is very much their jurisdiction and most companies will expect line managers to do regular performance appraisals (once a month where I work), i.e. what you're doing well, what you need to improve on, setting SMART goals/targets etc etc etc.

If your boss character wants to be a gaslighting control freak but at the same time look like they're the epitome of compassion, they can do performance management meetings like this: 1. discuss the employee's shortfalls in performance (if they're gaslighting the employee, these don't need to be real... they could be setting unachievable goals or pretending problems exist when they don't), 2. voice concerns (in a concerned tone) about the employee's mental health and imply this is the reason for the "poor" performance. 3. Imply that they're being oh so compassionate and caring by not firing the employee over this and 4. recommending the therapist in question as someone who's really good at helping employees whose mental health problems are affecting work performance. Phrased like this, if the employee's afraid of losing this job and isn't in a position to start looking elsewhere, then the implied threat of "see this shrink your you'll be fired" would probably result in them seeing the shrink. If the employee's already been influenced by the gaslighting to the extent of starting to question their own judgment, then they'll probably start to believe that it's them that's got the problem and their boss really is compassionate - or at least be questioning their own judgement enough to be unsure whether they believe themselves or their boss. At which point your therapist can do whatever he or she's going to do to continue with the gaslighting.

*you need to have some very good motives developed for this though, both the boss's motives and the therapist's motives

Los Pollos Hermanos
06-01-2017, 12:43 AM
Ooooh! That's really good and a far sleeker version of what I'm trying to achieve!! I can certainly fit some of my ideas around this so big thanks for the time you've spent sharing your ideas. However, Character KNOWS they're being gaslighted and that they're not what Employer says they are, but needs to ensure they convincingly play along with the CBT, all whilst silently seething inside.

A humungous thank you! :-)

p.s. Motives are all taken care of...
(does a Montgomery Burns impression)

cornflake
06-01-2017, 12:44 AM
Again, big thanks for so much help in trying to iron (hammer?) out a feasible sequence of events.

Character does not have mental health issues, but has a condition recognised as a disability under the Equality Act 2010. Employer is trying to wriggle out of making recommended reasonable adjustments, knows Character knows they're doing this, and has tried to gaslight Character into thinking they're cracking up. Character calls out Employer when the penny drops. Employer twists this to say Character is unhinged, medically suspends them and sends them to OH doc, who's in cahoots with Employer (a whole other sub-plot in itself!) and says Character needs CBT (or similar) in order to return to work. Employer covertly blackmails character by implying "No shrink = No work".

Character has a Big Dilemma because whilst they want/need to return for work (again, a whole other sub-plot in itself!), they don't see why they should see Therapist because there's nothing "wrong" with them. I'd feel exactly the same way, so I can't see it being too much trouble writing Character's PoV when I get to that part of the story. Hypothetically, say my boss pulled a similar stunt (although I'm sane - honestly!!!), what could I say or do during CBT to convince a shrink that I was engaging with it enough for a back-to-work recommendation? I know if I was in that situation and they recommended happy pills I'd play along by pretending to accept the prescription, take it to the chemist, pick up the pills and then at "dosage time" drop each pill in the bin - unless one of you lovely people has a better idea for my story?!

Thanks for all the suggestions and hopefully it'll all come together and make sense soon! :-) xx

Again though, I can't imagine requiring a specific type of therapy, especially something like CBT (as opposed to an Anger Mgmt course or whatever) is in any way legal.

Also, if a psych recommended meds and you didn't want to take them, why wouldn't you just discuss that with the psych? Like, why you didn't want to take them, why they thought you'd benefit, what alternatives they'd recommend, etc. Why play along and go through some weird throwing-away-a-pill-a-day ritual? It's not like you're an inpatient with a court order requiring you to take meds (which is very rare -- requiring anyone to take medication is a serious thing that will usually require a judicial order) hey're doctors - cannot report this stuff to anyone.

Even if you know the employer is in cahoots with an unethical dr., the character wouldn't know that, so...?

Los Pollos Hermanos
06-01-2017, 01:13 AM
It's not legal, but it's dodgy. Ultimately, Employer has the power to fire Character, so Character has their reasons for playing along.

So, does that mean Therapist (a psychiatrist) can't report back to Employer that Character declined a stash of happy pills?

cornflake
06-01-2017, 01:16 AM
Of course not.

Los Pollos Hermanos
06-01-2017, 01:21 AM
Cheers for that snippet.
I now need to decide how dodgy Therapist is - haha!

Albedo
06-01-2017, 02:56 AM
Cheers for that snippet.
I now need to decide how dodgy Therapist is - haha!
I'd be careful of violating suspension of disbelief too far in that direction, either ... doctors have a strong code of ethics, too. Multiple dodgy doctors on their payroll, including a specialist? Who are these guys, exactly?

Los Pollos Hermanos
06-01-2017, 04:14 AM
This is the point at which I need to place people on the dodginess scale. I'm currently thinking Therapist is being manipulated by Doctor, but for something completely unconnected with anyone's workplace. Nothing as blah-blah as them both being married (to other people) and having a bit of how's-yer-father on the sly though. Decisions, decisions...

cornflake
06-01-2017, 08:21 AM
Yeah, this stuff is not minor.

It's not like talking behind someone's back in an office. Violating ethics codes like this can end your career -- not because people won't want to work with you, but because your license can be revoked, and then there goes 8 or so years of graduate school and a boatload of money down the tubes and no job. It's also a potential lawsuit.

Those are worst-case, you can get suspended, reprimanded, etc., but that stuff will follow you your entire career; once it's on your record, it's on your record and anyone can see it's there. People don't violate confidentiality lightly. It is beaten into you in school, in many different scenarios, ethics classes, discussions, etc. This isn't something people just know or read a form to get. You're taught how to advise people about confidentiality, what exceptions there are, how to decide what is an exception, how to deal with it, and on and on.

Los Pollos Hermanos
06-01-2017, 03:48 PM
I'm quite happy for Doctor to be dodgy, as there's unethical people in any job, but I'm leaning towards Therapist being caught up in it through no fault of their own. Maybe they've seen/heard something they shouldn't have done, and there's now the threat of "if I go down, I'm bringing you with me" hanging in the air?

bombergirl69
06-01-2017, 04:46 PM
Absolutely every thing Cornflake said about ethics. It's a very Big Deal.

I'm still voting for substance abuse, which gets you out of the "dodgey" question (and ethics concerns) and into the cheerfully incompetent arena! I find myself wondering - if employer is threatened by MC, why not just fire him? (are there unions, etc that would make this hard?) If not fire him, what's the motivation for referring him? I m guessing discrediting him. Substance abuse would both do that and get you out of an unethical therapist trap. The employer would provide lots of sketchy details to therapist (hiding alcohol on the job, repeated promises to cut down, "accidents," "concerns" from co-workers, etc.) The well-meaning substance abuse counselor will take all that as gospel and your MC will be doing groups and therapy until their eyes cross. the counselor may never check with anyone other than the employer (sure, the good ones will but there are PLENTY of seriously crappy ones which would make no collateral data quite believable) Your MC will deny a problem and the therapist will note that one has to "break through the denial."

If your employer knew that about the system, I could see it as win--discredit the employee so his allegations will be tainted and keep him away from work. Then, when he "fails" therapy, fire his ass.

This might be very, very different in the UK! :)

Los Pollos Hermanos
06-01-2017, 07:11 PM
In these circumstances (i.e. breaching the EqA 2010), the unions would have an absolute field day!
Hence Employer is playing dirty.

bombergirl69
06-02-2017, 12:05 AM
What you might do is run a synopsis by the critters in SYW. I found that EXTREMELY helpful as people will pick up on all sorts of plot issues--plausibility, motivation, timing and so on. It's really, really a big help. Just a 5-700 word synop with the main plot points which might allow you to see where the problems are!

Anyway, just an idea

So, it's been a long time since I've done this (don't work for the gov't anymore) but with unions, if there was an issue, the supervisor, worker and their union rep would all sit down and develop a "plan"(remediation plan, I think?) to get the employee back on track. I suppose one thing in the plan could be therapy of some sort, to deal with whatever their problem is. The idea is that prior to termination, an employee has to "fail" their plan.

On CBT, you can think of it like surgery. Surgery is one tool docs have--a really GOOD tool for many things, but we typically don't say to someone - oh youhave a stomach ache? You need surgery! If an evaluation leads to a diagnosis of say, appendicitis, surgery would be indicated.

CBT may be just the thing, but it's a treatment, so, if it's got some evidence that it works for a particular issue, that great! But (here) we don't get referrals for "CBT." We get referrals for domestic violence problems, smoking cessation, addiction--whatever, Then WE determine what treatment is warranted!

Los Pollos Hermanos
06-02-2017, 04:25 AM
Cheers for the extras. Therapist is CBT specialist; the idea being that as part of the "there's something wrong with you" gaslighting-type experience, Character is supposed to see this as confirming they're "nuts". They don't, btw - and Character quietly thinks the whole CBT thing is a load of tosh.

If Character decided they weren't having any of it, but turned up to sessions to keep up the façade, what type of behaviour(s) might you expect to see? I did read about not doing "homework" which, with a label like that, I can understand!

bombergirl69
06-03-2017, 02:18 AM
So again, US based only, I would probably say I am a CB therapist. I was trained that way anyway (I'm actually pretty eclectic) But people don't get referred for CBT, they get referred for an issue. One hopes that the issue is one that responds to CBT.

I don't treat clients who think my approach is a load of tosh! I work with plenty of clients who are not happy to be there, but good therapists learn either how to engage clients, or refer them back if they can't be helpful (again, a vote for the substance abuse arena where this is not the case!)

If client denies the issue completely, ethical therapists can do a bunch of things.
Therapists can discuss why client thinks employer might have a concern (not argue with them but explore)
Therapists can see if client might have any other legitimate issue to discuss that would feel helpful (in 4 or 5 sessions)
Therapists can refer back to the employer and say client denied the issue.
Sometimes clients argue with this last one (but my PO will revoke me!) Maybe so, but I'm not lying, so if you say you have no issue i'm not doing pretend therapy (docs don't say, okay, i'll pretend to take out your appendix, although you don't need it done!), so take it up with your po. Sometimes POs have a magical effect on clients who return highly motivated to address stuff :)

homework is for the client's benefit, not mine. It's to extend the session, help people apply what we talk about in a particular way out in the world.If they don't do it, we talk about it. and clients agree to it before, usually help develop ;it **(what would feel helpful this week?) It's not a math test!

** ive worked for agencies where particular groups had regular assignments--biographies, thought journals--but clients tended to enjoy them!

Clients who are faking good tend to over estimate how well they're doing. they tend to give glib answers, have little insight and are lost when confronted about it. they tend to think we're morons! :)

Venavis
06-03-2017, 03:15 AM
I'm quite happy for Doctor to be dodgy, as there's unethical people in any job, but I'm leaning towards Therapist being caught up in it through no fault of their own. Maybe they've seen/heard something they shouldn't have done, and there's now the threat of "if I go down, I'm bringing you with me" hanging in the air?

I don't think you realize how many safeguards there are in place to prevent such a thing from happening. In this scenario, you've given your 'victim' an incredible amount of power. I grant that I am in the US, but I'll be blunt and say the US approach to mental illness is so incredible bass-ackwards that I have a hard time believing the UK is worse. Here in the US there are about eight different phone numbers I could call that would take down the whole house of cards with a single anonymous report.

Like Bombergirl above, this is my field. Even when dealing with an involuntary commit with a PO, social worker, and legal guardian there are still things I CANNOT legally share regarding my client.

bombergirl69
06-03-2017, 04:13 AM
I think at this point, probably getting specific about what kind of releases (ROIs!) there are, what kinds of info one can and can't release (releases dictate this--some you must state the purpose and what kind of information, ANd other agencies can have their own releases and forms) and so on, is not so helpful. You won't need to get that specific, it doesn't sound like. It sounds like getting a handle on your characters could be more useful, as in what do you need from your therapist? Who is this person? Would they be corrupt? Why? Incompetent? What does your story need? Figuring out what your story needs, then working out you need might work better, because this is probably much more detail than is helpful! :)

I still vote masters and under -level "counselor" and go for incompetence rather than corruption (again, broken record here but the training for substance abuse "counselors" is so minimal this is hardly a stretch.) Trust me, there is plenty of incompetence out there, lots of very poor training. Obviously, go where your story goes but I would look in that direction. And I would still run a synopsis by the critters in SYW--an EXCELLLENT place to sort out holes and all that! :)

Los Pollos Hermanos
06-03-2017, 05:22 AM
Thanks for the extras - again!! This sub-plot is causing much more of a headache than the main plot. It'll iron out in time, but it took me a while to plot the trilogy, so I know I'll get there in the end. The shrink-y details are great though; I'll be able to pick the most suitable/feasible snippets once the sub-plot is properly plotted.

What's a PO, btw?

And, have either of you ever had a client who'd been forced to attend (for whatever reason), and you thought "Actually, this one's telling the truth and s/he really doesn't need to be here"?

Cheers... :-)

bombergirl69
06-04-2017, 04:07 PM
So, I think you are getting into an area that is not going to be relevant to your story, unless your story involves a lot of psychological theory. We do not function as police, so we don't ferret out the truth, interrogate people and so on--responses are considered diagnostic but whether or not someone is telling the gospel truth or not is not necessarily linked to whether or not they need treatment (probably most clients lie about something or other, sometimes about many things.) Sure, most clients have different versions of events from the referent, not all, but many do. Things work a little differently for evaluations, but you're not doing that so I won't go there.

For therapy, it's still about figuring out what will help the client. Disagrees with referent's story? All of it? So what is he doing here? He wants his job? Why? Why is he in this mess? What does he need to get relief? If the client a) completely disagrees with referent's story, b) denies any interest in talking about anything --- > we're done. But just because I find the client plausible (many, MANY times!) doesn't mean we can't determine something meaningful to achieve the larger goal --- > keep referent happy (and not lie or commit fraud)

Of course, with ROIs we can report a lot, depending on a range of circumstances. There are plenty of ways to write a report that says, "I think this this client is full of shit" without actually spelling it out. :)

Los Pollos Hermanos
06-04-2017, 06:15 PM
Hmmm... thanks for even more goodies to consider!

Would you do an evaluation first, and then decide how to proceed (or not, as the case may be)? If so, what would you "do" to evaluate the person who'd been sent to you?

cornflake
06-04-2017, 06:28 PM
Presumably, people who turn up at a therapist's have some issue they want help with. Generally, depending on the type of practice, or the setup, one does an initial interview or an intake interview, but that depends. What it consists of depends on the practice, the issues, the psych, etc.

It's not like someone turning up at a dr. saying 'I think I broke my finger' getting an x-ray, and being told 'not broken, you're fine, go home.'

It's far more complex. In psychology, often, a disorder is only a disorder if it bothers you. If it causes no dysfunction or problems in your life, well... Also often, what people think is the problem is maybe not the problem.

If someone is sent by an employer, presumably there's some problem that caused something to go on that ended with them turning up. It's NOT 'they're not lying, don't need therapy,' or 'I spent 30 minutes evaluating you and you actually do not have a problem with anger.' <--- not a thing that's possible to do or tell like that. I mean if someone were referred from a specific type of employment for help with substance abuse and you, I dunno, gave them an MMPI-2, and they produced a valid result but didn't ping the scales that would normally be elevated with substance abuse that doesn't mean they don't have a substance abuse problem (it can mean tons of things), nor would it mean 'oh well, employer is mistaken, I'll check that on the form, go home.' There's an issue that resulted in their turning up. What it is and how to resolve it is an entire thing.

Any employer-based requirement is separate from that, in many ways.

bombergirl69
06-05-2017, 05:57 PM
Yes, and I can see why it' confusing. Ususally first appointments are diagnostic interviews - longer, as we review history, look at records, get a sense of who the person is and what they need.

Evaluations are different. There are many kinds --- > does this person have a disorder that warrants special testing conditions? Is this person nlikely to reoffend? Are there mental healthissues that preclude completing a parenting plan and what treatment can address them? Is this person competent to make medical decisions/stand trial/manage legal affairs? and sometimes the courts send over someone --- > what the hell's wrong with this person? In these cases, we are evaluators. I don't think your story involves this at all so I 'm not going to get into it much, except to say that good therapists do not both evaluate and treat their clients. We treat and refer for evals, or eval and refer for a treating doc.

bombergirl69
06-05-2017, 06:03 PM
Just adding, we like good referrals! Not the - this guy's nuts, f igure it out. that's like taking your car to the mechanic and saying "it's broken, fix it." he'd going to wonder (making a noise? not starting? stopping? squealing brakes==what??) We're the same way!

Many therapists give some general questionnaires at the start of therapy but it depends. Can give a quick snap shot of how someone's functioning, but many don't. Now insurance companies sort of demand it, as it quantifies the issue. I don't know any that give the big personality inventories for a therapy client (either expensive or time consuming to score)

EMaree
06-05-2017, 06:59 PM
Finally had a chat with manager buddy about how a dodgy employer might go about doing this.

Usual process would be that the employee gets sent to Occupational Health, and it would be a joint thing between the manager and HR with Occupational Health advising.

Easiest way to screw over the protag: use stats, use data, use charts. Data can easily be misrepresented to support the employer and discredit the employee.

Most believable way to screw up your employee's day: change shift last-minute. Create shifts that royally mess up your sleeping pattern, lates followed immediately by earlies, random out-of-hours call-ins. Bonus evil points if protag has a hell of a commute, which can turn a difficult shift into a damn near impossible one. But totally not the manager's fault, it's what 'the company' needs, not his fault the shifts are crazy.

Ask protag to come in early to do some tedious task. Then pretend the convo didn't happen, the task is wrong, and the employee needs to stay late to fix it. (Gasliiiightiiing!)

Have meetings and pretend they never happened. Ignore employee's discussions about holidays, docs appointments, dental etc and mark it all down as lateness.

CJSimone
06-05-2017, 07:04 PM
I still vote masters and under -level "counselor" and go for incompetence rather than corruption (again, broken record here but the training for substance abuse "counselors" is so minimal this is hardly a stretch.) Trust me, there is plenty of incompetence out there, lots of very poor training. Obviously, go where your story goes but I would look in that direction. :)

Hi Los Pollos Hermanos. Haven't read the whole thread and can only say for the US, but yeah, I wouldn't go with a psychiatrist. Psychiatrists and psychologists still do therapy sometimes, but more and more they're the supervisors of some sort. Most therapy is now done by a masters level therapist or counselor (licensed or not) or in some cases (especially within an organization with supervisors) a bachelors level counselor. Of course you can get incompetence even with more training and degrees, but less likely.

Good luck with your story!

CJ

ETA: If this is in an organization, then they probably wouldn't hire a psychologist or psychiatrist except as a supervisor cuz they wouldn't want to pay someone more when they can pay someone with a masters degree less.

Venavis
06-10-2017, 06:23 PM
What's a PO, btw?

Missed this. Parole Officer


And, have either of you ever had a client who'd been forced to attend (for whatever reason), and you thought "Actually, this one's telling the truth and s/he really doesn't need to be here"?

Cheers... :-)

Not at the level in which I work. I still do the 'let's talk about your mother' thing sometimes, but my work tends to involve a lot of 'please put the knife down' and 'would you like to talk about why you just tried to strangle me?'

Los Pollos Hermanos
06-19-2017, 04:19 AM
Many thanks for the extra goodies - I *think* I've worked it all out now, but the proof of the pudding is in the writing!